Aetna Attempts to Shut Down ConforMIS Lawsuit

Aetna, Inc. and Aetna Life Insurance Company (Aetna) have filed a motion to dismiss in an effort to end an ongoing battle with ConforMIS, Inc. and John Michael Schaub over the denial of claims for the use of customized total knee implants for knee replacement patients.

Earlier this year, ConforMIS and Schaub sued Aetna alleging Aetna violated its duties under the Employee Retirement Income Security Act (ERISA). ConforMIS’ additional claims against Aetna include product disparagement, tortious interference with a contractual relationship, and unfair trade practices. For OTW’s coverage of the lawsuit see, “Aetna’s Denial of ConforMIS Implants Results in Suit.”

In response, Aetna filed a motion to dismiss for failure to state a claim upon which relief can be granted. The motion was for all claims except for Schaub’s denial of benefits claim under ERISA.

In its motion to dismiss, Aetna stated, “The Complaint is ConforMIS’ novel, but improper, attempt to co-opt Mr. Schaub’s ERISA denial of benefits claim, and convert that claim into something it is not: a quasi-class action intended to force Aetna to cover the ConforMIS custom total knee replacement device nationwide under Aetna’s commercial health insurance benefit plans.”

Aetna seeks to dismiss all of ConforMIS’ claims. Aetna first argues that several of ConforMIS’ allegations against Aetna fail as a matter of law. Aetna also argues that ConforMIS’ tortious interference claim fails because the complaint alleges “no improper or intentional interference by Aetna in any actual contract or business relationship.”

Aetna makes several additional arguments in its motion to dismiss. Aetna argues that ConforMIS has no right to join in Schaub’s ERISA allegations because Schaub’s health plan contains an anti-assignment provision. Aetna asserts in the alternative that even if ConforMIS can sue under ERISA, ConforMIS should not be allowed to proceed on its breach of fiduciary duty claims because “Aetna cannot plausibly owe ConforMIS itself a fiduciary duty under ERISA.”

Aetna also requests that all of Schaub’s ERISA claims be dismissed, except for his wrongful denial of benefits claim. Aetna contends that Schaub lacks standing for his request and his claim for denial of full and fair review requires dismissal because the law “does not provide for a private right of action.”

OTW will continue to monitor the progress of the lawsuit. The parties have an initial scheduling conference set for August 31, 2020.