Larson v. United Healthcare Inc. Co.

Dist. Ct. did not err in dismissing for failure to state cause of action plaintiff’s class action alleging that insurance companies’ practice of charging co-payments for chiropractic care violated Wisc. insurance code (that prohibited health insurers from excluding coverage for chiropractic services if their policies covered diagnosis and treatment of same condition by physician), as well as ERISA provisions regarding recovery of benefits and breach of fiduciary duty. While plaintiffs could properly sue instant insurance companies, as opposed to heath plans, for recovery of benefits, where insurance companies made relevant decisions on award and payment of benefits, defendant’s decisions on whether to charge co-payments pertains to contents of insurance policies, which do not constitute fiduciary acts covered by ERISA. Moreover, Ct. found that instant practice of charging co-payments for chiropractic care did not violate Wisc. insurance code since said code did not expressly prohibit chiropractic co-payments.