{"id":3720,"date":"2026-01-19T16:42:31","date_gmt":"2026-01-19T16:42:31","guid":{"rendered":"https:\/\/www.insuracarelife.com\/blog\/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\/"},"modified":"2026-01-19T16:42:31","modified_gmt":"2026-01-19T16:42:31","slug":"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","status":"publish","type":"post","link":"https:\/\/www.insuracarelife.com\/blog\/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\/","title":{"rendered":"Supreme Court Declines Review in\u00a0Guardian Flight, Leaving Intact Fifth Circuit Ruling That No Private Right of Action Exists to Enforce IDR Awards | Troutman Pepper Locke"},"content":{"rendered":"
\n

On January 12, the U.S. Supreme Court denied the petition for writ of certiorari in Guardian Flight<\/em>, leaving in place the Fifth Circuit\u2019s June 2025 decision that we covered in our prior post (available here). As a result, within the Fifth Circuit, providers cannot rely on the No Surprises Act (NSA) itself to enforce Independent Dispute Resolution (IDR) awards in court and face a heightened standing bar for ERISA-based claims where patients are insulated from financial harm. And the persuasive effect of the Fifth Circuit\u2019s holding is bolstered nationwide.<\/p>\n

Background<\/strong>
As we explained previously, Guardian Flight<\/em> arose out of efforts by air ambulance providers Guardian Flight and Med-Trans to collect payments awarded through the IDR process under the NSA. After prevailing in multiple \u201cbaseball-style\u201d IDR proceedings against an insurer, the providers alleged that the insurer failed to pay the awards within the 30\u2011day deadline required by the NSA. They sued to enforce those awards, asserting: (1) direct claims under the NSA; (2) derivative ERISA claims based on assignments from plan beneficiaries; and (3) a Texas quantum meruit claim. The district court dismissed across the board, and the Fifth Circuit affirmed, holding that the NSA does not create a private right of action for providers to enforce IDR awards, that the providers lacked ERISA standing because NSA\u2011protected beneficiaries suffered no concrete financial injury, and that the quasi\u2011contract claim failed because the services were rendered for the patients, not for the insurer.<\/p>\n

Issues Presented in the Cert Petition<\/strong>
The certiorari petition asked the Supreme Court to review two issues with potentially far\u2011reaching consequences for NSA and ERISA litigation. First, it asked whether a breach of ERISA plan terms is itself an injury in fact to a plan beneficiary even where the beneficiary is insulated from out\u2011of\u2011pocket harm by the NSA\u2019s balance\u2011billing protections, and therefore whether assignee\u2011providers can rely on that breach alone to establish Article III standing. Second, it asked whether, when Congress made NSA IDR awards \u201cbinding\u201d and directed that insurers \u201cshall\u201d pay them within 30 days, it intended to permit providers to sue in court to enforce those awards, rather than leaving enforcement exclusively to administrative agencies. The petition argued that the Fifth Circuit\u2019s answers to both questions deepen existing splits among the circuits on what constitutes a concrete injury under Spokeo<\/em> and Ramirez<\/em>, and on how to read statutory \u201cbinding\u201d and \u201cshall pay\u201d language in the private-right-of-action context.<\/p>\n

Practical Impact in the Fifth Circuit<\/strong>
With the Supreme Court\u2019s denial of certiorari, the Fifth Circuit\u2019s analysis now firmly governs within Texas, Louisiana, and Mississippi and will be influential elsewhere. In practical terms, providers in the Fifth Circuit cannot bring standalone NSA claims to compel payment of IDR awards, and must instead look primarily to federal and state regulators (such as Health and Human Services) or to contract\u2011based remedies to address nonpayment. ERISA\u2011based claims will continue to face heightened standing scrutiny where patients are shielded from financial liability, as the Fifth Circuit treats the plan\u2019s alleged failure to pay as a \u201ctechnical\u201d breach insufficient, by itself, to constitute a concrete injury to the beneficiary. And state\u2011law quasi\u2011contract theories remain constrained by the court\u2019s view that services performed for patients do not satisfy Texas\u2019s requirement that services be rendered for the defendant\u2019s benefit.<\/p>\n

Numerous other district courts throughout the United States have followed the Fifth Circuit\u2019s lead in finding providers lack a private right of action to enforce IDR awards, and we expect the denial of certiorari will add further support for district courts considering the issue in the future.<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

On January 12, the U.S. Supreme Court denied the petition for writ of certiorari in Guardian Flight, leaving in place the Fifth Circuit\u2019s June 2025 decision that we covered in our prior post (available here). As a result, within the Fifth Circuit, providers cannot rely on the No Surprises Act (NSA) itself to enforce Independent […]<\/p>\n","protected":false},"author":1,"featured_media":3721,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[384,2016,1625,852,2325,2330,2329,1758,2331,2326,2328,2327,2311,2310,418,2294,1694,851,2309],"class_list":["post-3720","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog","tag-action","tag-awards","tag-circuit","tag-court","tag-declines","tag-enforce","tag-exists","tag-flight","tag-idr","tag-inguardian","tag-intact","tag-leaving","tag-locke","tag-pepper","tag-private","tag-review","tag-ruling","tag-supreme","tag-troutman"],"_links":{"self":[{"href":"https:\/\/www.insuracarelife.com\/blog\/wp-json\/wp\/v2\/posts\/3720","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.insuracarelife.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.insuracarelife.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.insuracarelife.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.insuracarelife.com\/blog\/wp-json\/wp\/v2\/comments?post=3720"}],"version-history":[{"count":0,"href":"https:\/\/www.insuracarelife.com\/blog\/wp-json\/wp\/v2\/posts\/3720\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.insuracarelife.com\/blog\/wp-json\/wp\/v2\/media\/3721"}],"wp:attachment":[{"href":"https:\/\/www.insuracarelife.com\/blog\/wp-json\/wp\/v2\/media?parent=3720"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.insuracarelife.com\/blog\/wp-json\/wp\/v2\/categories?post=3720"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.insuracarelife.com\/blog\/wp-json\/wp\/v2\/tags?post=3720"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}