Alphonse M. Santino v. Provident Life and Accident Insurance Company

276 F.3d 772, 27 Employee Benefits Cas. (BNA) 1199, 2001 U.S. App. LEXIS 26926, 2001 WL 1628316
CourtCourt of Appeals for the Sixth Circuit
DecidedDecember 20, 2001
Docket00-1926
StatusPublished
Cited by41 cases

This text of 276 F.3d 772 (Alphonse M. Santino v. Provident Life and Accident Insurance Company) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Alphonse M. Santino v. Provident Life and Accident Insurance Company, 276 F.3d 772, 27 Employee Benefits Cas. (BNA) 1199, 2001 U.S. App. LEXIS 26926, 2001 WL 1628316 (6th Cir. 2001).

Opinion

OPINION

BOYCE F. MARTIN, JR., Chief Judge.

Plaintiff Alphonse M. Santino appeals the district court’s determination that the Employee Retirement Income Security Act, 29 U.S.C. § 1001 et seq. (ERISA), preempts his state law claims and its dismissal of his lawsuit as untimely. For the following reasons, we AFFIRM.

I.

Santino is a physician specializing in urology. In 1984, Santino, then one of three shareholders in Wayne-Maycomb Urology Associates P.C., applied for disability insurance from Provident Life and Accident Insurance Company. On his application, Santino listed the Wayne-Ma-comb clinic as his employer and answered “yes” to the question: “Will your employer pay for all Accident and Sickness disability coverage to be carried by you with no portion of the premium to be included in your taxable income?” Provident Life issued two disability insurance policies to Santino. Both policies provide: “No [legal] action may be brought after three years from the time written proof of loss is required to be given.” The Wayne-Ma-comb clinic paid the policies’ premiums.

In 1994, Santino suffered an illness that prevented him from providing urological patient care. He submitted disability claims under both policies. Because San-tino could still perform administrative functions at the Wayne-Macomb clinic, Provident Life classified his illness as a “residual disability.” On January 20, 1995, Provident Life informed Santino of its disability classification. Santino accepted Provident Life’s classification and began receiving “residual disability” payments.

In December 1998, Santino filed suit against Provident Life in Michigan state court, asserting for the first time that Provident Life should have considered his illness a “total disability.” Claiming that ERISA preempted Santino’s state claims, Provident Life removed the case to the Eastern District of Michigan. The district court denied Santino’s motion to remand and dismissed his lawsuit as untimely. Santino appealed.

II.

The district court’s ruling that ERISA preempts Santino’s state law claims is a legal conclusion, which this Court reviews de novo. See Agrawal v. Paul Revere Life Ins. Co., 205 F.3d 297, 299 (6th Cir.2000). ERISA regulates “employee welfare benefits plans,” which “ ‘through the purchase of insurance or otherwise’ provide ... benefits in the event of ... disability.” Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 44, 107 S.Ct. 1549, 95 L.Ed.2d 39 (1987) (quoting 29 U.S.C. § 1002(1)). Thus, ERISA applies when a “participant” entitled to benefits under an “employee benefit plan,” sues under that plan. See 29 U.S.C. §§ 1002(1) and 1002(7) (2001).

Santino argues that the policies do not constitute an “employee welfare benefit plan” because he is not an “employee” under ERISA. He further argues that his shareholder status precludes him from be *775 ing a “participant” under ERISA. As discussed below, we find that Santino is a “participant” in an “employee welfare benefit plan.”

A.

An “employee welfare benefit plan” must provide benefits to at least one employee. See 29 C.F.R. § 2510.3-3(b) (2001) (excluding from the definition of “employee welfare benefit plans” any plan “under which no employees are participants”).

ERISA defines an “employee” as “any individual employed by an employer.” 29 U.S.C. § 1002(6) (2001). In Nationwide Mutual Insurance Company v. Darden, 503 U.S. 318, 323 & n. 3, 112 S.Ct. 1344, 117 L.E.2d 581 (1992), the Supreme Court expanded on the statute’s circular definition of “employee” by incorporating common law agency criteria. It is undisputed that the Wayne-Macomb clinic is in business. Moreover, it is undisputed that Santino draws a salary from the WayneMacomb clinic, performs services for the clinic, and listed the clinic as his employer on his policy application. Therefore, absent an applicable exception, Santino is an ERISA “employee.”

Santino claims that his shareholder status and his authority within the WayneMacomb clinic make him an “employer” under ERISA, see 29 U.S.C. § 1002(5), thereby precluding him from being an ERISA “employee.” See Fugarino v. Hartford Life & Accident Ins. Co., 969 F.2d 178, 186 (6th Cir.1992) (“An ‘employee’ and ‘employer’ are plainly meant to be separate entities under ERISA.”). This Court, however, has already rejected the notion that an individual’s shareholder status and authority, without more, confer ERISA “employer” status. See Scarbrough v. Perez, 870 F.2d 1079, 1082-84 (6th Cir.1989) (finding that the sole shareholder and chief executive officer of a corporation was not an ERISA “employer” and could not be held liable for the corporation’s unpaid contribution); see also Int’l Brotherhood of Painters v. George A Kracher, Inc., 856 F.2d 1546, 1547-48 (D.C.Cir.1988) (rejecting as “foolhardy” the claim that the “chief corporate officer and principal shareholder who made all corporate decisions regarding payment of pension contributions” was an ERISA “employer”).

Santino also argues that the Department of Labor’s ERISA regulations prevent him from being an “employee.” Relying on 29 C.F.R. § 2510.3-3(e)(l), which provides that an individual “shall not be deemed [an] employee[]-with respect to a ... business ... which is wholly owned by the individual,” Santino claims that he cannot be an employee because, as a shareholder, he owns part of the Wayne-Macomb clinic.

Section 2510.3-3(c)(l), however, does not exclude joint shareholders from the ERISA definition of “employee.” On its face, the regulation applies only to “an individual” who “wholly own[s]” a business. Moreover, the Department of Labor interprets section 2510.3-3(c)(l) as applying “only where the stock of the corporation is wholly owned by one shareholder.” Op. Dep’t of Labor 76-67 (May 21, 1976) (emphasis added). Under Chevron U.S.A., Inc. v. Natural Resources Defense Council, Inc.,

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276 F.3d 772, 27 Employee Benefits Cas. (BNA) 1199, 2001 U.S. App. LEXIS 26926, 2001 WL 1628316, Counsel Stack Legal Research, https://law.counselstack.com/opinion/alphonse-m-santino-v-provident-life-and-accident-insurance-company-ca6-2001.