Zausmer Secures Published Sixth Circuit Victory in ERISA Dispute

Zausmer Shareholder Nathan Scherbarth and Associate Bailey Couger secured a favorable published decision in the U.S. Court of Appeals for the Sixth Circuit, affirming dismissal of state-law claims brought by healthcare providers seeking additional reimbursement.

Before providing treatment, the providers contacted the administrator of an employer-sponsored health plan to confirm coverage and reimbursement. They alleged that they were told reimbursement would be based on the usual customary and reasonable rate. After receiving less reimbursement than they anticipated, the providers sued under state-law theories of negligent misrepresentation and promissory estoppel.

The Sixth Circuit affirmed dismissal of the claims, holding that they were preempted by the Employee Retirement Income Security Act (ERISA), the federal law governing many employer-sponsored benefit plans. The court concluded that the providers’ claims depended on alleged representations concerning reimbursement under an ERISA-governed plan and therefore could not proceed under the state-law theories asserted.

In reaching its decision, the Sixth Circuit applied its existing precedent on ERISA preemption and emphasized the narrow scope of its holding. The published opinion provides further guidance on when state-law claims arising from representations about healthcare reimbursement are preempted by ERISA.

Michigan Lawyers Weekly featured the decision in its September 21, 2026, issue in the article, “ERISA Preempts Providers’ Reimbursement Misrepresentation Claims.”