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3rd Circuit revives suit North Jersey Brain v. Aetna

By Allison Bell

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The 3rd U.S. Circuit Court of Appeals sided with five other circuit appeals courts in a recent ruling on when providers have standing to sue health insurers for benefits under the Employee Retiree Income Security Act (ERISA).

A three-judge panel at the 3rd Circuit reversed a lower-court decision on a New Jersey case, North Jersey Brain & Spine Center v. Aetna, and found that the spine treatment center gained standing to sue for benefits when three patients assigned the center the right to get insurance benefits payments.

See also: ERISA experts weigh in on Tibble victory

Earlier, a U.S. District Court judge had ruled that providers need explicit authorization from patients to sue insurers on their behalf, not simply assignment-of-benefits authorizations.

Charles Toutant covered the case in full for the New Jersey Law Journal.

To read Toutant’s article, click here.