American Council of Life Insurers v. Ken Ross

Court of Appeals for the Sixth Circuit·Decided March 18, 2009·No. 08-1406·Published

Opinion

RECOMMENDED FOR FULL-TEXT PUBLICATION Pursuant to Sixth Circuit Rule 206 File Name: 09a0107p.06

UNITED STATES COURT OF APPEALS FOR THE SIXTH CIRCUIT

X

AMERICA’S HEALTH INSURANCE PLANS; LIFE - AMERICAN COUNCIL OF LIFE INSURERS;

-

INSURANCE ASSOCIATION OF MICHIGAN, -

Plaintiffs-Appellants, -

No. 08-1406

, > - -

v.

- -

KEN ROSS, Acting Commissioner of the Office of Financial and Insurance Services, -

- -

Michigan Department of Labor and

Defendant-Appellee. -

Economic Growth,

N

Appeal from the United States District Court for the Western District of Michigan at Grand Rapids.

No. 07-00631—Richard A. Enslen, District Judge.

Argued: January 13, 2009

Decided and Filed: March 18, 2009 Before: MERRITT, COLE, and SUTTON, Circuit Judges.

COUNSEL

ARGUED: Edward A. Scallet, GROOM LAW GROUP, Washington, D.C., for Appellants. William A. Chenoweth, MICHIGAN DEPARTMENT OF ATTORNEY GENERAL, Lansing, Michigan, for Appellee. ON BRIEF: Edward A. Scallet, GROOM LAW GROUP, Washington, D.C., for Appellants. William A. Chenoweth, MICHIGAN DEPARTMENT OF ATTORNEY GENERAL, Lansing, Michigan, Michael P. Farrell, OFFICE OF THE MICHIGAN ATTORNEY GENERAL, Lansing, Michigan, for Appellee. Meir Feder, JONES DAY, New York, New York, Mary Ellen Signorille, AARP FOUNDATION LITIGATION, Washington, D.C., for Amici Curiae.

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OPINION

COLE, Circuit Judge. Defendant-Appellee Ken Ross is the Commissioner (“Commissioner”) of the Michigan Office of Financial and Insurance Services (“OFIS”). Under OFIS’s authority to regulate insurance, it promulgated rules, Mich. Admin. Code Rules 500.2201-500.2202 and 550.111-550.112, prohibiting insurers from issuing, delivering, or advertising insurance contracts or policies that contain “discretionary clauses” (the “rules”). Such clauses provide that courts will give deference to a plan administrator’s decision to award or deny benefits or interpretation of plan terms in any court proceeding challenging such decisions or interpretations. Plaintiffs-Appellants American Council of Life Insurers, America’s Health Insurance Plans, and Life Insurance Association of Michigan (collectively, “Insurance Industry”) filed suit, seeking declaratory and injunctive relief to prevent OFIS from enforcing the rules. Both parties moved for summary judgment, with the Insurance Industry arguing that the rules are preempted by the Employee Retirement Income Security Act of 1974 (“ERISA”), as amended, 29 U.S.C. § 1001 et seq. The district court concluded that because the rules constitute laws regulating insurance under ERISA’s savings clause, ERISA § 514(b)(2)(A), 29 U.S.C. § 1144(b)(2)(A), they are not preempted by ERISA, and granted summary judgment in favor of the Commissioner. The Insurance Industry appealed. For the following reasons, we conclude that Michigan’s rules fall within the ambit of ERISA’s savings clause insofar as they are state laws regulating insurance, and thus are not preempted by ERISA.

I. BACKGROUND

A. Background of the Rules

The parties stipulated to the following pertinent facts for the purpose of the crossmotions for summary judgment. (Stip. Facts, Joint Appendix (“JA”) 44.)

OFIS is responsible for licensing, examining, and supervising insurers and nonprofit health-care corporations doing business in the State of Michigan. To this end, OFIS’s authority includes the power to disapprove insurance policy forms, and documents associated

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with such forms, which are filed by insurers and nonprofit health-care corporations doing business in Michigan. Pursuant to this authority, OFIS promulgated administrative rules, Mich. Admin. Code Rules 500.2201-500.2202 and 550.111-550.112, which generally prohibit insurers and nonprofit health-care corporations from issuing, advertising, or delivering to any person in Michigan, a policy, contract, rider, indorsement, certificate, or similar contract document that contains a discretionary clause and provide that any such clause is void and of no effect. The rules define discretionary clauses as:

[A] provision in a form that purports to bind the claimant to or grant deference in subsequent proceedings to the insurer’s decision, denial, or interpretation on terms, coverage, or eligibility for benefits including, but not limited to, a form provision that does any of the following: (i) Provides that a policyholder or other claimant may not appeal a denial of a claim. (ii) Provides that the insurer’s decision to deny policy coverage is binding upon a policyholder or other claimant. (iii) Provides that on appeal the insurer’s decision-making power as to policy coverage is binding. (iv) Provides that the insurer’s interpretation of the terms of a form is binding upon a policyholder or other claimant. (v) Provides that on appeal the insurer’s interpretation of the terms of a form is binding. (vi) Provides that or gives rise to a standard of review on appeal that gives deference to the original claim decision. (vii) Provides that or gives rise to a standard of review on appeal other than a de novo review.

Mich. Admin. Code Rules 500.2201 (b) and 550.111(c).

The rules took effect June 1, 2007. Given that employee-benefit plans established or maintained under ERISA commonly contain discretionary clauses, the rules would prohibit any entity covered by them from “issuing, advertising, or delivering to any person in the State of Michigan, including an employee benefit plan subject to ERISA, an underwritten policy or certificate that includes a discretionary clause.” (JA 46.)

Plaintiffs American Council of Life Insurers and America’s Health Insurance Plans are national trade associations representing health plans, health insurers, and life insurers that conduct business in Michigan. Both trade associations “advocate public policies on behalf of their members in legislative, regulatory, and judicial forums at the state and federal levels.” (JA 47.) Their members offer a variety of insurance products, including “health

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care coverage, medical expense insurance, long-term care insurance, disability income insurance, [and] dental insurance.” (Id.) Plaintiff Life Insurance Association of Michigan represents life insurance companies licensed in Michigan that provide similar insurance products to Michigan customers that sponsor employee benefit plans subject to ERISA.

Because the Insurance Industry is subject to certain rules promulgated by OFIS, the Insurance Industry “would be affected if the [r]ules are upheld because some of their members have in the past used policy forms approved by OFIS that had discretionary clauses and the members may wish to use such clauses in future policy forms submitted to OFIS.” (JA 48.) Similarly, many of the customers of the Insurance Industry’s members “ would be affected if the [r]ules are upheld because they have also purchased OFIS approved policies containing discretionary clauses to fund their employee benefit plans, and many may wish to do so again in the future.” (Id.)

B. Procedural Background

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