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SC Shine PLLC v. Aetna Life Insurance Co.

Court: WD Tx  06/26/2023  ERISA Does Not Preempt Dental Provider's Assigned Claims for Benefits

A court of the Western District of Texas granted in part an insurer's motion to dismiss in a dispute with a dental health care provider regarding dental plan benefits, holding that ERISA does not preempt the provider's claims and that the the provider plaintiff, as an assignee of plan benefits, properly pleaded claims for fraud, fraud-related claims, and certain violations of the Texas Insurance Code as well as breach of contract and breach of an implied contract, but that the provider may not pursue claims under the Tex. Ins. Code Sec. 542.003(b) where the Code does not provide a private cause of action and that claims under Sections 541.060(a) and 541.051 are not assignable and must be dismissed.

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