Douglas Ghee, as personal representative of the Estate of Billy Fleming v. USAble Mutual Insurance Company d/b/a…

Summary

The court held that ERISA defensively preempted the portion of the wrongful-death claim based on Blue Advantage's decision not to approve or pay for surgery because that decision concerned administration of plan benefits. The court held that dismissal was premature as to allegations that Blue Advantage separately provided negligent medical advice after denying coverage, because the complaint did not clearly establish that the advice was given in the course of plan administration. The judgment was therefore affirmed in part, reversed in part, and remanded.