⚖ Oral Arguments, with Context

The Second Circuit hears two related appeals between the Central Orthopedic Group and Aetna. The medical practice says it provided care outside Aetna's network to patients covered by Aetna plans, but was not properly reimbursed. To sue for plan benefits under the federal law known as ERISA, the practice relies on patients' assignments of their benefit rights: claimed transfers of the right to pursue payment. But the plans contain anti-assignment clauses, and Aetna says those restrictions prevent the practice from bringing the patients' claims. The practice responds that Aetna gave up that defense by dealing directly with it, processing claims and appeals, and paying part of some bills. This is a waiver argument: intentionally giving up a contractual right. The district court dismissed the federal benefits claims, finding that ordinary claims handling did not show a waiver, and denied permission to amend the complaints. The practice will argue that the plan clauses needed further examination, and that its allegations justify discovery or at least another chance to amend. Aetna will argue that processing claims and paying providers directly are consistent with its obligations to patients, not a surrender of its contractual defenses. The court will also consider whether the practice adequately told the district judge what additional facts it could plead. Listen for the difference between an insurer paying a doctor directly and the doctor acquiring a patient's right to sue for plan benefits.

The Central Orthopedic Group, LLP v. Aetna Life Insurance Company (No. 25-2813) — U.S. Court of Appeals for the Second Circuit, argued November 12, 2026.