HLD, v. 29, n. 11
Holds That Assignee of Patient's Assignee Lacks Standing to Sue Under ERISA
Patient "M.M." received medical treatment from Humanistic Mental
Health Foundation ("Humanistic"), which charged $25,600 for its services. M.M.
assigned his health benefits from General Electric Life Disability and Medical
Plan ("Plan") to Humanistic. The Plan denied payment of $5,637 of Humanistic's
charges and rejected Humanistic's resulting appeal. Humanistic then assigned
M.M.'s claims to Stephen Simon, a non-lawyer, who sought to recover the unpaid
amount. After failing to obtain payment, Simon sued the Plan and others (collectively
"defendants") in federal district court, asserting claims of denial of benefits
under the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C.
� 1001 et seq., and of breach of fiduciary duty under ERISA.
Defendants moved for dismissal, arguing that Simon lacked standing under ERISA.
The court granted defendants' motion and dismissed Simon's complaint. Simon
The Second Circuit affirmed, agreeing that Simon, as assignee
of an assignee, was not a participant or beneficiary of an ERISA plan and thus
had no standing for his lawsuit. Simon had conceded that he was neither a participant
nor beneficiary of the Plan, but had claimed standing "as an assignee of a beneficiary."
In rejecting Simon's argument, the appeals court noted that it had previously
joined other circuits in "carving out a narrow exception to the ERISA standing
requirements" and emphasized that this exception "grants standing only to healthcare
providers to whom a beneficiary has assigned his claim in exchange for health
care." Because Simon was not a healthcare provider assignee, the appeals court
concluded that he did not have standing to bring his lawsuit.
Simon v. General Elec. Co., No. 00-9437, 2001 WL 1001163
(2d Cir. Aug. 29, 2001) (5 pages).