No. 18-134

Jennifer Perkins v. US Airways, Inc., et al.

Lower Court: Fourth Circuit
Docketed: 2018-07-31
Status: Denied
Type: Paid
Response Waived
Tags: 12(b)(6) benefits-denial current-employment-status erisa health-benefits medicare-as-secondary-payer medicare-secondary-payer plan-documents summary-judgment unreasonable-denial-of-benefits
Latest Conference: 2018-09-24
Question Presented (from Petition)

Petitioner has been continuously employed as a
flight attendant with Respondent US Airways, Inc.
(US Air), a member of the flight attendants' union,
and a participant in the US Airways Health Benefit
Plan (the Plan) since 1992. Lightning struck
Petitioner on a jetway while she was working for US
Air. Petitioner continued working for US Air without
taking a leave of absence after she was struck.
Petitioner's condition worsened considerably, and she
has been on approved medical leave of absence since
October 2001. Petitioner began receiving long-term
disability benefits from US Air in February 2002, and
she began receiving Medicare disability benefits in
September 2003. As a result of her current
employment status with US Air and her membership
in the union, Petitioner is entitled to continue
receiving benefits, including retirement benefits,
health benefits, and seniority through US Air. While
on approved medical leave, Petitioner has experienced
several issues with Respondents improperly
determining its payer status as secondary to
Medicare. During all relevant times, Petitioner has
timely paid the full amount of her health insurance
premium in order to maintain the high-quality
coverage offered by the Plan. Petitioner successfully
appealed those determinations through 2010; however,
in 2011, Respondents refused to correct its
erroneous payer status determination and denied
Petitioners' claims for health benefits. In connection
with Respondents' denials in 2010 and 2011,
Petitioner requested copies of certain Plan documents
in order to assist her in appealing the denials.
Respondents repeatedly failed to timely provide
Petitioner with copies of the Plan documents she
requested.

The questions presented are:

1) Did the Court of Appeals err in affirming
the District Court's dismissal of Petitioner's claims
based on alleged violations of subsection (b) of the
Medicare as Secondary Payer Act when the dismissal
was not based on the unambiguous statutory
definition of "current employment status" provided by
Congress in that subsection and instead was based
upon a regulatory definition for that same term, see
Chevron, U.S.A., Inc. v. Natural Res. Def. Council,
Inc., 467 U.S. 837 (1984); when Petitioner's Complaint
established Petitioner's status as a current employee
and union member; and when Petitioner's Complaint
alleged Medicare had already determined its payer
status was secondary to Petitioner's employer sponsored health benefits claims?

2) Did the Court of Appeals err in affirming
the dismissal of Petitioner's claim alleging a violation
of the Employee Retirement Income Security Act of
1974 for unreasonable denial of benefits when the
terms of Petitioner's employer-sponsored health
benefit plan forming the basis for Respondents' denial
of Petitioner's employer-sponsored health benefit
claims pertaining to Medicare payment priority alter
the express and unambiguous definition of "current
employment status" set forth by Congress in the
Medicare as Secondary Payer Act; when precedent
from the Courts of Appeals for the D.C. and the Sixth
Circuits indicates that plan provisions violating
federal statutes, including the Medicare as Secondary
Payer Act, are void for violating federal law and denial
of benefits claims; when Medicare previously
determined its payer status was secondary to
Petitioner's employer-sponsored health benefits; and
when an independent third-

Question Presented (AI Summary)

Whether the court erred in dismissing petitioner's claims under the Medicare as Secondary Payer Act and ERISA for unreasonable denial of benefits, and in granting summary judgment against petitioner on her claim for failure to timely provide plan documents

Docket Entries

2018-10-01
Petition DENIED.
2018-08-22
DISTRIBUTED for Conference of 9/24/2018.
2018-08-15
Waiver of right of respondents US Airways, Inc., et al. to respond filed.
2018-05-29
Petition for a writ of certiorari filed. (Response due August 30, 2018)

Attorneys

Jennifer Perkins
Wynetka Ann ShuttBurnette Shutt & McDaniel, PA, Petitioner
US Airways, Inc., et al.
Deanna Marie RiceO'Melveny & Myers, LLP, Respondent