In a significant decision, the U.S. Supreme Court has opted not to review the Fourth Circuit Court's partial revival of a lawsuit involving the death of an airline employee whose employer delayed covering his heart transplant surgery until after his death.

SCOTUS Won't Hear ERISA Suit Over Heart Transplant : Background of the Case

On Monday, the justices declined the petition from Jody Rose, mother of the late Kyree Devon Holman. Rose had argued that the Supreme Court's 2011 ruling in Cigna Corp. v. Amara held that health plans cannot retain funds earmarked for medical treatments, asserting her son's estate was entitled to the money under the "surcharge" provision of the Employee Retirement Income Security Act (ERISA).

The Fourth Circuit had previously revived Rose's unjust enrichment claim but kept her denial of benefits claim dismissed.

Troubling Denial of Medical Coverage

Rose's initial suit, filed in December 2019 on behalf of her son's estate, claimed PSA Airlines and other administrators of Holman's health plan violated ERISA by repeatedly denying necessary heart transplant surgery, leading to a deterioration of his condition. By the time the procedure was finally approved after an expedited review, Holman had already passed away in February 2019.

UMR Inc., a UnitedHealthcare subsidiary and third-party administrator of Holman's plan, is among the health administration companies named in the lawsuit.

SCOTUS Won't Hear ERISA Suit Over Heart Transplant : Legal Battles and Outcomes

A federal district court dismissed Rose's case in September 2021, noting she sought compensation for her son's death, an outcome the health plan wouldn't have allowed. The Fourth Circuit reinstated Rose's claim for breach of fiduciary duty citing unjust enrichment but stopped short of awarding an ERISA "surcharge," prompting Rose's appeal to the Supreme Court.

Representation and Legal Firms

Jody Rose's legal team comprises Peter K. Stris, Radha A. Pathak, John Stokes, and Colleen R. Smith of Stris & Maher LLP, along with Norris A. Adams II and Caitlin Hale Walton of Essex Richards PA.

PSA Airlines is represented by Edward J. Meehan and Ross P. McSweeney of Groom Law Group and Anton Metlitsky and Ashley Robertson of O'Melveny & Myers LLP.

Health administration companies were represented at the Fourth Circuit by Brian D. Boone and Brandon C.E. Springer of Alston & Bird LLP, Rachel Ann Smoot of Taft Stettinius & Hollister LLP, and Megan M. Stacy and Alfred Victor Rawl Jr. of Gordon Rees Scully Mansukhani LLP.

Despite the setback in the Supreme Court, Rose's partial victory in the Fourth Circuit indicates her fight for justice is far from over.