Federal Circuits, 4th Cir. (July 03, 2003)
Docket number: 01-1102
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U.S. Court of Appeals for the 3rd Cir. - James W. Wood, v. Prudential Insurance Company of America James W. Wood; Karen Wood, Individually and as Guardians of Matthew Wood, Incompetent v. Prudential Insurance Company of America James Wood; Karen Wood, Individually and as Guardians of Matthew Wood, Incompetent Appellants, 207 F.3d 674 (3rd Cir. 2000) v. Prudential Insurance Company of America James W. Wood; Karen Wood, Individually and as Guardians of Matthew Wood, Incompetent v. Prudential Insurance Company of America James Wood; Karen Wood, Individually and as Guardians of Matthew Wood, Incompetent Appellants
U.S. Court of Appeals for the 4th Cir. - Marks v. Watters, et al, 322 F.3d 316 (4th Cir. 2003)
U.S. Court of Appeals for the 5th Cir. - Sandwich Chef of Texas, Inc., Doing Business as Wall Street Deli, Individually and for Others Similarly Situated, Plaintiff-Appellee, v. Reliance National Indemnity Insurance Company, Formerly Known as Planet Insurance Company; Reliance Insurance Company; Reliance Lloyds; Reliance National Insurance Co.; United Pacific Insurance Co.; Home Insurance Company, Formerly Known as City Insurance Co., Formerly Known as Home Indemnity Company, Formerly Known as Home Insurance Company, Formerly Known as Home Insurance Company of Indiana; Liberty Mutual Insurance Company; Liberty Mutual Fire Insurance Company; Liberty Insurance Corporation; American & Foreign Insurance Company; Globe Indemnity Co.; Royal Indemnity Co.; Royal Insurance Company of America; Safeguard Insurance Co.; Bituminous Casualty Corporation; Bituminous Fire and Marine Insurance Co.; Great West Casualty Insurance Co.; International Business & Mercantile Reassurance Co.; Old Republic Insurance Company; North River Insurance Co.; Internatio..., 319 F.3d 205 (5th Cir. 2003) Inc., Doing Business as Wall Street Deli, Individually and for Others Similarly Situated, Plaintiff-Appellee, v. Reliance National Indemnity Insurance Company, Formerly Known as Planet Insurance Company; Reliance Insurance Company; Reliance Lloyds; Reliance National Insurance Co.; United Pacific Insurance Co.; Home Insurance Company, Formerly Known as City Insurance Co., Formerly Known as Home Indemnity Company, Formerly Known as Home Insurance Company, Formerly Known as Home Insurance Company of Indiana; Liberty Mutual Insurance Company; Liberty Mutual Fire Insurance Company; Liberty Insurance Corporation; American & Foreign Insurance Company; Globe Indemnity Co.; Royal Indemnity Co.; Royal Insurance Company of America; Safeguard Insurance Co.; Bituminous Casualty Corporation; Bituminous Fire and Marine Insurance Co.; Great West Casualty Insurance Co.; International Business & Mercantile Reassurance Co.; Old Republic Insurance Company; North River Insurance Co.; Internatio...
US Code - Title 28: Judiciary and Judicial Procedure - 28 USC 1331 - Sec. 1331. Federal question
US Code - Title 29: Labor - 29 USC 1144 - Sec. 1144. Other laws
US Code - Title 29: Labor - 29 USC 1132 - Sec. 1132. Civil enforcement
U.S. Supreme Court - UNUM Life Ins. Co. of America v. Ward, 526 U.S. 358 (1999)
U.S. Supreme Court - FMC Corp. v. Holliday, 498 U.S. 52 (1990)
U.S. Supreme Court - Ingersoll-Rand Co. v. McClendon, 498 U.S. 133 (1990)
U.S. Supreme Court - Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41 (1987)
U.S. Supreme Court - Metropolitan Life Ins. Co. v. Taylor, 481 U.S. 58 (1987)
U.S. Supreme Court - Electrical Workers v. Hechler, 481 U.S. 851 (1987)
U.S. Supreme Court - Metropolitan Life Ins. Co. v. Massachusetts, 471 U.S. 724 (1985)
U.S. Supreme Court - Rush Prudential HMO, Inc. v. Moran, 536 U.S. 355 (2002)
U.S. Court of Appeals for the 7th Cir. - 20 Employee Benefits Cas. 1580, Pens. Plan Guide P 23922N Betty Jass, Plaintiff-Appellant, v. Prudential Health Care Plan, Incorporated, a Corporation, Karen Margulis and Peter J. Anderson, M.D., Defendants-Appellees., 88 F.3d 1482 (7th Cir. 1996) Pens. Plan Guide P 23922N Betty Jass, Plaintiff-Appellant, v. Prudential Health Care Plan, Incorporated, a Corporation, Karen Margulis and Peter J. Anderson, M.D., Defendants-Appellees.
U.S. Court of Appeals for the 4th Cir. - Casselman v. Amer Family Life (4th Cir. 2005)
Before NIEMEYER, MICHAEL, and KING, Circuit Judges.
Affirmed in part, reversed in part, and remanded by published opinion. Judge NIEMEYER wrote the opinion, in which Judge MICHAEL and Judge KING joined.OPINIONNIEMEYER, Circuit Judge:Sabriyana Singh commenced this action in State court against Prudential Health Care Plan, Inc., a health maintenance organization, seeking primarily reimbursement of monies paid to Prudential pursuant to a subrogation term in its policy that was issued as an employee benefit plan. Singh's complaint alleged that the subrogation term was illegal under the provisions of the Maryland Health Maintenance Organization Act (the "HMO Act"), Md. Code Ann., Health-Gen. II § 19-701 et seq., that have been construed by the Maryland Court of Appeals in Riemer v. Columbia Medical Plan, Inc., 358 Md. 222, 747 A.2d 677 (2000), to prohibit HMOs from pursuing subrogation with respect to their members' claims against third parties. Prudential removed the case to federal court, asserting that Singh's claims based on State law were completely preempted by the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. 1001 et seq., and then moved to dismiss Singh's complaint. Singh filed a motion to remand the case to State court. The district court denied Singh's motion to remand and granted Prudential's motion to dismiss the complaint.Because we agree with the district court that ERISA completely preempts Singh's state-law claims, we affirm the district court's denial of Singh's motion to remand. We reverse, however, its order dismissing Singh's claims, holding that they must be taken as ERISA claims and resolved under § 502(a) of ERISA.* After Sabriyana Singh was involved in an automobile accident in March 1998, Prudential Health Care Plan, Inc. ("Prudential"), an HMO with whom Singh's employer contracted to provide healthcare benefits under an employee benefit plan, paid Singh $950.12 in respect to injuries sustained in the accident. Singh also made a claim against the other party to the accident, and in settlement of that claim, Allstate Insurance Company paid Singh $5,000 in February 1999. Based on a term of the employee benefit plan permitting Prudential, through subrogation, to assert members' claims against third parties for reimbursement of benefits paid, Prudential asserted a subrogation claim against the $5,000 for reimbursement of the $950.12 payment that it had earlier made to Singh, and in September 1999 Singh paid the subrogation claim.Contending that the Prudential plan's subrogation provision was illegal under the Maryland HMO Act, Singh commenced this action in State court as a class action, alleging under State common law that Prudential was unjustly enriched and that it negligently misrepresented its right to subrogation. For relief, she sought (1) a declaratory judgment that the subrogation provision in the Prudential plan was illegal under the Maryland HMO Act, (2) an equitable award of restitution for subrogation amounts already paid by HMO members, (3) compensatory damages, and (4) an injunction directing Prudential to "cease and desist from asserting a subrogation interest in and a lien against any third-party recoveries" and prohibiting it from "increasing premiums, co-payments, or other charges to recover the losses incurred in connection with this litigation."The Maryland HMO Act, on which Singh relied in her complaint, regulates any person or organization that provides its members with healthcare services on a "prepaid basis." See Md.Code Ann., Health-Gen. II § 19-701(f). Based on an HMO's provision of healthcare on a prepaid basis, the Maryland Court of Appeals construed the HMO Act to prohibit HMOs from "pursu[ing] its members for restitution, reimbursement, or subrogation after the members have received damages from a third-party tortfeasor." Riemer v. Columbia Medical Plan, Inc., 358 Md. 222, 747 A.2d 677, 697 (2000). Accordingly, if Maryland law were to apply, the provision of the Prudential plan that authorizes Prudential to pursue a subrogation claim with respect to benefits it provided under the plan would be illegal.In response to the holding of Riemer, the Maryland legislature enacted, and on May 18, 2000, the governor signed, Senate Bill 903 to provide that an HMO is authorized to pursue subrogation with respect to members' recoveries from third parties. That legislation was made effective June 1, 2000, and provided that it would apply retroactively to all subrogation recoveries by HMOs since January 1, 1976. After the proceedings in this case were completed before the district court, the Maryland Court of Appeals held that the provision of Senate Bill 903 authorizing retroactive subrogation by HMOs violated the Maryland Constitution. Harvey v. Kaiser Foundation Health Plan, 370 Md. 604, 805 A.2d 1061 (Md.2002). Consequently, as Maryland law now stands, the subrogation prohibition of the HMO Act remained applicable until June 1, 2000.In response to Singh's complaint, Prudential filed a notice of removal to federal court, pursuant to 28 U.S.C. 1331 and 1441, asserting that the employee benefit plan in this case was regulated by ERISA and not by State law.Singh filed a motion to remand to State court, arguing that her complaint arose under State law regulating insurance that was saved from preemption under ERISA's "saving clause," § 514(b)(2)(A), 29 U.S.C. 1144(b)(2)(A), and that her claims did not seek impermissible alternative remedies to ERISA's enforcement provisions, § 502(a), 29 U.S.C. 1132(a). Prudential filed a motion to dismiss under Federal Rule of Civil Procedure 12(b)(6), contending that Singh's complaint failed to state a claim under ERISA upon which relief could be granted. Following a hearing on the motions, the district court issued an oral ruling denying Singh's motion to remand because her claims required interpretation of the terms of an ERISA plan and were completely preempted under § 502(a) of ERISA. The district court apparently rejected Singh's argument that the State law on which her claims were based was "saved" from preemption under § 514(b)(2)(A). Because of this, the court dismissed Singh's claims, presumably because state-law claims relating to an ERISA plan that are not saved from preemption under § 514(b)(2)(A) must be dismissed. As an additional basis for its dismissal, the court noted that Senate Bill 903 was "clear on its face" in allowing retroactive subrogation by HMOs, and that plaintiff would, therefore, be unable to get any relief in any court. The court did not, of course, have the benefit of the Maryland Court of Appeals' Harvey decision holding the retroactivity provision of Senate Bill 903 unconstitutional. In view of the district court's apparent ruling that the HMO Act was not saved under § 514(b)(2)(A), the role of its commentary on the preempted State law, including Senate Bill 903, was not made clear.From the district court's order denying remand and dismissing the complaint, Singh appealed.IISingh contends that her State common-law claims seek only to enforce the antisubrogation provision of the Maryland HMO Act, which she argues is a State regulation of insurance that is "saved" from ERISA's preemption under the express terms of § 514(b)(2)(A). She argues, "ERISA has no application to this state law dispute, and thus dismissal and removal were improper and the case should be remanded immediately to the state court."Prudential contends that Singh's complaint seeks state-law remedies for claims based on the HMO Act that are preempted and subject to the exclusive remedial provisions of § 502(a) of ERISA, and therefore her claims must, under the doctrine of "complete preemption," be treated as federal claims. Therefore, according to Prudential, the action was properly removed. Prudential then argues, in the alternative and perhaps inconsistently, that Singh's claims cannot arise under the Maryland HMO Act because that Act does not create a private right of action. It asserts further that any common-law causes of action to enforce the subrogation prohibition of the HMO Act are preempted by § 514 of ERISA and thus should be dismissed.In this appeal, we review the district court's order (1) denying Singh's motion to remand and (2) granting Prudential's motion to dismiss. To decide the remand issue, which actually involves Singh's challenge to removal jurisdiction, requires a determination of whether Singh's State common-law claims fall within the scope of ERISA's exclusive remedial scheme set forth in § 502(a), 29 U.S.C. 1132(a), and therefore are completely preempted. As we explain herein, Singh's claims fall within the scope of § 502(a) if they are claims for benefits, entitlement to which must be determined by passing on the validity, interpretation or applicability of a term of an ERISA plan. Removal jurisdiction is only proper, then, if Singh's State common-law claims for unjust enrichment and negligent misrepresentation are, in fact, claims for benefits due under the terms of an ERISA plan. In this particular case, Singh's claims cannot be thought of as seeking enforcement of the terms of an ERISA plan unless a State law, the Maryland HMO Act, acts to define a term of the plan. Thus, our jurisdictional analysis must answer preliminarily what the terms of the plan are and only then may we proceed to determine whether Singh's claims are, in fact, claims for benefits due under the terms of the plan. In determining the HMO Act's impact on the plan at issue here, we take the course of analysis set forth in Rush Prudential HMO v. Moran, 536 U.S. 355, 122 S.Ct. 2151, 153 L.Ed.2d 375 (2002), a case in which the claimant, like Singh here, sought reimbursement from an HMO, relying in part on a State HMO Act's impact on the plan. See id. (discussing the impact of a State HMO Act that was "saved" under ERISA § 514(b)(2)(A) on the terms of an ERISA plan and on the exclusive remedial scheme set forth in § 502(a)).In Parts III and IV, therefore, we conduct the Rush analysis to determine whether the Maryland HMO Act's subrogation prohibition ? on which Singh's State common-law claims depend ? defines a term of the relevant plan through § 514(a) and (b)(2)(A) of ERISA. This requires us to determine whether the HMO Act itself is preempted by ERISA under the relevant statutory provisions and whether the HMO Act conflicts with ERISA's remedial scheme. Concluding that the HMO Act is "saved" from preemption as a State regulation of insurance and therefore is applied to negate the plan's subrogation term, we assess, in Part V, whether Singh's claims for the return of funds under State common law are claims for entitlement to benefits under the terms of the plan as modified by the saved State law, such that the claim is "completely preempted."In Part VI, after having concluded that the case was properly removed to federal court under the doctrine of complete preemption, we turn to the review of the district court's order dismissing the case.IIIThe parties do not dispute that the Prudential plan, of which Singh is a participant, is an employee benefit plan regulated by ERISA. They differ on whether ERISA preempts the Maryland HMO Act, which would prohibit Prudential, an HMO subject to Maryland regulation, from enforcing the subrogation provision in the plan against Singh.Section 514(a) of ERISA, containing the "preemption clause," provides:Except as provided in subsection (b) of this section, the provisions of this subchapter... shall supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan....29 U.S.C. 1144(a). Defining the scope of this preemption by any State law that "relates" to an employee benefit plan, this preemption clause is recognized to be "broad" and "expansive." Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 47, 107 S.Ct. 1549, 95 L.Ed.2d 39 (1987); see also Cal. Div. of Labor Standards Enforcement v. Dillingham Constr. N.A., Inc., 519 U.S. 316, 324, 117 S.Ct. 832, 136 L.Ed.2d 791 (1997) (reviewing the Court's many previous acknowledgments that ERISA's premption provision is "clearly expansive," has a "broad scope" and an "expansive sweep," is "broadly worded," "deliberately expansive," and "conspicuous for its breadth").Subsection (b) referred to in § 514(a) contains the "saving clause," which excepts from the preemption clause any State law regulating, among other things, insurance. It provides:Except as provided in subparagraph (B), nothing in this subchapter shall be construed to exempt or relieve any person from any law of any State which regulates insurance, banking, or securities.29 U.S.C. 1144(b)(2)(A). The scope of the saving clause is limited by the "deemer clause," subparagraph (B) referred to in the saving clause, which provides:Neither an employee benefit plan ... nor any trust established under such a plan, shall be deemed to be an insurance company or other insurer ... or to be engaged in the business of insurance ... for purposes of any law of any State purporting to regulate insurance companies [or] insurance contracts.29 U.S.C. 1144(b)(2)(B).We apply these provisions of § 514 sequentially in determining whether the subrogation prohibition of the Maryland HMO Act is preempted by ERISA.First, the parties do not dispute that the provisions of the Maryland HMO Act that have been construed to prohibit subrogation by HMOs prior to June 2000 "relate to" an employee benefit plan for the purposes of § 514(a). Indeed, both the Supreme Court and this court, recognizing the expansive sweep of § 514(a) preemption, have held that State antisubrogation laws "relate to" an employee benefit plan. FMC Corp. v. Holliday, 498 U.S. 52, 58, 111 S.Ct. 403, 112 L.Ed.2d 356 (1990) ("Pennsylvania's antisubrogation law `relate[s] to' an employee benefit plan"); Hampton Indus., Inc. v. Sparrow, 981 F.2d 726, 729 (4th Cir.1992) (holding that a North Carolina law limiting subrogation "`relate [s] to' an employee benefits plan within the meaning of the preemption clause").The more complex question is whether the saving clause, § 514(b)(2)(A), excepts from application of the preemption clause the State subrogation prohibition on the basis that the prohibition "regulates insurance." Prudential argues that the saving clause does not apply here for two reasons. First, it argues that the Maryland HMO Act is not a regulation of insurance because it regulates HMOs, and under Maryland law, HMOs are classified as healthcare providers rather than insurers. Second, it argues more broadly that, in any event, antisubrogation laws are not regulations of insurance.Neither of Prudential's arguments is persuasive. Prudential's first argument ? that the Maryland HMO Act does not regulate insurance because HMOs are not considered insurers in Maryland ? is based principally on the fact that the HMO Act is located in the Maryland Health-General Article of the Maryland Code. Prudential points to statutory language providing that "the General Assembly intends to ... exempt health maintenance organizations from the insurance laws of this State, except as set forth in this subtitle." Md.Code Ann., Health-Gen. II § 19-702. But the exception at the end of the quoted language indicates that HMOs are not categorically exempted from insurance laws. Nor need it mean that the HMO Act does not, or any law concerning HMOs could not, provide its own form of insurance law.More fundamentally, Prudential's argument fails because it wanders from the guideposts established by the Supreme Court for determining the applicability of the saving clause, advancing instead a formalistic argument that has already been rejected. The Supreme Court recently clarified the test for determining the applicability of the saving clause, reducing it to two factors:First, the state law must be specifically directed toward entities engaged in insurance. Second ... the state law must substantially affect the risk pooling arrangement between the insurer and the insured.Kentucky Ass'n of Health Plans, Inc. v. Miller, ___ U.S. ___, 123 S.Ct. 1471, 1479, 155 L.Ed.2d 468 (2003) (citation omitted). In so holding, the Court in Miller made "a clean break from the McCarran-Ferguson factors" that previously served as "considerations" in the saving-clause analysis but which ultimately "added little to the relevant analysis." Id. at 1478-79. Nonetheless, it retained the mandate to focus not on how a regulated entity is classified, but on whether the State law is aimed at the provision of insurance.In Metropolitan Life Insurance Co. v. Massachusetts, for example, the insurer argued that a Massachusetts law requiring certain mental health coverage was "in reality a health law that merely operates on insurance contracts to accomplish its end, and that it [was] not the kind of traditional insurance law intended to be saved by § 514(b)(2)(A)." 471 U.S. 724, 741, 105 S.Ct. 2380, 85 L.Ed.2d 728 (1985). The Supreme Court found this argument "unpersuasive," and stated that Congress did not distinguish between "traditional and innovative insurance laws." Id.; see also id. ("Appellants assert that ... laws that regulate the substantive terms of insurance contracts are more recent innovations more properly seen as health laws rather than as insurance laws, which § 514(b)(2)(A) does not save. This distinction reads the saving clause out of ERISA entirely").More recently, in Rush Prudential HMO, Inc. v. Moran, 536 U.S. 355, 366, 122 S.Ct. 2151, 153 L.Ed.2d 375 (2002), an HMO proffered a similar argument:Rush contends that seeing an HMO as an insurer distorts the nature of an HMO, which is, after all, a health care provider, too. This, Rush contends, should determine its characterization, with the consequence that regulation of an HMO is not an insurance regulation within the meaning of ERISA.The Court, however, rejected this argument:The answer to Rush is, of course, that an HMO is both: it provides health care, and it does so as an insurer. Nothing in the saving clause requires an either-or choice between health care and insurance in deciding a preemption question, and as long as providing insurance fairly accounts for the application of state law, the saving clause may apply.Id. at 367, 122 S.Ct. 2151.Thus, we reject Prudential's argument that the subrogation prohibition is not saved because HMOs should not be considered insurers.Prudential's second argument maintains that, even under the framework established by the Supreme Court, the antisubrogation provisions of the Maryland HMO Act are not "saved" from preemption because "subrogation laws are not laws that regulate the business of insurance." When making this argument, Prudential did not have the benefit of Miller, where the Supreme Court jettisoned the portion of the saving-clause analysis that, applying the McCarran-Ferguson factors, focused on whether the state law regulated the "business of insurance": Rather than concerning itself with whether certain practices constitute "[t]he business of insurance," or whether a state law was "enacted ... for the purpose of regulating the business of insurance," [§ 514(b)(2)(A)] asks merely whether a state law is a "law ... which regulates insurance, banking, or securities."123 S.Ct. at 1478. But even before Miller, which did not work any fundamental change in the substance of saving-clause analysis, both the Supreme Court and this court rejected Prudential's argument. In FMC Corp. v. Holliday, the Supreme Court dealt precisely with the question of whether a State antisubrogation law was saved from preemption under § 514(b)(2)(A), and held that it was:There is no dispute that the Pennsylvania [antisubrogation] law falls within ERISA's insurance saving clause.... [The antisubrogation law] directly controls the terms of insurance contracts by invalidating any subrogation provisions that they contain. It does not merely have an impact on the insurance industry; it is aimed at it. This returns the matter of subrogation to state law. Unless the statute is excluded from the reach of the saving clause by virtue of the deemer clause, therefore, it is not pre-empted.498 U.S. at 60-61, 111 S.Ct. 403 (citations omitted). Following FMC Corp., we noted that "limits on subrogation recoveries appear to be aimed at the insurance industry, and therefore would also appear to come within the scope of the saving clause." Hampton Indus., Inc., 981 F.2d at 729-30 (holding that the State law limiting subrogation was not saved, however, because of the applicability of the deemer clause).Controlled by the holding of FMC Corp. and consistent with our observation in Hampton Industries, we conclude that the subrogation prohibition of the Maryland HMO Act applicable before June 2000 is a state-law regulation of insurance that is saved from preemption under § 514(b)(2)(A). But notwithstanding the holding of FMC Corp., it is difficult to imagine an antisubrogation law of this type as anything other than an insurance regulation, as it addresses who pays in a given set of circumstances and is therefore directed at spreading policyholder risk. See Miller, 123 S.Ct. at 1479 (directing focus on whether the State law is "specifically directed toward entities engaged in insurance" and "substantially affect[s] the risk pooling arrangement between the insurer and the insured").While the application of the saving clause is limited by the deemer clause, Prudential abandoned its argument made below that the deemer clause is applicable. The deemer clause operates to "exempt self-funded ERISA plans from State laws that `regulat[e] insurance' within the meaning of the saving clause." FMC Corp., 498 U.S. at 61, 111 S.Ct. 403 (emphasis added). Because the Prudential plan at issue here is an insured plan, the deemer clause does not operate to exempt it from application of the HMO Act, which is saved under § 514(b)(2)(A).In sum, we agree with Singh that the saving clause contained in § 514(b)(2)(A) appears to exempt the subrogation prohibition of the Maryland HMO Act from preemption by ERISA. But reaching this tentative conclusion does not end the inquiry because we must still assess whether the otherwise saved State law nonetheless frustrates the overall purposes of ERISA by inappropriately supplementing or supplanting ERISA's exclusive remedies. See Conover v. Aetna U.S. Health Care, Inc., 320 F.3d 1076, 1078 (10th Cir.2003) ("A state law otherwise regulating insurance within the meaning of § 514(b)(2)(A) may still be preempted if it allows plan participants and beneficiaries `to obtain remedies under state law that Congress rejected in [ERISA]'" (citations omitted)).IVThe Supreme Court has recognized a "limited exception from the saving clause" created by the "overpowering" reach of § 502(a) of ERISA, in which Congress set forth the exclusive remedies available for claims relating to employee benefit plans. Rush, 536 U.S. at 381, 375, 122 S.Ct. 2151. The Supreme Court concluded that State laws regulating insurance could be applied to ERISA plans, but only so long as doing so would not undermine the objectives of § 502(a). Id. at 387 122 S.Ct. 2151; id. at 377, 122 S.Ct. 2151 ("Although we have yet to encounter a forced choice between the congressional policies of exclusively federal remedies and the `reservation of the business of insurance to the States,' we have anticipated such a conflict, with the state insurance regulation losing out if it allows plan participants `to obtain remedies ... that Congress rejected in ERISA'" (citations omitted)).In Rush, the Court was presented with a State law that authorized HMO members to demand an independent medical review of a decision to deny coverage for a procedure deemed by the HMO to be medically unnecessary. Concluding that this law was exempt from preemption by the saving clause and did not create a new claim or enlarge the remedies prescribed by § 502(a), the Court held that the saved State law did not interfere with § 502(a) and therefore would be enforced as part of an ERISA plan. The Court explained that the saved State law did not create a conflicting enforcement scheme or an arbitration system that would supplement the specific remedies prescribed by § 502(a), but rather provided a standard for making medical judgments:The practice of obtaining a second opinion ... is far removed from any notion of an enforcement scheme, and once [the State law] is seen as something akin to a mandate for a second-opinion practice in order to insure sound medical judgments, the preemption argument that arbitration under [the State law] supplants judicial enforcement runs out of steam.* * *This case therefore does not involve the sort of additional claim or remedy exemplified in Pilot Life, Russell[,