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05-200 EMPIRE HEALTHCHOICE ASSURANCE V. MCVEIGH DECISION BELOW:396 F3d 136 CERT. GRANTED 1/6/2006 QUESTIONS PRESENTED: Whether federal question jurisdiction exists over a suit by a federal government contractor to enforce, on behalf of the United States, a provision in a health benefits plan for federal employees that is part of a government contract established pursuant to the Federal Employees Health Benefits Act. LOWER COURT CASE NUMBER: 03-9098
The case Empire Healthchoice Assurance, Inc., DBA Empire Blue Cross Blue Shield v. Denise F. McVeigh, as Administratrix of the Estate of Joseph E. McVeigh (2005) revolved around a dispute over health insurance benefits paid by Empire to cover medical expenses for Joseph E. McVeigh before his death in 2002. After his passing, Denise F. McVeigh became administratrix of his estate and sued Empire under the Employee Retirement Income Security Act (ERISA), claiming that they had not provided full coverage for her late husband's healthcare costs during his illness. Empire counter-sued to recover $157,309 it claimed was erroneously paid due to misrepresentation about other available insurance coverage at the time of Mr.Mcveigh’s treatment. The Supreme Court ruled in favor of Ms.Mcveigh stating that ERISA did not provide federal jurisdiction for this type claim because it was essentially a legal malpractice claim arising from state law rather than an action brought under or to enforce provisions within ERISA itself.
The dissenting opinion in the case of Empire Healthchoice Assurance, Inc., DBA Empire Blue Cross Blue Shield v. Denise F. McVeigh argued that federal jurisdiction should not be extended to this case as it did not involve a substantial federal question or issue. The dissenters believed that the majority's decision was an unwarranted expansion of federal power and could potentially lead to an increase in litigation involving employee benefits disputes being moved from state courts to federal courts, contrary to Congress' intent when enacting ERISA (Employee Retirement Income Security Act). They pointed out that there is no explicit provision within ERISA allowing for such suits by insurers against beneficiaries for reimbursement of medical expenses paid on their behalf due to third-party liability settlements or judgments. Furthermore, they contended that the insurer’s claim was essentially a contract dispute under state law rather than a matter concerning interpretation or application of ERISA provisions.