Federal Circuits, 9th Cir. (September 01, 1992)
Docket number: 91-35098,91-35125
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US Code - Title 29: Labor - 29 USC 1144 - Sec. 1144. Other laws
US Code - Title 29: Labor - 29 USC 1102 - Sec. 1102. Establishment of plan
US Code - Title 29: Labor - 29 USC 1002 - Sec. 1002. Definitions
U.S. Court of Appeals for the 4th Cir. - Willis Hope White, Plaintiff-Appellant, v. Provident Life & Accident Insurance Company, Defendant-Appellee., 114 F.3d 26 (4th Cir. 1997) Plaintiff-Appellant, v. Provident Life & Accident Insurance Company, Defendant-Appellee.
Peter M. Kirwan and Michael G. Garrity, Kirwan & Barrett, Bozeman, Mont., for plaintiffs-appellants-cross-appellees.
Gene I. Brown and Steve Reida, Landoe, Brown & Planalp, Bozeman, Mont., for defendants-appellees-cross-appellants.Marshal L. Mickelson, Corette, Smith, Pohlman & Allen, Butte, Mont., for defendant-appellee.Appeal from the United States District Court for the District of Montana.Before: TROTT and KLEINFELD, Circuit Judges, and DIMMICK,* District Judge.TROTT, Circuit Judge:Patrick Greany, an employee of Western Farm Bureau Life Insurance Company ("Western") and Mountain West Farm Bureau Mutual Insurance Company ("Mountain West") (collectively "Farm Bureau"), and his wife Marcia Greany appeal the district court's dismissal of their common law claims brought against Western, Mountain West, Western Farm Bureau Group Health Insurance Trust ("the Trust"), and Lincoln National Life Insurance Group ("Lincoln National"). The Greanys' claims were based on Lincoln National's denial of insurance benefits. Among the theories of liability unsuccessfully advanced by the Greanys was a claim based on the federal common law of estoppel. Western, Mountain West, and the Trust appeal the judgment entered by the district court against Western following a jury verdict in favor of the Greanys. The jury verdict was based on Western's alleged failure to act with the required degree of competence in procuring adequate health insurance coverage for the Greanys. We have jurisdiction over the timely appeals pursuant to 28 U.S.C. 1291 (1988).I FACTS AND PROCEEDINGS BELOWIn March of 1977, Patrick Greany began working as an insurance salesman for Farm Bureau. As a Farm Bureau employee, Patrick was offered group health insurance coverage. In April of 1981, Patrick enrolled in a Farm Bureau group health insurance plan under a policy issued by Lincoln National ("the group plan"). The group plan provided $1,000,000 in lifetime benefits and covered most medical expenses related to pregnancy and childbirth. Premiums on the group plan were shared by Patrick and Farm Bureau.On July 15, 1983, Patrick submitted his resignation from employment with Farm Bureau and informed the company his last day of employment would be August 1, 1983. Prior to submitting his resignation, Patrick began investigating various insurance options because he knew that eventually he would no longer be eligible for coverage under the group plan when he left Farm Bureau's employ. On July 15, 1983, Patrick completed and submitted an application to obtain an insurance policy through Western States Life Insurance Company ("Western States"), Patrick's new employer. Sometime during the last week of July 1983, Patrick requested that the Western States policy go into effect on September 1, 1983, based on his belief that the group plan coverage continued until August 31, 1983.Upon receiving Patrick's resignation, Farm Bureau sent Patrick a Mountain West form entitled "Notice of Terminated Agents Privileges," and a Western form entitled "Notice of Conversion Insurance." Patrick received both forms on approximately July 25, 1983. The forms stated that Patrick had thirty-one days after terminating employment to convert the group plan into an individual policy.Because Patrick was interested in comparing the cost of the Western States policy with a conversion policy available through Lincoln National, Patrick sent Farm Bureau a memo on August 1, 1983, requesting that the necessary conversion information and forms be sent to him. On August 5, 1983, Farm Bureau completed the front side of a "Preliminary Request for Conversion Information" form ("conversion request form") and forwarded it to Patrick. On the front of the conversion request form, Farm Bureau noted that the group plan coverage had terminated on August 1, 1983. After Patrick received the conversion request form from Farm Bureau, he completed the back side and forwarded it to Lincoln National.Conversion representatives for Lincoln National reviewed Patrick's conversion request form and concluded, based on their understanding of the "Master Contract" between Lincoln National and Farm Bureau, that the date of termination of group plan coverage contained on the conversion request form should have been August 31, 1983, not August 1, 1983. Lincoln National sent Patrick a letter on August 25, 1983, attaching conversion information and stating that "your group coverage terminates August 31, 1983."On August 26, 1983, Marcia Greany went into premature labor and delivered a two pound seven ounce baby girl who had a hole between her main pulmonary artery and her aorta. The Greanys incurred approximately $62,000 in medical expenses associated with the child's premature birth and subsequent medical care.Patrick contacted Lincoln National on August 29, 1983, to inform the insurer of his daughter's premature birth. A Lincoln National agent confirmed that the Greanys were covered under the group plan until August 31, 1983.However, the Greanys' expectation of coverage through August 31, 1983, abruptly evaporated. Lorna Young, a Farm Bureau employee, contacted Lincoln National on September 2 and 9, 1983, to inform Lincoln National that an incorrect date had been used by Lincoln National in evaluating the Greanys' coverage under the group plan. Young apprised the Lincoln National conversion agents of a modification to the Master Contract that changed the coverage termination date to coincide with the last day of employment. The district court record establishes that the amendment to the Master Contract that changed the termination of coverage to the last day of employment had gone into effect on April 1, 1982. The Lincoln National conversion agents contacted Lincoln National's new business division and confirmed that the Farm Bureau Master Contract was being revised to change the coverage termination date to the last day of work. The conversion agents, in dealing with Patrick, had apparently referred to a version of the Master Contract that did not include the recent amendments regarding coverage termination.In a letter dated September 9, 1983, Lincoln National informed the Greanys that the termination date of August 31, 1983, quoted in the prior letter, was incorrect. The Greanys were also notified that the group plan benefits had actually terminated on August 1, 1983. Due to Lincoln National's error, the Greanys were given an opportunity to convert the group plan to an individual policy prior to October 1, 1983. Lincoln National thereafter refused to pay any of the Greanys' claims under the group plan. The Greanys converted the group plan into an individual policy with Lincoln National. Lincoln National paid the full $25,000 benefit available under the conversion policy. The Greanys also made a claim on their Western States policy and received a payment of $29,000. All but approximately $7,000 of the Greanys' medical expenses of $62,000 was paid by either Lincoln National or Western States.The Greanys filed a complaint on August 19, 1986, against Farm Bureau, the Trust, and Lincoln National alleging: Count I--wrongful denial of benefits under the group plan; Count II--violations by Lincoln National of Montana's unfair claims settlement practice laws; Count III--violations of Montana's mandatory insurance content laws; Count IV--interference by Farm Bureau and the Trust with the Greanys' contractual and business relations with Lincoln National; and Count V--negligence by Farm Bureau in failing to provide the Greanys with adequate health insurance coverage.1In the district court, Farm Bureau alleged the group plan was an employee benefit plan covered by the terms of the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. 1001-1461 (1988); the Greanys did not contest this allegation. Based on this concession, the district court dismissed all of the Greanys' claims except Count III (violation of Montana's statute regulating conversion policies) and Count V (negligence), concluding that most of the claims were preempted by ERISA.2On September 10, 1990, a jury trial commenced on the remaining two claims. At the close of the evidence, the district court granted Lincoln National's motion for directed verdict or dismissal of Count III. The jury returned a verdict against Mountain West in favor of the Greanys on Count V and awarded them $7,000 in compensatory damages3 and $75,000 in punitive damages.Both sides filed notices of appeal. Farm Bureau challenges the sufficiency of the evidence, the punitive damage award, and the district court's failure to dismiss the negligence claim against it. The Greanys challenge the district court's dismissal of their claims.II STANDARD OF REVIEWWe review de novo a grant of summary judgment. Felton v. Unisource Corp., 940 F.2d 503, 508 (9th Cir.1991). We must determine, viewing the evidence in the light most favorable to the nonmoving party, whether there are any genuine issues of material fact and whether the district court correctly applied the relevant substantive law. Tzung v. State Farm Fire and Casualty Co., 873 F.2d 1338, 1339-40 (9th Cir.1989).ERISA preemption is a conclusion of law reviewed de novo. Olson v. General Dynamics Corp., 951 F.2d 1123, 1125 (9th Cir.1991). We review for clear error the district court's findings regarding whether a benefit is provided pursuant to an ERISA plan. See Nevill v. Shell Oil Co., 835 F.2d 209, 211 (9th Cir.1987) (the district court's finding that a special separation benefit was offered as part of the ERISA plan is a finding of fact reviewed for clear error).III DISCUSSIONA DISTRICT COURT'S REVIEW OF THE PLAN ADMINISTRATOR'S ACTIONSThe Greanys contend the district court reviewed for an abuse of discretion the plan administrator's actions when it should have reviewed the actions de novo. See generally Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 111-15, 109 S.Ct. 948, 954-56, 103 L.Ed.2d 80 (1989). The Greanys focus on the magistrate's statement that the insurance policy was being strictly construed in favor of Lincoln and therefore coverage terminated on August 1, 1983. The Greanys objected to the magistrate's finding. The district court's August 21, 1990 order affirming the magistrate's finding specifically stated that it would review de novo findings which were objected to by the parties. There is no indication in the record that the district court, upon subsequent review of the magistrate's finding, applied a deferential standard of review to the plan administrator's actions. Thus, the Greanys cannot demonstrate that the policy and claims were reviewed by the district court using any standard other than de novo. The record belies their contention, and we reject it.B ERISA'S APPLICABILITY TO THE CONVERSION POLICY"ERISA's pre-emption provision does not refer to state laws relating to 'employee benefits,' but to state laws relating to 'employee benefit plans'...." Fort Halifax Packing Co. v. Coyne, 482 U.S. 1, 7, 107 S.Ct. 2211, 2215, 96 L.Ed.2d 1 (1987) (emphasis omitted). The Greanys conceded in district court that the group plan was an employee benefit plan falling under the purview of the ERISA provisions. See 29 U.S.C. 1002(1) (definition of "employee welfare benefit plan"), 1002(3) (definition of "employee benefit plan"), 1002(5) (definition of "employer"), 1003(a) (ERISA coverage enunciated). Therefore, any of the Greanys' claims that relate to the group plan are governed by ERISA.The Greanys argue, however, that the conversion policy and the facts surrounding its processing are merely an employee benefit that is free from ERISA's broad reach. We disagree.The opportunity to convert the group plan to an individual policy is a benefit provided pursuant to the group plan. Individual conversion rights of group health or disability plans are provided for both by ERISA, see 29 U.S.C. 1161 and 1162, and by Montana law, see Mont.Code Ann. §§ 33-22-508(1).4 The predicate to the conversion right, under both ERISA and Montana law, is qualification as a beneficiary under a group health or disability plan. See 29 U.S.C. 1161(a) (qualified beneficiaries of a group health plan are entitled to elect continuation of coverage under the plan); Mont.Code Ann. § 33-22-508(1) (group disability insurance policies must allow an insured party under the policy the opportunity to convert to an individual policy if the party is no longer eligible for membership in the class covered by the policy). No conversion benefits would be available unless the party seeking the conversion policy was an eligible insured beneficiary of a group plan.The group plan in this case, which the Greanys admit is an ERISA plan, provides for the conversion benefit. Because the Greanys would not be eligible for a conversion policy without first belonging to the class of beneficiaries covered by the ERISA group plan, we conclude that the individual conversion benefits are part of the ERISA plan and are thus governed by ERISA. Had the Greanys not received health benefits pursuant to the ERISA group plan, they would not have been eligible to receive conversion benefits, and would have no cause of action arising from the conversion policy. Despite the Greanys' attempts to recharacterize their relationship with Farm Bureau to create a duty independent of the group plan, "[t]here would be no relationship or cause of action ... without the Plan." Gibson v. Prudential Ins. Co., 915 F.2d 414, 417 (9th Cir.1990). Therefore, any of the Greanys' claims that arise from facts surrounding the conversion benefit are to be analyzed with reference to ERISA. See FMC Corp. v. Holliday, 498 U.S. 52, 111 S.Ct. 403, 407-08, 112 L.Ed.2d 356 (1990) (the state law governing subrogation provisions in insurance contracts "reference[d]" the benefit plans governed by ERISA); Tingey v. Pixley-Richards W., Inc., 953 F.2d 1124, 1132-33 (9th Cir.1992) (state mandated conversion rights for group health benefits subject to ERISA provisions); Henkin v. Northrop Corp., 921 F.2d 864, 866-67 (9th Cir.1990) (group policy providing for conversion benefits treated by court as part of the ERISA plan and analyzed under the ERISA preemption provisions); Nevill, 835 F.2d at 211 (separation allowance was offered under the ERISA plan and was therefore governed by ERISA).C ERISA PREEMPTION"ERISA contains one of the broadest preemption clauses ever enacted by Congress." PM Group Life Ins. v. Western Growers Assur. Trust, 953 F.2d 543, 545 (9th Cir.1992) (quotation omitted). The ERISA provisions "supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan...." 29 U.S.C. 1144(a). A state law "relate[s] to" an employee benefit plan "if it has a connection with or reference to such a plan." Fort Halifax, 482 U.S. at 8, 107 S.Ct. at 2215 (quotation omitted).Nevertheless, a state law that ordinarily would be preempted by ERISA may be "saved" from preemption if it "regulates insurance." See 29 U.S.C. 1144(b)(2)(A) (the saving clause); 29 U.S.C. 1144(b)(2)(B) (the deemer clause); FMC Corp., 498 U.S. at ----, 111 S.Ct. at 407 (although ERISA preemption is broad, the saving clause returns to the states the power to enforce state laws that "regulates insurance," but "[u]nder the deemer clause, an employee benefit plan governed by ERISA shall not be 'deemed' an insurance company, [or] an insurer ... for purposes of state laws 'purporting to regulate' insurance companies or insurance contracts"). With the foregoing in mind, we now turn to an analysis of the various counts at issue.1. Negligence--Count VThe Greanys were permitted to proceed to trial against Farm Bureau on the theory that Farm Bureau, acting as the Greanys' insurance agent in procuring the conversion policy, "fail[ed] to act with a minimum degree of care owed by a professional insurance agent to its customers...." The district court upheld this theory because it concluded "the Greany's [sic] claim arises out of facts surrounding the conversion policy rather than the ERISA plan, thus the preemption defense is inapplicable."The Greanys first argue that neither the sale nor the content of conversion policies is governed by ERISA because Farm Bureau was required by Mont.Code Ann. § 33-22-508 to provide the conversion policy. Farm Bureau correctly points out the basis of the Greanys' negligence claim is not a violation of the Montana statute requiring conversion benefits, but revolves instead around the group plan and conversion benefits themselves. Thus, the Greanys cannot rely on § 33-22-508 to "save" their negligence claim from preemption.The Greanys also argue that Farm Bureau breached a duty owed to them as customers. Because we conclude the conversion benefits are governed by ERISA, see supra Part III.B, the Greanys' negligence claim must be based on duties independent of the conversion benefit provided pursuant to the ERISA group plan to survive ERISA preemption. The Greanys' attempts to analogize Farm Bureau to a private insurance agent fail. Farm Bureau was acting in all respects as an employer, not in the capacity as a private insurance agent. Outside of the employment relationship, the Greanys never requested that Farm Bureau investigate various insurance options and recommend a policy for the Greanys. Contrary to the Greanys' assertions, they could not have brought a claim against Farm Bureau, the Trust, or Lincoln National regarding the conversion rights in the absence of the ERISA group plan.The negligence claim was not based on breach of a duty owed to the Greanys by Farm Bureau that was independent from the duties created by the group plan. In reality, the Greanys challenge the administration of ERISA plan benefits, specifically the conversion rights. Farm Bureau's conduct regarding the conversion benefits was merely a continuation of the duties it had as an employer in providing the group plan. Therefore, the state negligence claim "relate[s] to" the ERISA group plan and is preempted by ERISA. See Tingey, 953 F.2d at 1131 (all claims which involve the ERISA plan, even if drafted to refer to the employment relationship, are preempted by ERISA); Lea v. Republic Airlines, Inc., 903 F.2d 624, 632 (9th Cir.1990) (state claims for negligence, breach of contract, fraud, and equitable estoppel relating to an ERISA plan were preempted). The district court erred in allowing the state negligence claim to proceed to trial. The jury verdict awarding compensatory and punitive damages is reversed.52. Unfair Claims Settlement Practices--Count IIThe district court granted summary judgment on the Greanys' claim that the defendants had violated Montana's unfair claims settlement practices statutes, Mont.Code Ann. §§ 33-18-101, et seq. Citing Kanne v. Connecticut Gen. Life Ins. Co., 867 F.2d 489 (9th Cir.1988) (per curiam), cert. denied,Try vLex for FREE for 3 days
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