Macro v. Independent Health Ass’n

Macro v. Independent Health Ass’n,

No. 01-CV-0504C(SC) (W.D.N.Y. Oct. 25, 2001)

Two women, who were receiving medical treatment to assist conception, brought suit
against their insurer when the women received a notice that the plan would no
longer cover the treatment of infertility as part of their group health contract.
The women were insured by the health insurance plan offered through their husbands’
employer. Alleging, among other things, that the insurer’s denial of coverage
for infertility violated New York Insurance Law, the women brought this class
action suit against the insurer in New York state court. After the insurer removed
the case to federal court on the claiming ERISA preemption, the women challenged
the validity of the preemption on the basis of ERISA’s “savings clause”
asserting that the federal court lacked subject matter jurisdiction over their
claim. The “savings clause” prevents the ERISA preemption of a law
suit brought in state court when the suit is based on state laws that purport
to “regulate[ ] insurance” even if the claims “relate to”
an employee benefit plan.

The United States District Court for the Western District of New York ruled
that the suit was not pre-empted and remained the case back to state court.
The court held that the state statute at issue, a statute that prohibited an
insurance policy from denying coverage for diagnosis and medical and surgical
treatment of a correctable medical condition solely because the condition results
in infertility, fulfilled the “savings clause” requirement that it
be clearly and obviously directed toward the insurance industry. Each provision
of the statute contained a mandatory prohibition against an insurance policy’s
exclusion of certain treatments.