The Seventh Circuit held that a health insurer that makes benefits determinations and pays benefit claims, rather than the health plan itself, is a proper defendant in an action for benefits under ERISA Section 502(a)(1)(B). In Larson v. United Healthcare Ins. Co., No. 12-1256, 2013 WL 3836236 (7th Cir. July 26, 2013) (unpublished), plan participants filed an ERISA class action against six health insurance companies, alleging that they were improperly required to pay co-payments for chiropractic care. While recognizing that plans are “normally” the proper defendant in a claim for benefits because plans normally owe the benefits, the Seventh Circuit ruled that a health insurer is a proper defendant in cases where it decides all eligibility questions and also owes the benefits due to participants. In the end, however, plaintiffs’ claims failed because there was nothing in the plans that precluded co-payment charges for chiropractic services.
