Franco v. Connecticut General Life Ins. Co.

Franco v. Connecticut General Life Ins. Co.

Case 2:07-cv-06039-SRC–PS
Court Ruled Against CIGNA & UHC UCR Class Actions by Out-of-Network Providers On Poor ERISA Assignment.
Franco v. Connecticut General Life Ins. Co.PDF file
Ramifications of Court Decision:

  1. The court concluded that standard industry provider assignment of benefits are only limited assignment under ERISA and legally useless, but a complete ERISA assignment of benefits is required for all ERISA appeals and lawsuits by third-party providers.
  2. What exactly does an ERISA complete Assignment of Benefits mean?
  3. How to secure a valid and complete ERISA compliant Assignment of Benefits?
  4. Why is ERISA Assignment of Benefits Form required for both in and out of network providers?

“At best, the allegations provide only the most ambiguous and conclusory information about what the purported assignments entail. At worst for Provider Plaintiffs, they indicate that the assignments were limited to a patient’s assigning his or her right to receive reimbursement from CIGNA for the covered portion of the service bill, which in no way can be construed as tantamount to assigning the right enforce his or her rights under the plan. The Court cannot conclude, based on the information supplied in the Complaints, that the assignments encompass a CIGNA-insured’s claim to benefits, such that any of the Provider Plaintiffs can legally be deemed a “participant or beneficiary” of his or her patient’s ERISA health plan. Simply put, Provider Plaintiffs have not met their burden of demonstrating that they have derivative standing to sue under ERISA.”



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