The Sixth Circuit has joined the Fifth, Ninth, and Eleventh Circuits in holding that a participant doesn’t need to suffer a financial loss in order to sue a plan for denying a benefit. In this case, a plan denied a participant’s claim for coverage of air ambulance transportation because it was not pre-certified. The plan affirmed the denial, but paid a portion of the bill that reflected the amount a preferred provider would have charged. The air ambulance service did not bill the participant for the remainder of the bill, but the participant sued the plan to pay the outstanding amount.
The Plan argued that the participant did not have a right to sue because he did not suffer any harm through financial loss or denial of the medical service. The court, however, held that the participant suffered harm because he was denied the use of specific funds that were rightfully his under the plan.
Springer v. Cleveland Clinic Employee Health Plan Total Care, No. 17-4181 (6th Cir. Aug. 14, 2018).