AG EQUIPMENT CO. v. AIG Life Ins. Co., Inc.

636 F. Supp. 2d 1210, 2009 U.S. Dist. LEXIS 58689, 2009 WL 2044773
CourtDistrict Court, N.D. Oklahoma
DecidedJuly 9, 2009
DocketCase 07-CV-0556-CVE-PJC
StatusPublished

This text of 636 F. Supp. 2d 1210 (AG EQUIPMENT CO. v. AIG Life Ins. Co., Inc.) is published on Counsel Stack Legal Research, covering District Court, N.D. Oklahoma primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
AG EQUIPMENT CO. v. AIG Life Ins. Co., Inc., 636 F. Supp. 2d 1210, 2009 U.S. Dist. LEXIS 58689, 2009 WL 2044773 (N.D. Okla. 2009).

Opinion

OPINION AND ORDER

CLAIRE V. EAGAN, Chief Judge.

Now before the Court are Plaintiffs Motion for Judgment Notwithstanding the Verdict Pursuant to Rule 50 (Dkt. # 397) and Plaintiffs Motion for Judgment Notwithstanding the Verdict Pursuant to Rule 59 (Dkt. # 398). Plaintiff AG Equipment Company (AG) seeks judgment it its favor on all claims between AG and defendant AIG Life Insurance Company, Inc. (AIG) or, in the alternative, a new trial.

I.

AG is an Oklahoma corporation that provides health insurance benefits to its employees through a self-funded employee benefits plan known as the AG Equipment Company Employee Benefit Plan (the Plan). Dkt. #200, Ex. 5. Beginning in May 2003, AG purchased stop-loss insurance from AIG to insure some expenses incurred under the Plan. Under the stop-loss or excess loss policy (the Policy) issued by AIG, AG agreed to pay the first $40,000 of medical expenses incurred by a covered employee and AIG would reimburse AG for excess amounts up to $1 million per employee. Id., Ex. 1. Under the Policy, AIG agreed to cover any expenses “covered and paid under the Plan” within these limits. Id. at 5. AG retained a third-party claims administrator, Mercer Health & Benefits Administration, LLC (Mercer), to process claims under the Plan, and AIG retained Medical Excess, LLC (Medical Excess), as an underwriter and claims administrator to process claims for reimbursement received from employers operating self-funded plans.

AIG reviewed the Plan and agreed to provide stop-loss coverage for expenses covered by the Plan. Under the Plan, a person is eligible for coverage if he or she:

*1215 (1) is a Full-Time, Active Employee of the Employer. An Employee is considered to be Full-Time if he or she normally works at least 30 hours per week and is on the regular payroll of the Employer for that work.
(2) is in a class eligible for coverage.
(3) completes the employment Waiting Period of 60 consecutive days as an Active Employee....

Id., Ex. 5, at 6. The Plan does not expressly distinguish between hourly and salaried employees and there is no provision of the Plan exempting salaried employees from the 30 hour per week requirement. AG claims that it subsequently informed AIG in 2004 that it did not track hours for salaried employees and all salaried employees were considered full-time employees under the Plan. AG hired Suzanne Ash Kurtz in 2001, and agreed to pay her $30,000 per year and provide benefits under the Plan.

AG claims that Kurtz was hired as its in-house counsel, but AIG has not conceded that Kurtz actually worked in this capacity. Kurtz was the ex-wife of AG’s CEO, Grady Ash, and they remained friends after their divorce. In 2003, Kurtz was diagnosed with Leiomyosarcoma, a form of cancer in the connective tissue around her lungs. 1 Kurtz required extensive medical treatment and AG covered her medical expenses under the Plan. Between 2003 and 2007, Kurtz submitted medical bills to AG for several hundred thousand dollars and, in turn, AG sought reimbursement from AIG for these expenses. AIG paid the claims submitted by AG from 2003 to 2007 based on AG’s statements that Kurtz was a full-time employee of AG.

On March 24, 2007, Mercer received a call from Mark Heidenreiter, a janitor for AG, who claimed that he found copies of emails in Ash’s wastebasket suggesting that Kurtz’s employment was a sham for the purpose of providing her health benefits. That same day, AIG had sent a check for $467,775.89 to AG as reimbursement for Kurtz’s medical expenses, and AIG immediately stopped payment on the check. Mark Heidenreiter’s wife, Kileen Heidenreiter, worked for AG until 2005, and he stated that she could provide additional information concerning Kurtz’s employment for AG. AG claims that Mark Heidenreiter had a grudge against Ash for placing his wife on disability leave and that Mark Heidenreiter illegally accessed Ash’s computer to obtain the e-mails.

Most of the e-mails dated back to 2001, and described Kurtz’s efforts to establish for Ash a tax-exempt foundation named the H.G. Ash Foundation. On May 7, 2001, Kurtz sent an e-mail to Ash stating “Hey General .... how about 30 hours at minimum wage? ? ? ? Help me figure out this insurance thing, oh, and is that 30 hours a week? or 30 hours a month? ...” Id., Ex. 17, at 13. Ash responded on the same day:

OK Sugar, let’s do this.
I will put you on our payroll as a full-time assistant to our controller, Kileen Heidenreiter. Your primary responsibility will be [sic] assist Kileen evolve our human resources objectives and document the plan.
Your initial compensation will be $2,500/ month with discretionary bonuses based on our perception of your contribution to our growth plan.
We, of course, will not expect you to work unless you feel like doing so. Your work, [sic] can further be accomplished in the convenient atmosphere of your home surroundings.
*1216 We will further consider your starting employment date to be 4/1/01, which will allow you and your dependents to enroll in our group health insurance program on 6/01/01.
You will need to visit with Kileen before 6/01 /01, and complete all of the enrollment documents. Her direct phone is 461-7305. She will be expecting your call for this purpose. For the time being let’s keep our deal between [sic] the three of us. Secondly, it’s nobody’s business but ours anyway.
Welcome to AG Equipment Sugar. We are excited about having you on our side.

Id. at 14. Based on the e-mails produced by Mark Heidenreiter, AIG initiated an investigation into Kurtz’s employment status with AG, and Marie Bott was assigned as the investigator. Bott requested from AG documents concerning Kurtz’s hiring and employment. She received a response from Dana Kurtz, Kurtz’s step-daughter, who informed Bott that she is an attorney representing AG in this matter. Bott reviewed the documents produced by AG and the e-mails, but found that this information was not sufficient to determine if Kurtz was a full-time employee of AG. Id., Ex. 21, at 2-3.

AG claimed that it had provided all information requested by AIG and demanded immediate payment of its outstanding claim for reimbursement of Kurtz’s medical expenses. Id., Ex. 22, at 2. AIG rejected AG’s demand and requested an examination under oath of Kurtz and Ash. Id. at 4. AG denied AIG’s request for examinations under oath because it claimed that Policy did not specifically authorize such examinations. AIG responded that AG’s claim for reimbursement of Kurtz’s medical expenses would be held in abeyance until AG complied with AIG’s requests for additional information. Id. at 9.

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Bluebook (online)
636 F. Supp. 2d 1210, 2009 U.S. Dist. LEXIS 58689, 2009 WL 2044773, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ag-equipment-co-v-aig-life-ins-co-inc-oknd-2009.