Baackes v. Kaiser Foundation Health Plan, Inc.

990 F. Supp. 2d 228, 57 Employee Benefits Cas. (BNA) 1924, 2014 WL 29353, 2014 U.S. Dist. LEXIS 678
CourtDistrict Court, N.D. New York
DecidedJanuary 3, 2014
DocketNo. 1:12-CV-583 (FJS/RFT)
StatusPublished
Cited by2 cases

This text of 990 F. Supp. 2d 228 (Baackes v. Kaiser Foundation Health Plan, Inc.) is published on Counsel Stack Legal Research, covering District Court, N.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Baackes v. Kaiser Foundation Health Plan, Inc., 990 F. Supp. 2d 228, 57 Employee Benefits Cas. (BNA) 1924, 2014 WL 29353, 2014 U.S. Dist. LEXIS 678 (N.D.N.Y. 2014).

Opinion

MEMORANDUM-DECISION AND ORDER

SCULLIN, Senior District Judge.

I. INTRODUCTION

On April 4, 2012, Plaintiff filed his initial complaint against Defendants. See Dkt. No. 1. On June 4, 2012, he filed an amended complaint, in which he asserted the following eight claims under the Employee Retirement Income Security Act (“ERISA”): (1) Defendants had no basis in the Plan or documents that justified their denial of his lump sum benefit; (2) Defendants could not change their initial rationale for denial of benefits; (3) even if Defendants could change their initial rationale, the documents on which they relied were not in effect at the time of Plaintiffs employment; (4) the relevant provisions of the Plan did not exclude his service with CHP to vest and count towards accrual of his retirement benefits; (5) Defendants violated their fiduciary duties and certain obligations under ERISA; (6) he had justifiably relied on the official determination of his benefits to his detriment; (7) Defendants were estopped from changing their reasoning; and (8) the Appeals Sub-Committee’s determination was untimely and, thus, an abuse of discretion. See Dkt. No. 17, Amended Complaint at ¶¶ 44-50; 52-62; 64-66; 68-74; 76; 78-81; 83-86; 94-95. In addition, Plaintiff alleged a claim for breach of contract. See id. at ¶¶ 88-91.

Currently before the Court are Defendants’ motions for summary judgment and judgment on the pleadings, see Dkt. Nos. 23-24, and Plaintiffs cross-motion for leave to amend his amended complaint, see Dkt. No. 28.

II. BACKGROUND

Plaintiff began work for the Community Health Plan (“CHP”) on December 1, 1976. See Dkt. No. 23-3, Defendants’ Statement of Material Facts at ¶ 1. Plaintiff worked for CHP 20 years prior to its merger with Defendant Kaiser Foundation Health Plan (“Kaiser”) in August 1996. See id. at ¶ 2. On January 1, 1997, Plaintiff began work for Defendant Kaiser as President of the Kaiser Permanente Northeast Division and joined Defendants’ retirement plan. See id. at ¶ 3. On October 1, 1998, Plaintiffs employment ended with Defendant Kaiser. See id. at ¶ 4. Plaintiff advised Defendant Kaiser of his plans to retire in November 2010, and subsequently retired on February 1, 2011, shortly after his sixty-fifth birthday. See id. at ¶ 7.

Third-party administrator Aon Hewitt sent Plaintiff a Pension Calculation Statement (“December 13, 2010 letter”), in which it calculated a retirement benefit in the amount of $782,733.65. See id. at ¶ 8. In February 2011, Plaintiff received a lump sum distribution in that amount. See id. at ¶ 17. Within a month, on March 1, [233]*2332011, Plaintiff received a notice explaining the overpayment. See id. at ¶ 18. The figure to which Plaintiff was entitled according to the Overpayment Notice was $54,264.62. See id. at ¶ 19. Defendants informed Plaintiff that their initial calculation was based on an incorrect termination date of November 28, 2001, 21.87 years of Credited Service, and a final average monthly pay of $16,190.48. See id. at ¶ 17.

Defendants concede that the initial reasoning given in the Overpayment Notice was incorrect; i.e., the Notice stated it was due to Plaintiffs paying into a Defined Contribution Plan from December 1, 1976, through December 31, 1996. See id. at ¶20. On August 24, 2011, Benjamin F. Spater, counsel for Defendant Kaiser, sent a letter to Plaintiff (“August 24, 2011 Denial Letter”) explaining that, based on the provisions of the Plan, Plaintiff was entitled to a lump sum of $57,282.61, see id. at ¶ 24; he also informed Plaintiff that he had the right to appeal this decision, see id. at ¶ 28. On September 18, 2011, Plaintiff received the Plan document that was in effect when he became a participant in the Plan (“1997 Plan Document”). See id. at ¶ 29.

Plaintiff appealed the decision on November 21, 2011. See id. at ¶ 30. On April 13, 2012, Defendant Kaiser’s Appeals Sub-Committee heard Plaintiffs appeal. See id. at ¶ 32. Plaintiff, relying on Hall v. Metro. Life Ins. Co., 259 Fed.Appx. 589, 593-94 (4th Cir.2007), argued that a plan administrator was disallowed from changing its initial rationale. See id. at ¶ 45. The Sub-Committee disagreed, stating that the Plan administrator had discretion to correct a former mistake and/or add revised reasons. See id. at ¶ 46. In addition, the Sub-Committee determined that a full de novo review was unnecessary because the Plan administrator had not made any procedural errors. See id. at ¶ 48. On April 18, 2012, the Sub-Committee sent notice to Plaintiff outlining the basis for its decision to deny Plaintiffs appeal.

The Sub-Committee concluded that Plaintiff was not eligible to receive credited service for his 20-year employment at CHP. See id. at ¶ 52. The Sub-Committee also determined that the mere fact of payment was not a documentary basis for Plaintiffs entitlement to this amount. See id. at ¶ 53. In addition, the Sub-Committee addressed Plaintiffs assertion that he was never told that his previous work for CHP would count only as vesting credit for eligibility purposes, rather than benefit credit, see id. at ¶ 56, by noting that, in fact, on January 31, 1997, Defendants had sent a letter to Plaintiffs financial representative, projecting his benefits (“1997 Benefits Letter”), see id. at ¶ 57. Notably, that letter did not include Plaintiffs previous work in the calculus to project future benefits — i.e., his projection for January 1, 2002, showed “Credited Service (years)' — ■ 5.00.” See id. at ¶¶ 58-59.

Furthermore, the Sub-Committee addressed Plaintiffs concern that the August 24, 2011 Denial Letter cited the 2010 version of the Current Plan Document and Supplement, thus, regulations that were not in effect when Plaintiff worked for Defendant Kaiser in 1997, see id. at ¶ 60, by explaining that there was no difference in calculation of retirement benefits from the 1997 to the 2011 version, see id. at ¶ 61. Therefore, in recalculating the retirement benefits, the Sub-Committee determined that the total lump sum to which Plaintiff was entitled equaled $57,232.61, an amount equal to that set forth in the August 24, 2011 Denial Letter. See id. at ¶ 73.

III. DISCUSSION

A. Plaintiff’s breach-of-contract claim

Defendants have moved for judgment on the pleadings with respect to [234]*234Plaintiffs breach-of-contract claim, arguing that ERISA preempts that claim. See Dkt. No. 24. In response, Plaintiff has cross-moved for leave to amend his amended complaint to clarify his breach-of-contract claim and to substantiate his argument that ERISA does not preempt this claim. See Dkt. No. 28-1 at 5. For the reasons explained below, because ERISA does preempt Plaintiffs breach-of-contract claim, even with the proposed amendment to that claim, the Court grants Defendants’ motion for judgment on the pleadings and denies Plaintiffs cross-motion for leave to amend because the proposed amendment would be futile. See Foman v. Davis, 371 U.S. 178, 182, 83 S.Ct. 227, 9 L.Ed.2d 222 (1962) (stating that courts need not grant leave to amend if the amendment would be futile).

In Aetna Health Inc. v.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

DeCesare v. Aetna Life Insurance
95 F. Supp. 3d 458 (S.D. New York, 2015)
Halo v. Yale Health Plan
49 F. Supp. 3d 240 (D. Connecticut, 2014)

Cite This Page — Counsel Stack

Bluebook (online)
990 F. Supp. 2d 228, 57 Employee Benefits Cas. (BNA) 1924, 2014 WL 29353, 2014 U.S. Dist. LEXIS 678, Counsel Stack Legal Research, https://law.counselstack.com/opinion/baackes-v-kaiser-foundation-health-plan-inc-nynd-2014.