No. 18-134

Jennifer Perkins v. US Airways, Inc., et al.

Lower Court: Fourth Circuit
Docketed: 2018-07-31
Status: Denied
Type: Paid
Response Waived
Tags: 12(b)(6) benefits-denial current-employment-status erisa health-benefits medicare-as-secondary-payer medicare-secondary-payer plan-documents summary-judgment unreasonable-denial-of-benefits
Key Terms:
AdministrativeLaw Arbitration ERISA SocialSecurity LaborRelations JusticiabilityDoctri
Latest Conference: 2018-09-24
Question Presented (AI Summary)

Whether the court erred in dismissing petitioner's claims under the Medicare as Secondary Payer Act and ERISA for unreasonable denial of benefits, and in granting summary judgment against petitioner on her claim for failure to timely provide plan documents

Question Presented (OCR Extract)

QUESTIONS PRESENTED Petitioner has been continuously employed as a flight attendant with Respondent US Airways, Inc. (US Air), a member of the flight attendants’ union, and a participant in the US Airways Health Benefit Plan (the Plan) since 1992. Lightning struck Petitioner on a jetway while she was working for US Air. Petitioner continued working for US Air without taking a leave of absence after she was struck. Petitioner’s condition worsened considerably, and she has been on approved medical leave of absence since October 2001. Petitioner began receiving long-term disability benefits from US Air in February 2002, and she began receiving Medicare disability benefits in September 2003. As a result of her current employment status with US Air and her membership in the union, Petitioner is entitled to continue receiving benefits, including retirement benefits, health benefits, and seniority through US Air. While on approved medical leave, Petitioner has experienced several issues with Respondents improperly determining its payer status as secondary to Medicare. During all relevant times, Petitioner has timely paid the full amount of her health insurance premium in order to maintain the high-quality coverage offered by the Plan. Petitioner successfully appealed those determinations through 2010; however, in 2011, Respondents refused to correct its erroneous payer status determination and denied Petitioners’ claims for health benefits. In connection with Respondents’ denials in 2010 and 2011, Petitioner requested copies of certain Plan documents in order to assist her in appealing the denials. Respondents repeatedly failed to timely provide i Petitioner with copies of the Plan documents she requested. The questions presented are: 1) Did the Court of Appeals err in affirming the District Court’s dismissal of Petitioner’s claims based on alleged violations of subsection (b) of the Medicare as Secondary Payer Act when the dismissal was not based on the unambiguous statutory definition of “current employment status” provided by Congress in that subsection and instead was based upon a regulatory definition for that same term, see Chevron, U.S.A., Inc. v. Natural Res. Def. Council, Inc., 467 U.S. 837 (1984); when Petitioner’s Complaint established Petitioner’s status as a current employee and union member; and when Petitioner’s Complaint alleged Medicare had already determined its payer status was secondary to Petitioner’s employersponsored health benefits claims? 2) Did the Court of Appeals err in affirming the dismissal of Petitioner’s claim alleging a violation of the Employee Retirement Income Security Act of 1974 for unreasonable denial of benefits when the terms of Petitioner’s employer-sponsored health benefit plan forming the basis for Respondents’ denial of Petitioner’s employer-sponsored health benefit claims pertaining to Medicare payment priority alter the express and unambiguous definition of “current employment status” set forth by Congress in the Medicare as Secondary Payer Act; when precedent from the Courts of Appeals for the D.C. and the Sixth Circuits indicates that plan provisions violating federal statutes, including the Medicare as Secondary ii Payer Act, are void for violating federal law and denial of benefits claims; when Medicare previously determined its payer status was secondary to Petitioner’s employer-sponsored health benefits; and when an independent third-party reviewer selected and paid by Respondents determined Respondents’ payment priority was primary to Medicare? 3) Did the Court of Appeals err in affirming the District Court’s grant of summary judgment against Petitioner on her claim for failure to timely provide plan documents, as required by ERISA, when Respondent US Airways, Inc. did not timely provide Petitioner with the documents she requested on multiple occasions, as required by ERISA; when the District Court’s grant of summary judgment was based on clear errors of law; and when the evide

Docket Entries

2018-10-01
Petition DENIED.
2018-08-22
DISTRIBUTED for Conference of 9/24/2018.
2018-08-15
Waiver of right of respondents US Airways, Inc., et al. to respond filed.
2018-05-29
Petition for a writ of certiorari filed. (Response due August 30, 2018)

Attorneys

Jennifer Perkins
Wynetka Ann ShuttBurnette Shutt & McDaniel, PA, Petitioner
Wynetka Ann ShuttBurnette Shutt & McDaniel, PA, Petitioner
US Airways, Inc., et al.
Deanna Marie RiceO'Melveny & Myers, LLP, Respondent
Deanna Marie RiceO'Melveny & Myers, LLP, Respondent