Adv Physicians v. NFL ( 2021 )

Case: 20-10998 Document: 00515923132 Page: 1 Date Filed: 07/01/2021
United States Court of Appeals
for the Fifth Circuit United States Court of Appeals
Fifth Circuit
FILED
July 1, 2021
No. 20-10998 Lyle W. Cayce
Clerk
Advanced Physicians, S.C.,
Plaintiff—Appellant,
versus
National Football League,
Defendant—Appellee.
Appeal from the United States District Court
for the Northern District of Texas
USDC No. 3:19-CV-2432
Before Davis, Duncan, and Oldham, Circuit Judges.
Per Curiam:*
Advanced Physicians (“Advanced”) appeals the district court’s
dismissal of its state-law tortious-interference claim against the National
Football League (“NFL”). According to its complaint, Advanced began
providing medical treatment to former NFL players in 2007. In exchange for
that treatment, the players assigned to Advanced their health insurance
*
Pursuant to 5th Circuit Rule 47.5, the court has determined that this
opinion should not be published and is not precedent except under the limited
circumstances set forth in 5th Circuit Rule 47.5.4.
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No. 20-10998
benefits under the NFL Player Insurance Plan (“Plan”) so that Advanced
could “receive payment from the Plan.” The Plan, in turn, covered certain
expenses that were “Medically Necessary.” But it specifically excluded
expenses “incurred in connection with an Occupational Disease or an
Occupational Injury,” along with expenses “incurred . . . in connection with
an Injury or Sickness which is covered under any workers’ compensation or
similar law.” Cigna Health and Life Insurance Company (“Cigna”) was “the
sole entity with the legal right to administer the medical benefits covered by
the Plan.”
Advanced treated dozens of NFL players between 2007 and 2014 and
“received payment from Cigna with minimal difficulties.” The payments
eventually stopped. According to Advanced, this occurred because “the
NFL directed Cigna to deny all of Advanced’s claims as work-related.”
Advanced sued the NFL in Illinois state court, alleging that the NFL had
tortiously interfered with its patient relationships in violation of Illinois law.
The NFL removed the case to the Northern District of Illinois on the
theory that the Employee Retirement Income Security Act of 1974
(“ERISA”) completely preempted Advanced’s claim. See Aetna Health Inc.
v. Davila, 542 U.S. 200, 210 (2004) (recognizing complete preemption under
ERISA); Metro. Life Ins. Co. v. Taylor, 481 U.S. 58, 67 (1987) (holding that
completely preempted state-law claims arise under federal law and are
removable to federal court (citing 28 U.S.C. §§ 1331, 1441(b))). The district
court agreed and upheld the NFL’s removal. Then it transferred the case to
the Northern District of Texas, where Advanced was litigating similar claims
against Cigna. That court also found complete preemption under ERISA. So
when Advanced refused to amend its complaint to state a valid ERISA claim,
the district court dismissed it. Advanced timely appealed.
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The Supreme Court has established a two-part test for determining
when ERISA completely preempts a state-law claim. First, we must ask
whether the plaintiff “could have brought his claim under ERISA
§ 502(a)(1)(B).” Davila, 542 U.S. at 210. We answer that question by
identifying what the plaintiff is truly “complain[ing] . . . about.” Id. at 211. If
the “only action complained of” is the “denial[] of coverage promised under
the terms of [an] ERISA-regulated employee benefit plan[],” Davila’s first
requirement is satisfied. Ibid.; see also 29 U.S.C. § 1132(a)(1)(B). Second, we
must ask whether the plaintiff’s suit implicates a “legal duty . . . independent
of ERISA or the plan terms.” Davila, 542 U.S. at 210. We answer that
question by reviewing the plaintiff’s allegations alongside the state law on
which they are based. See id. at 211–13. If “interpretation of the terms of [a]
benefit plan[] forms an essential part” of the plaintiff’s claim, Davila’s
second requirement is satisfied. Id. at 213.
Here, the only action Advanced complained of was the NFL’s
“direct[ing] Cigna to deny all of Advanced’s claims as work-related.” In
other words, the “essence” of Advanced’s complaint is that the NFL
wrongfully facilitated a coverage denial. Hubbard v. Blue Cross & Blue Shield
Ass’n, 42 F.3d 942, 946 (5th Cir. 1995). ERISA § 502(a)(1)(B) allows
beneficiaries like Advanced to vindicate that claim. See 29 U.S.C.
§ 1132(a)(1)(B).
Furthermore, interpreting an ERISA benefit plan forms an essential
part of Advanced’s tort claim. To prevail on its claim of tortious interference,
Advanced must show that it had a “reasonable expectation of [maintaining]
a valid business relationship” with its NFL patients. Dowd & Dowd, Ltd. v.
Gleason, 693 N.E.2d 358, 370 (Ill. 1998) (quotation omitted). Advanced’s
complaint makes clear that its business relationship with NFL players hinged
on those players being covered under the Plan: the relationship began when
the players assigned their benefits to Advanced so that Advanced could
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No. 20-10998
“receive payment from the Plan”; and the relationship faltered when Cigna
and the NFL determined that the players were seeking treatment for “work-
related” injuries not covered under the Plan. Whether the NFL players
actually sought “work-related” treatment plainly requires interpreting the
work-related exclusions in the Plan. So Plan interpretation is essential to
Advanced’s claim. Therefore, Advanced’s tort claim is completely
preempted.
AFFIRMED.
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