The panel affirmed in part and reversed in part the district court’s dismissal and remanded for further proceedings in an action brought under the Employee Retirement Income Security Act (“ERISA”) and California state law by Healthcare Ally Management of California, LLC (“HAMOC”), against WSP USA, Inc., and Aetna Life Insurance Co.

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The case arose from a dispute over the proper payment rate for a surgery that took place at the La Peer Surgery Center. At the time, the patient was enrolled in an ERISA healthcare plan provided by the patient’s employer, WSP, and Aetna administrated the plan. Before providing out-of-network surgical services, La Peer placed a verification call to Aetna, which told La Peer that the patient would cover a portion of the surgery but that WSP’s plan would pay the remaining balance at the usual, customary, and reasonable rate and that payment would not be based on the Medicare fee schedule. Contrary to Aetna’s representation, however, WSP paid La Peer not at the USR rate, but at the Medicare rate, which amounted to five percent of La Peer’s bill.

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HAMOC, La Peer’s successor in interest, brought suit. The district court held that HAMOC lacked derivative standing to assert an ERISA claim on La Peer’s behalf and dismissed that claim. The district court dismissed the remainder of HAMOC’s complaint pursuant to Fed. R. Civ. P. 12(b)(6), concluding that the state law claims necessarily depended on the existence of an ERISA-covered plan and so were preempted by ERISA.

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Under 29 U.S.C. § 1144(a), ERISA preempts all state laws that “relate to” any healthcare plan regulated by the statute. The two categories of state-law claims that “relate to” an ERISA plan are claims that have a “reference to” an ERISA plan and claims that have “an impermissible connection with” an ERISA plan.

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Reversing in part, the panel held that ERISA did not preempt HAMOC’s negligent misrepresentation claim, which arose from coverage representations made to an out-of-network medical provider during a verification call in advance of medical services. Because this claim did not focus on an ERISA-regulated relationship, it was not preempted under the “connection with” test. Agreeing with other circuits, the panel concluded that the negligent misrepresentation claim was not preempted under the “reference to” test because it was not a claim that Congress could have intended to route through ERISA’s civil enforcement scheme. Rather, HAMOC was simply an independent entity claiming damages. The panel explained that the result it reached accorded with the underlying premises of ERISA preemption. The panel distinguished Bristol SL Holdings, Inc. v. Cigna Health & Life Ins. Co., 103 F.4th 597 (9th Cir. 2024), which held that ERISA preempted state law breach of contract and promissory estoppel claims.

Affirming in part, the panel held that under Bristol, ERISA preempted HAMOC’s California state law claim of promissory estoppel.

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https://cdn.ca9.uscourts.gov/datastore/opinions/2026/08/11/24-3479.pdf