Alloco v. Metropolitan Life Insurance

256 F. Supp. 2d 1023, 2003 U.S. Dist. LEXIS 11664, 2003 WL 1821522
CourtDistrict Court, D. Arizona
DecidedMarch 31, 2003
DocketCIV.01-2220-PHX-ROS
StatusPublished
Cited by2 cases

This text of 256 F. Supp. 2d 1023 (Alloco v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Arizona primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Alloco v. Metropolitan Life Insurance, 256 F. Supp. 2d 1023, 2003 U.S. Dist. LEXIS 11664, 2003 WL 1821522 (D. Ariz. 2003).

Opinion

ORDER

SILVER, District Judge.

Pending before the Court is Defendant’s Motion for Partial Summary Judgment on All Claims Relating to Long Term Disability Benefits [Doc. # 19], filed March 15, 2002. Plaintiff submitted a Response [Doc. # 25] on April 22, 2002, and Defendant filed a Reply on May 17, 2002 [Doc. #27], For the following reasons, partial summary judgment will be granted for *1026 Defendant on Plaintiffs claims relating to long term disability benefits. 1

I. Facts

The following facts are not in dispute. At all relevant times, Plaintiff Cynthia Al-locco was employed as a telephone service center representative at American Express Travel Related Services, Inc. (“AMEX”). Defendant’s Statement of Facts (“SOF”) ¶ 1. Plaintiff was eligible, as an employee, for benefits under AMEX’s group insurance benefit program (“benefits plan”). SOF ¶ 2. Relevant parts of the plan are administered by Defendant, Metropolitan Life Insurance Company. SOF ¶ 3. The benefit plan provided life insurance and business travel accident insurance to employees at AMEX’s expense. SOF ¶ 8. The benefit plan also allowed certain employees, including Plaintiff, to enroll in a plan for long-term disability benefits (“LTD”) at their own expense. SOF ¶¶ 3-6. Plaintiff paid premiums on her LTD coverage under the benefit plan. SOF ¶ 7.

In 2000 and 2001, Plaintiff and Defendant engaged in a series of disputes related to Plaintiffs alleged development of fibromyalgia and her subsequent requests for benefits. On May 9, 2000, Plaintiff submitted a claim for salary continuation benefits to AMEX. SOF ¶ 12. Defendant denied this application for benefits on June 20, 2000. SOF ¶ 13. On July 24, 2000, Plaintiff filed an administrative appeal with Defendant in accordance with the provisions of the benefit plan, and the appeal was denied on July 24, 2000. SOF ¶ 14. On about January 29, 2001, Plaintiff contacted Defendant and applied for LTD benefits due to her fibromyalgia. SOF ¶ 17. Defendant denied Plaintiffs claim for LTD benefits in a letter dated September 12, 2001. SOF ¶ 19, Exh. G to SOF. That letter informed Plaintiff that she could appeal the denial of her claim for LTD benefits within 60 days of receiving the notice of denial. SOF ¶ 20, Exh. G to SOF.

Plaintiff, however, never filed an appeal of the denial of her LTD benefits. SOF ¶ 21. On October 16, 2001, Plaintiff filed suit in state court, alleging claims for breach of contract and bad faith under state law. SOF ¶ 22, Exh. B to Notice of Removal. The state law suit was then removed to federal court on Nov. 14, 2001 (Doc. # 1). Defendant contends that her failure to appeal the denial of LTD benefits is dispositive of any claim based on LTD benefits.

II. Discussion

As an initial matter, Defendant contends that Plaintiffs LTD benefit plan is covered by the Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. §§ 1001-1461 (ERISA), and that Plaintiffs state law claims for LTD benefits are preempted by ERISA. Concomitantly, Defendant contends that Plaintiff failed to exhaust her administrative appeals pursuant to ERISA, requiring that her claim for LTD benefits be dismissed.

Three issues must be resolved: first, whether the LTD plan is covered by ERISA; second, whether ERISA preempts Plaintiffs state law causes of action; and third, if her claims are governed by ERISA, whether Plaintiff has *1027 failed to exhaust her remedies under ERISA.

A. Is the plan covered by ERISA?

Whether Plaintiffs LTD benefit plan is an “employee benefit plan” is defined by ERISA. “ERISA defines an ‘employee benefit plan’ to include, among others, ‘any plan, fund, or program ... estáblished or maintained by an employer ... for the purpose of providing for its participants or their beneficiaries, through the purchase of insurance ... medical, surgical, or hospital care or benefits.” Stuart v. UNUM Life Ins. Co. of America, 217 F.3d 1145, 1149 (9th Cir.2000) (quoting Qualls ex rel. Qualls v. Blue Cross of California, Inc., 22 F.3d 839, 843 (9th Cir.1994); 29 U.S.C. §§ 1002(1), (3)). Also, “[t]he existence of an ERISA plan is a question of fact, to be answered in light of all the surrounding circumstances from the point of view of a reasonable person.” Stuart, 217 F.3d at 1149 (quoting Zavora v. Paul Revere Life Ins. Co., 145 F.3d 1118, 1120 (9th Cir.1998)).

A benefit plan can fall outside the coverage scope of ERISA if it meets the four requirements under the Department of Labor’s “safe harbor” regulation, 29 C.F.R. § 2510.3 — l(j). These four requirements are:

(1) No contributions are made by an employer or employee organization;
(2) Participation in the program is completely voluntary for employees or members;
(3) The sole functions of the employer of employee organization with respect to the program are, without endorsing the program, to permit the insurer to publicize the program to employees or members, to collect premiums through payroll deductions or dues checkoffs and to remit them to the insurer; and
(4) The employer or employee organization receives no consideration in the form of cash or otherwise in connection with the program, other than reasonable compensation, excluding any profit, for administrative services actually rendered in connection with payroll deductions or due checkoffs.

Id.; Stuart, 217 F.3d at 1149. See also The Meadows v. Employers Health Ins., 826 F.Supp. 1225, 1228 (D.Ariz.1993). Moreover, “an employer’s failure to satisfy just one requirement of the safe harbor regulation conclusively demonstrates that an otherwise qualified group insurance plan is an employee welfare benefit plan under ERISA.” Stuart, 217 F.3d at 1151-2. See also The Meadows, 826 F.Supp. at 1228 (“behavior inconsistent with any one of the four criteria constitutes evidence of the establishment of an ERISA plan”).

In this case, Plaintiff contends that her LTD benefit plan was not covered by ERISA. Plaintiff notes that she paid her own premiums on the LTD benefit plan, and participation was voluntary, which meets at least the first two prongs of the safe harbor requirement. Plaintiffs argument fails, however, for two reasons. First, the LTD benefit plan cannot be viewed in isolation from the overall benefit plan provided by AMEX, which clearly is an ERISA plan. Second, the LTD plan does not meet the requirements of the third prong of the safe harbor regulation.

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Bluebook (online)
256 F. Supp. 2d 1023, 2003 U.S. Dist. LEXIS 11664, 2003 WL 1821522, Counsel Stack Legal Research, https://law.counselstack.com/opinion/alloco-v-metropolitan-life-insurance-azd-2003.