Barrett v. Insurance Co. of North America

813 F. Supp. 798, 1993 U.S. Dist. LEXIS 1842, 1993 WL 44593
CourtDistrict Court, N.D. Alabama
DecidedFebruary 16, 1993
DocketCiv. A. No. 92-G-2879-S
StatusPublished
Cited by4 cases

This text of 813 F. Supp. 798 (Barrett v. Insurance Co. of North America) is published on Counsel Stack Legal Research, covering District Court, N.D. Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Barrett v. Insurance Co. of North America, 813 F. Supp. 798, 1993 U.S. Dist. LEXIS 1842, 1993 WL 44593 (N.D. Ala. 1993).

Opinion

MEMORANDUM OPINION

GUIN, Senior District Judge.

Security Technical Services, Inc. [hereinafter Security], established and maintained an Employee Retirement Income Security Act [hereinafter ERISA] employee welfare benefit plan1 for the purpose of providing benefits to its employees,2 including plaintiff James D. Barrett.

Among the benefits provided were those set forth under an insurance plan issued by Insurance Company of North America to the Trustees of the National Group Benefits Insurance Trust and its subscribing companies, including Security. The health and accident insurance plan, number SGA-748-313, offered accidental death and medical expense coverage. Participation in the plan was voluntary. Security’s payroll manager served as the plan administrator, and was identified as such in the summary plan description which was distributed to its employees. Security collected the full premiums3 for the plan from its employees and remitted them to Life Insurance Company of North America.

Security distributed booklets describing the plans to its employees upon the commencement of their employment. Enrollment application within 31 days of employment or the Plan effective date prompted [799]*799automatic approval. Thereafter, applicants had to provide acceptable evidence of good health in order to obtain coverage. The booklet, which bears the corporate logo, is entitled “Security Technical Services, Inc., for Full and Part Time Hourly Employees and their Dependents.”

Language in the plan summary provided to employees refers to the ERISA plan in several instances. Under the section entitled “CONTINUATION OF HEALTH COVERAGE,” the participant or his dependent is advised how to continue coverage in the event of employment termination, reduction of work hours, death of the employee, divorce or legal separation, advent of Medicare eligibility, loss of a dependent’s eligibility, or loss of coverage for retired employees and eligible dependents due to the employer’s filing for Chapter 11 Bankruptcy.4 The language following the itemization of qualifying events is set forth below:

* In these cases, the employee or eligible dependent is responsible for notifying the “ERISA” Plan Administrator or employer within 60 days after the later of (a) the date of the qualifying event or (b) the date the employee would lose coverage on account of the qualifying event. If the “ERISA” Plan Administrator is not so notified, the dependent will not be given the opportunity to continue coverage.
The “ERISA” Plan Administrator or Employer must, within 14 days of notification of a qualifying event, advise the employee or eligible dependent of the right to continue medical coverage....

Further on, while discussing disability, the participant is advised that in the case of disability, notice of disability must be provided to the ERISA Plan Administrator or the Employer. The same notification is required when the participant is no longer considered disabled. “[T]he ERISA Plan Administrator or Employer must be notified within thirty days of the date a final determination is made that the individual is no longer disabled for purposes of the Social Security Act.”

Page seven of the summary devotes six paragraphs to the rights of employees under ERISA. Pertinent language follows:

STATEMENT OF ERISA RIGHTS
As a participant in the employee benefit plans of the employer, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (“ERISA”). ERISA provides that all plan participants shall be entitled to:
IMPORTANT INFORMATION ABOUT YOUR COVERAGE
Please keep this packet in a safe place after you- have read it. All of the features of your coverage are fully explained in this Plan description,- but if you have some questions please ask your supervisor. This is the Summary Plan Description, required by the Employee Retirement Income Security Act of 1974 (ERISA). A full disclosure of your ERISA rights is printed above____

Pursuant to the offerings provided by the Plan, plaintiff James D. Barrett entered into a contract of medical insurance with the defendants on August 1, 1991. Language of the “PRE-EXISTING CONDITIONS" paragraph of the policy issued to Mr. Barrett states, in bold print, the following:

We will not pay benefits for a condition for which a Covered Person received medical treatment, care or advice within 6 months before being covered under this policy. This does not apply if either:
a) he has received no such treatment, care or advice for that condition for 6 straight months after being covered under this policy; or
b) he has been covered under this policy for 12 months.

On October 3, 1991, plaintiff. Shawn E. Barrett underwent surgery in Jefferson County, Alabama, and incurred medical, hospital and doctor bills. Defendants denied the claims and refused payment. [800]*800Plaintiffs thereafter, on November 3, 1992, in the Circuit Court of Jefferson County, Alabama, sued for embarrassment, emotional stress, and mental anguish resulting from the breach of contract.

Defendants removed the case to this court and filed a motion to dismiss on December 14, 1992, on the grounds that the plaintiff’s complaint failed to state a claim on which relief could be granted and that ERISA preempted all of plaintiff’s state law claims.

On December 21, 1992, plaintiffs filed an amended complaint adding ERISA counts as alternatives to the first two counts.

In opposing defendants’ motion to dismiss, plaintiffs have contended that the medical insurance policy in question is exempted from employee welfare benefit plans pursuant to 29 C.F.R. 2510.3 — l(j). The Department of Labor Regulations provide that the term- “employee welfare benefit plan” exempts plans under which

(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 or 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 dues checkoffs.

29 C.F.R. 2510.3-l(j).

There is no doubt that the first, second, and fourth criteria listed above apply to Security’s plan. . Security made no contribution to the program, participation in the program was voluntary, and Security received no compensation in connection with the program.

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Related

Ackerman v. Fortis Benefits Insurance
254 F. Supp. 2d 792 (S.D. Ohio, 2003)

Cite This Page — Counsel Stack

Bluebook (online)
813 F. Supp. 798, 1993 U.S. Dist. LEXIS 1842, 1993 WL 44593, Counsel Stack Legal Research, https://law.counselstack.com/opinion/barrett-v-insurance-co-of-north-america-alnd-1993.