Judge Joseph Bianco
United Healthcare Service administered Con Edison’s benefit plans for employees and retirees. Korman underwent cancer treatment in April 2009, while an employee. He retired that May. He sued United Healthcare under ERISA and the common law seeking damages alleging misrepresentation, in an August 2009 explanation of benefits (EOB) that he had a lifetime medical maximum benefit of $2 million. Finding both prongs of the test in Aetna Health v. Davila met, the court dismissed Korman’s negligent misrepresentation claim against United as preempted by ERISA §502(a)(1)(B). United’s alleged misrepresentation via the EOB was inextricably intertwined with an interpretation of Con Edison’s plan coverage and benefits. In deeming Korman’s claim “colorable” under ERISA for Davila‘s first prong, the court found the case went beyond a dispute over payment quantity, and triggered issues of coverage availability and benefit eligibility under ERISA-governed plans, particularly the effect his retirement had on his entitlement to medical benefits under the plans. On Davila‘s second prong, the court rejected Korman’s claim that New York Insurance Law §3234 created an independent legal duty between him and United, removing his claim from ERISA.
