The U.S. Court of Appeals for the Third Circuit has turned back a challenge to Aetna's requirement that parties receiving health insurance coverage for injuries caused by a third party must reimburse the company if they recover from that party.

The plaintiff, Jay Minerley, claimed his Aetna HMO policy was not an ERISA plan document that governed his benefits because his employer did not incorporate it into a document labeled as such, and because insurance policies cannot be plan documents. But the Third Circuit disagreed, finding that Minerley's argument rested on the erroneous premise that under ERISA, an employer needs to incorporate terms of its employee benefit plan in a single document. An employee benefit plan can be collectively formed by multiple documents, which need not be formally labeled as comprising the plan, the appeals court said.

The panel of Judges Michael Chagares, L. Felipe Restrepo and Stephanos Bibas affirmed a June 2019 decision by U.S. District Judge Noel Hillman, who dismissed the suit.

Minerley, an employee of Weiss-Aug Co. of East Hanover, suffered injuries in a motorcycle accident in 2010. Aetna paid $3,512 for medical treatment of Minerley's injuries and advised him the company had a lien for medical benefits in the event he recovered from the party responsible for the accident.

Minerley filed a suit in connection with the accident and received a recovery from the responsible party. He paid the $3,512 to Aetna but filed a class action against the insurer in state court, claiming it violated a New Jersey regulation that forbids insurers from seeking such reimbursements.

But Minerley is a Pennsylvania resident and was issued a policy under Aetna's Pennsylvania plan. Reimbursement requirements such as the one Minerley complained of are permitted in Pennsylvania.

After the case was removed to U.S. District Court, the state law claims were held to be preempted by ERISA. Minerley filed an amended complaint alleging that under ERISA he is entitled to a refund of the $3,512 because that money is a benefit due to him, and because Aetna's demand breached its fiduciary duties. Hillman dismissed those claims and found Minerley failed to exhaust administrative remedies before filing suit.

The appeals court also found Aetna is not the plan administrator, and is not subject to ERISA's general disclosure requirements for plan administrators, a fact that dooms Minerley's argument at the Third Circuit, Chagares wrote for the panel.

"The plain text of the regulation on which Minerley relies elaborates on disclosure obligations for 'the administrator of an employee benefit plan.' We will not stretch the word administrator, a term of art in the regulation, to impose consequences on 'others whom a disappointed plan participant might like to reach,'" Chagares wrote for the panel, citing the Third Circuit's 2019 decision in Bergamatto v. Board of Trustees of the NYSA-ILA Pension Fund.

The panel also rejected Minerley's claim that Aetna breached a duty of loyalty owed to him as a beneficiary by seeking reimbursement. His claim that Aetna violated ERISA by enforcing the plan terms in the HMO policy is "difficult to reconcile with" the U.S. Supreme Court's 2013 holding in U.S. Airways v. McCutchen that the law "countenances only such relief as will enforce the terms of the plan or the statute," reflecting "ERISA's principal function: to protect contractually defined benefits."

Gerald Lawrence from Lowey Dannenberg in White Plains, New York, who represented Aetna, declined to comment. Charles Kannebecker, an attorney in Milford, Pennsylvania, who represented Minerley, did not respond to requests for comment.