Federal Circuits, 7th Cir. (April 15, 1991)
Docket number: 90-1379
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U.S. Supreme Court - Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41 (1987)
U.S. Supreme Court - Metropolitan Life Ins. Co. v. Taylor, 481 U.S. 58 (1987)
U.S. Supreme Court - Metropolitan Life Ins. Co. v. Massachusetts, 471 U.S. 724 (1985)
U.S. Supreme Court - Hishon v. King & Spalding, 467 U.S. 69 (1984)
U.S. Supreme Court - Shaw v. Delta Air Lines, Inc., 463 U.S. 85 (1983)
U.S. Court of Appeals for the 7th Cir. - 20 Employee Benefits Cas. 1580, Pens. Plan Guide P 23922N Betty Jass, Plaintiff-Appellant, v. Prudential Health Care Plan, Incorporated, a Corporation, Karen Margulis and Peter J. Anderson, M.D., Defendants-Appellees., 88 F.3d 1482 (7th Cir. 1996) Pens. Plan Guide P 23922N Betty Jass, Plaintiff-Appellant, v. Prudential Health Care Plan, Incorporated, a Corporation, Karen Margulis and Peter J. Anderson, M.D., Defendants-Appellees.
Marjan R. Kmiec, Christopher A. McConville, Milwaukee, Wis., for plaintiffs-appellants.
Kim M. Cafaro, Laurel Barnes, Milwaukee, Wis., for defendant-appellee.Christopher A. McConville, Marjan R. Kmiec, Milwaukee, Wis., for appellant.Before CUMMINGS, MANION, and KANNE, Circuit Judges.MANION, Circuit Judge.Kathleen and Michael Maciosek appeal the district court's decision to dismiss their lawsuit against Blue Cross and Blue Shield ("Blue Cross"). Their counsel, Marjan R. Kmiec of Kmiec Law Offices, appeals the court's imposition of Rule 11 sanctions. We affirm both district court rulings.I.Kathleen Maciosek was treated for fertility problems between 1986 and 1988. As wife and dependent of Michael Maciosek, an employee of Trent Tube Division, Crucible Materials Corporation, she was covered by a Blue Cross group health insurance plan for Trent Tube employees and dependents. Blue Cross initially paid approximately $4,000 for in vitro fertilization (IVF) treatments administered by Dr. K. Paul Katayama at Waukesha Memorial Hospital. When Blue Cross determined it was not obligated to pay for the IVF treatments, it recovered the payments from Dr. Katayama and the hospital, leaving the Macioseks responsible for the bill.The Macioseks sued Blue Cross on May 30, 1989 in the Circuit Court for Waukesha County, claiming that Blue Cross breached their insurance contract, tortiously interfered with their contractual relationship with Dr. Katayama and the hospital, intentionally inflicted emotional distress on them, and violated Wisconsin common law which prohibits an insurer from recovering mistaken payments unless the payment was caused by a mistake of fact. On June 30, 1989, Blue Cross succeeded in removing the case to the United States District Court for the Eastern District of Wisconsin because it presents a federal question governed by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. Sec . 1001 et seq. On July 3, 1989, Blue Cross filed motions to dismiss and for Rule 11 sanctions, arguing that the Maciosek's state law claims were preempted by ERISA and were frivolous. The Macioseks filed a brief in opposition to the motion to dismiss and for sanctions, arguing that ERISA did not preempt their claims and that a split of authority on the issue made their argument reasonable and nonfrivolous. The district court granted Blue Cross' motion to dismiss, and awarded Blue Cross 50 percent of its reasonable costs and attorneys fees under Fed.R.Civ.P. 11. The district court held that the Macioseks' attorneys knew from their involvement in previous cases that two of the Macioseks' four claims had been ruled preempted by ERISA, yet the attorneys failed to even cite the relevant cases. The Macioseks appeal the dismissal of their claims, and their lead counsel, Marjan R. Kmiec of Kmiec Law Offices, appeals the ruling on sanctions.II.The Supreme Court thoroughly discusses the preemptive scope of ERISA in a series of four opinions authored by Justice O'Connor. See Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 107 S.Ct. 1549, 95 L.Ed.2d 39 (1987); Metropolitan Life Ins. Co. v. Taylor, 481 U.S. 58, 107 S.Ct. 1542, 95 L.Ed.2d 55 (1987); FMC Corp. v. Holliday, --- U.S. ----, 111 S.Ct. 403, 112 L.Ed.2d 356 (1990); Ingersoll-Rand Co. v. McClendon, --- U.S. ----, 111 S.Ct. 478, 112 L.Ed.2d 474 (1990). Congress passed "the massive undertaking of ERISA"1 to " 'promote the interests of employees and their beneficiaries in employee benefit plans.' " Ingersoll-Rand, 111 S.Ct. at 482, quoting Shaw v. Delta Air Lines, Inc., 463 U.S. 85, 90, 103 S.Ct. 2890, 2896, 77 L.Ed.2d 490 (1983). This comprehensive statute " 'imposes participation, funding, and vesting requirements on pension plans. It also sets various uniform standards, including rules concerning reporting, disclosure, and fiduciary responsibility, for both pension and welfare plans.' " Ingersoll-Rand, id., quoting Shaw, id. at 91, 103 S.Ct. at 2896. ERISA's comprehensive regulatory scheme provides safeguards to prevent abuse and to effectuate its purposes, including a broad preemption provision (29 U.S.C. Sec . 1144), a provision which precludes interference with rights protected by ERISA (29 U.S.C. Sec . 1140), and a "carefully integrated" civil enforcement scheme (29 U.S.C. Sec . 1132(a)). Ingersoll-Rand, Id. "In determining whether federal law preempts a state statute, we look to congressional intent." FMC Corp., 111 S.Ct. at 407. "Where, as here, Congress has expressly included a broadly worded pre-emption provision in a comprehensive statute such as ERISA, our task of discerning congressional intent is considerably simplified." Ingersoll-Rand, 111 S.Ct. at 482. "The pre-emption clause is conspicuous for its breadth," FMC Corp., 111 S.Ct. at 407, and should be "expansively applied." Ingersoll-Rand, 111 S.Ct. at 482. That clause provides:Except as provided in subsection (b) of this section [the saving clause], the provisions of this subchapter and subchapter III of this chapter shall supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan.29 U.S.C. Sec . 1144(a). Two other provisions of ERISA are relevant in determining the scope of preemption Congress intended--the saving clause and the deemer clause. The saving clause provides:Except as provided in subparagraph (B) [the deemer clause], nothing in this subchapter shall be construed to exempt or relieve any person from any law of any State which regulates insurance, banking, or securities.29 U.S.C. Sec . 1144(b)(2)(A). The deemer clause provides:Neither an employee benefit plan ... nor any trust established under such a plan, shall be deemed to be an insurance company or other insurer, bank, trust company, or investment company or to be engaged in the business of insurance or banking for purposes of any law of any State purporting to regulate insurance companies, insurance contracts, banks, trust companies, or investment companies.29 U.S.C. Sec . 1144(b)(2)(B). The Supreme Court has noted that these clauses "are not a model of legislative drafting," Metropolitan Life Ins. Co. v. Massachusetts, 471 U.S. 724, 739, 105 S.Ct. 2380, 2389, 85 L.Ed.2d 728 (1985), but "[t]heir operation is nevertheless discernible," FMC Corp., 111 S.Ct. at 407:[The pre-emption clause] establishes as an area of exclusive federal concern the subject of every state law that "relate[s] to" an employee benefit plan governed by ERISA. The saving clause returns to the States the power to enforce those state laws that "regulat[e] insurance," except as provided in the deemer clause. Under the deemer clause, an employee benefit plan governed by ERISA shall not be "deemed" an insurance company, an insurer, or engaged in the business of insurance for purposes of state laws "purporting to regulate" insurance companies or insurance contracts.FMC Corp., Id. In Taylor, supra at 538, the Supreme Court ruled that state common law contract and tort claims arising from an employer's termination of disability benefits were preempted by ERISA and removable from state to federal court. In Pilot Life the Court went further, holding that ERISA preempts all state common law causes of action based on the alleged improper processing of a claim for benefits. In that case, the plaintiff sought contract damages, tort damages for mental and emotional distress, and punitive damages, but failed to assert any ERISA causes of action. All of the plaintiff's claims were held preempted. In FMC Corp., the Court held that ERISA preempts a state law precluding employee welfare benefit plans from exercising subrogation rights on a claimant's tort recovery. And in Ingersoll-Rand, the Court held that a state common law cause of action based on an alleged wrongful discharge, which sought punitive damages and recovery for future lost wages and mental anguish rather than lost pension benefits, was also preempted by ERISA. While FMC Corp. and Ingersoll-Rand were decided after briefing and oral argument in this case, the Macioseks will find no comfort there; ERISA's preemptive power remains virtually undefeated.III.The Macioseks' efforts to avoid the clear preemptive mandate of ERISA are unpersuasive. The state law causes of action alleged by the Macioseks obviously are preempted under the Supreme Court's construction of ERISA. As the Macioseks admit, all of the claims are based on the improper denial of benefits by an ERISA-regulated health care plan. This court previously has ruled that state common law claims for punitive damages based on an alleged improper denial of benefits is preempted by ERISA. Reilly v. Blue Cross & Blue Shield, 846 F.2d 416, 418 (7th Cir.), cert. deniedTry vLex for FREE for 3 days
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