Grasso Enter. v. Express Scripts

Plaintiffs filed suit, alleging that ESI is systematically denying payment of compound drug claims without adhering to the procedural requirements of the Employee Retirement Income Security Act's "Claims Regulation." 29 U.S.C. 1001 et seq. The court concluded that there is no need for injunctive relief under section 502(a)(3), or for equitable relief to enforce or clarify the beneficiary’s rights under the plan under section 502(a)(1)(B). In this case, the district court did not abuse its discretion in denying the preliminary injunction requested by plaintiffs as assignees of plan beneficiaries because plaintiffs have cited no reported decision, and the court has found none, where a circuit court has upheld a private plaintiff’s claim for injunctive relief mandating the future procedures an ERISA plan must follow to comply with the Claims Regulation. In the alternative, the court concluded that plaintiffs do not have standing under ERISA to assert harm to themselves because they are not ERISA beneficiaries. Accordingly, the court affirmed the judgment. View "Grasso Enter. v. Express Scripts" on Justia Law