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Does ERISA Require that Health Insurers Provide Claims Data?

Does ERISA Require that Health Insurers Provide Claims Data?

Congress’s expansion of ERISA to regulate employee health care benefits resulted in many new cases, particularly in regards to gaining access to claims data and pricing information. For example, to assess the value and performance of their employee health benefits, plan fiduciaries may need to see health care insurance claims and other data. Some providers have been slow to grant access to this data.

In response, employee benefits committees at some companies have filed lawsuits to gain access to more health benefit data. Last year, employees at Owens & Minor, Inc., a medical supply logistics company based in Virginia, sued their company’s insurance provider, Anthem Health Plans of Virginia. The employees claimed they couldn’t access enough data to assess the value and performance of their benefits.

“What should have been a simple transfer of the plan’s information from Defendant to Plaintiff turned into a year-long trail of emails and other correspondence, littered with Defendant’s excuses, arbitrary conditions, and illusory promises,” the lawsuit said. Owens & Minor, Inc., and Anthem Health Plans settled out of court on undisclosed terms, so we don’t know how much information Anthem agreed to share.

Along with filing lawsuits in federal and state courts, employees have also filed complaints with the federal departments of Health and Human Services, Labor, and the Treasury. The complaints accuse employers — and their third-party benefit managers — of violating the expanded ERISA’s health plan oversight provisions, making it difficult to impossible for plan fiduciaries to monitor plan benefits. 

We will continue monitoring the progress of litigation and other challenges to federal law.


Boutwell Fay LLP

For over 20 years, the attorneys and other professionals at Boutwell Fay have been successfully solving the complex legal puzzles in the areas of employee benefits and ERISA. We have a federal practice in all 50 states.

We are a nationally recognized ERISA law firm with an unquenchable thirst to continue to learn, share, and deeply care for clients.



Owens & Minor, Inc. and Owens & Minor Flexible Benefits Plan v. Anthem Health Plans of Virginia, Inc. dba Anthem Blue Cross And Blue Shield


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