Supreme Court Declines Review in Guardian Flight, Leaving Intact Fifth Circuit Ruling That No Private Right of Action Exists to Enforce IDR Awards | Troutman Pepper Locke

On January 12, the U.S. Supreme Court docket denied the petition for writ of certiorari in Guardian Flightleaving in place the Fifth Circuit’s June 2025 resolution that we lined in our prior put up (obtainable here). Consequently, inside the Fifth Circuit, suppliers can’t depend on the No Surprises Act (NSA) itself to implement Unbiased Dispute Decision (IDR) awards in courtroom and face a heightened standing bar for ERISA-based claims the place sufferers are insulated from monetary hurt. And the persuasive impact of the Fifth Circuit’s holding is bolstered nationwide.

Background
As we defined beforehand, Guardian Flight arose out of efforts by air ambulance suppliers Guardian Flight and Med-Trans to gather funds awarded via the IDR course of beneath the NSA. After prevailing in a number of “baseball-style” IDR proceedings in opposition to an insurer, the suppliers alleged that the insurer did not pay the awards inside the 30‑day deadline required by the NSA. They sued to implement these awards, asserting: (1) direct claims beneath the NSA; (2) by-product ERISA claims primarily based on assignments from plan beneficiaries; and (3) a Texas quantum meruit declare. The district courtroom dismissed throughout the board, and the Fifth Circuit affirmed, holding that the NSA doesn’t create a non-public proper of motion for suppliers to implement IDR awards, that the suppliers lacked ERISA standing as a result of NSA‑protected beneficiaries suffered no concrete monetary harm, and that the quasi‑contract declare failed as a result of the companies have been rendered for the sufferers, not for the insurer.

Points Introduced within the Cert Petition
The certiorari petition requested the Supreme Court docket to evaluate two points with doubtlessly far‑reaching penalties for NSA and ERISA litigation. First, it requested whether or not a breach of ERISA plan phrases is itself an harm in actual fact to a plan beneficiary even the place the beneficiary is insulated from out‑of‑pocket hurt by the NSA’s stability‑billing protections, and due to this fact whether or not assignee‑suppliers can depend on that breach alone to ascertain Article III standing. Second, it requested whether or not, when Congress made NSA IDR awards “binding” and directed that insurers “shall” pay them inside 30 days, it supposed to allow suppliers to sue in courtroom to implement these awards, fairly than leaving enforcement solely to administrative companies. The petition argued that the Fifth Circuit’s solutions to each questions deepen current splits among the many circuits on what constitutes a concrete harm beneath Spokeo and Ramirezand on how one can learn statutory “binding” and “shall pay” language within the private-right-of-action context.

Sensible Influence within the Fifth Circuit
With the Supreme Court docket’s denial of certiorari, the Fifth Circuit’s evaluation now firmly governs inside Texas, Louisiana, and Mississippi and will probably be influential elsewhere. In sensible phrases, suppliers within the Fifth Circuit can’t convey standalone NSA claims to compel cost of IDR awards, and should as a substitute look primarily to federal and state regulators (akin to Well being and Human Companies) or to contract‑primarily based cures to handle nonpayment. ERISA‑primarily based claims will proceed to face heightened standing scrutiny the place sufferers are shielded from monetary legal responsibility, because the Fifth Circuit treats the plan’s alleged failure to pay as a “technical” breach inadequate, by itself, to represent a concrete harm to the beneficiary. And state‑legislation quasi‑contract theories stay constrained by the courtroom’s view that companies carried out for sufferers don’t fulfill Texas’s requirement that companies be rendered for the defendant’s profit.

Quite a few different district courts all through the US have adopted the Fifth Circuit’s lead find suppliers lack a non-public proper of motion to implement IDR awards, and we anticipate the denial of certiorari will add additional help for district courts contemplating the difficulty sooner or later.