title: Health benefits--reimbursement--state law claim not preempted. Providence Health Plan v. McDowell.
abstract: A claim to enforce a reimbursement provision or a separate promise to reimburse a plan out of recovery from a responsible third party cannot be brought in federal court under ERISA, because it is a legal claim for monetary damages and ERISA allows fiduciaries to bring suit only for equitable relief However, a claim for reimbursement of medical benefits paid from a third-party settlement is a state law breach-of-contract claim that cannot be removed to federal court and is not preempted by ERISA. Thus, a plan can bring an action in state court for breach of contract against a participant or beneficiary who fails to reimburse the plan for medical benefits paid when he or she recovers from a third party in a settlement or through a judgment, as required by a reimbursement provision in the plan and/or a separate reimbursement agreement.
mesh_terms: D019461:Employee Retirement Income Security Act; D006264:Health Benefit Plans, Employee / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D006801:Humans; D019458:Insurance Coverage; D013219:State Government; D014481:United States