Not what you're
looking for? Try an advanced search.
Buy This Entire Record For
PARISH v. METROPOLITAN LIFE INSURANCE COMPANY
September 19, 2005.
PATTI PARISH PLAINTIFF
METROPOLITAN LIFE INSURANCE COMPANY DEFENDANT.
The opinion of the court was delivered by: GEORGE HOWARD, District Judge
Plaintiff filed suit in the Woodruff County Circuit Court for
certain long-term care disability benefits based on the agreement
between defendant and plaintiff's employer, American Greetings.
Defendant removed the case on the basis that plaintiff is seeking
recovery of benefits under an employee welfare benefit plan
governed by ERISA.
Pending before the Court is plaintiff's motion to remand the
case for lack of subject matter jurisdiction. She argues that
since defendant did not attach a copy of the insurance policy,
there is no evidence that it is an employee welfare benefit plan
governed by ERISA based on the face of her complaint. Plaintiff
also asserts concurrent jurisdiction applies until it is proven
that ERISA governs.
Defendant counters that, while ERISA is not referenced in the
complaint, her cause of action is to recover long term disability
benefits under a plan established by her employer which is within
the scope of ERISA and therefore preempted as shown by the
summary plan description ("SPD") attached as an exhibit
establishing a plan providing health and welfare benefits to
active American Greetings associates, with employees electing
coverage to pay through deductions from their payroll checks and the claims submitted to the claims administrator
Gates McDonald for review. It continues that, even relying on just
the complaint allegations, defendant insures a long-term
disability policy for plaintiff's employer; plaintiff alleges
that she was diagnosed with Cushing's Syndrome which would
qualify her for additional benefits under the program established
by her employer.
In her reply, plaintiff maintains that defendant has still
failed to provide a copy of the policy and so has not
demonstrated that the policy is governed by ERISA. Turning to the
SPD, plaintiff asserts that while the SPD does discuss employee
benefits, it does not address the employer's involvement in the
administration of the plan or how the plan is funded and even
anticipates that a plaintiff may seek relief in state court.
The Court finds that the following excerpts from the case of
Witthoeft v. Aon Corp., 2004 WL 2935853, *1-2 (N.D. Ill. 2004)
are applicable here:
Dennis Witthoeft filed a lawsuit against his employer
Aon Corp. in Illinois state court. Witthoeft alleged
that through his employment, he became a beneficiary
of a group long term disability (LTD) insurance
policy issued by Prudential Insurance. Following an
illness, he applied for benefits under the policy and
was approved, but this decision was later reversed on
the basis that Witthoeft had a preexisting condition
within the 90 days before the policy's effective
date. Witthoeft sued for breach of contract and under
the doctrine of promissory estoppel. Aon removed the
case to federal court, asserting that Witthoeft's
suit was a claim to recover benefits under an
employee welfare benefit plan governed by the federal
Employee Retirement Income Security Act and was
completely preempted by federal law. Witthoeft has
moved to remand the case to state court.
Under the "well-pleaded complaint" rule, federal
jurisdiction, including removal jurisdiction,
ordinarily is determined based on the plaintiff's
complaint, not on possible or anticipated defenses.
See, e.g., Metropolitan Life Ins. Co. v. Taylor,
481 U.S. 58, 63, 107 S.Ct. 1542, 95 L.Ed.2d 55
(1987). But under the rather inaptly named "complete
preemption" doctrine, if the plaintiff's claim is one
which may be brought only under federal law, then it
may be recharacterized as a federal claim, and
removal is proper. See, e.g., Moran v. Rush
Prudential HMO, Inc., 230 F.3d 959, 967 (7th
Cir. 2000). If Witthoeft's claim is, in fact, a claim
for benefits under an ERISA plan, it may be brought
only under ERISA, and the case was appropriately
removed to federal court. Id. (citing Metropolitan
Life, 481 U.S. at 67). Under ERISA, an "employee welfare benefit plan" is a
"plan, fund, or program . . . established or
maintained by an employer . . . for the purpose of
providing for its participants or their
beneficiaries, through the purchase of insurance or
otherwise . . . medical, surgical, or hospital care
or benefits, or benefits in the event of sickness,
accident, disability, death or unemployment. . . ."
29 U.S.C. § 1002(1). Aon's employee benefit plan, as
described in its materials submitted in opposition to
the motion to remand, meets these criteria. The fact
that part of the plan is administered by Prudential,
an outside entity, does not mean that Aon did not
"establish or maintain" the plan. See, e.g.,
Gaylor v. John Hancock Mut. Life Inc. Co.,
112 F.3d 460, 465 (10th Cir. 1997) (citing
29 U.S.C. § 1105(c)(1)); cf. Brundage-Peterson v. Compcare
Health Serv. Ins. Corp., 877 F.2d 509, 511 (7th
Cir. 1989) (group insurance plan that employer
creates by contract with an insurance company,
designating which employees are eligible to enroll,
is covered by ERISA).
Witthoeft points out that Aon paid none of the
premiums for the LTD coverage; coverage was
voluntary; the policy was provided by a separate
entity, Prudential Insurance; and Prudential
administered the group policy and determined claims
for benefits. Based largely on these factors, and on
a Department of Labor regulation indicating that a
plan meeting these criteria falls outside ERISA, see
29 C.F.R. § 2510.3-1(j), Witthoeft argues that the
LTD policy is not an ERISA plan and thus his claim is
properly a state law claim.
The Court disagrees. Though reference to the DOL
regulation is an appropriate guide for determining
ERISA coverage, see Postma v. Paul Revere Life Ins.
Co., 223 F.3d 533, 537 (7th Cir. 2000), it is
improper to "unbundle" the various aspects of an
employee benefit plan in making the determination.
Id. at 538. The LTD insurance was only one aspect
of the Aon employee benefit plan. Aon also provided
medical and dental benefits, as well as coverage for
short term disability and sick time. See Def. Resp.
to Pl's Mot. for Remand, Ex. 1 (Aff. of John A.
Reschke) ¶¶ 7, 13. Aon paid the cost of coverage for
certain of these benefits, though not for LTD
coverage. Id. ¶ 13. The benefit plan as a whole is
covered by ERISA, even though the LTD insurance might
not be if it were the exclusive aspect of the Aon
benefit plan (a question the Court need not decide).
Thus Witthoeft's claim may be made, if at all, only
Thus, based on the current record, the Court is persuaded that
defendant properly removed the case from state court under ERISA.
Accordingly, plaintiff's motion (#4) to remand is denied and the
parties are to comply with the ERISA scheduling order previously
filed. IT IS SO ORDERED.
© 1992-2005 VersusLaw ...
Buy This Entire Record For