Bell v. Employee Security Benefit Ass'n

437 F. Supp. 382, 1 Employee Benefits Cas. (BNA) 1703, 1977 U.S. Dist. LEXIS 14360
CourtDistrict Court, D. Kansas
DecidedAugust 22, 1977
Docket77-4066
StatusPublished
Cited by53 cases

This text of 437 F. Supp. 382 (Bell v. Employee Security Benefit Ass'n) is published on Counsel Stack Legal Research, covering District Court, D. Kansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bell v. Employee Security Benefit Ass'n, 437 F. Supp. 382, 1 Employee Benefits Cas. (BNA) 1703, 1977 U.S. Dist. LEXIS 14360 (D. Kan. 1977).

Opinion

MEMORANDUM AND ORDER

ROGERS, District Judge.

This case involves an interpretation of the Employee Retirement Income Security Act of 1974 (ERISA), and comes before the Court for a decision on the merits as to plaintiff’s prayer for permanent injunctive relief. Jurisdiction is predicated upon 28 U.S.C. § 1337, and venue is proper under 28 U.S.C. § 1391(c).

Plaintiff Bell is the Commissioner of Insurance of the State of Kansas. Defendant Employee Security Benefit Association (ESBA) is an unincorporated association headquartered in Bellevue, Washington. Defendant Tresham is ESBA’s president.

ESBA is (or was until this suit was filed) soliciting agents to offer to the working people of Kansas (and other States) what it terms an “employee benefit plan”. On April 22, 1977, plaintiff filed a complaint seeking to enjoin ESBA’s activities in Kansas until ESBA complies with the statutes and regulations governing the business of insurance in Kansas. Also on April 22, 1977, this Court granted plaintiff’s request for a temporary restraining order which enjoined defendants from doing further business in Kansas until a preliminary injunction hearing could be held. On June 24, 1977, this action came before the Court for a hearing as to the merits of the action, the preliminary injunction hearing having been consolidated with the hearing on the merits pursuant to F.R.Civ.P. 65(a)(2). Despite the fact that defendants had received adequate notice of the hearing, they intentionally defaulted by failing to appear. At the hearing, plaintiff presented depositions of several of the principals of ESBA, and the Court considers the evidentiary record before it an adequate basis for the rulings which must be made.

The crux of this case involves interpretation of the provisions of ERISA, 29 U.S.C. § 1001, et seq. Plaintiff argues that defendants’ program is a program of “insurance” which is subject to regulation by the Kansas Department of Insurance. Defendants argue that ESBA’s program is not “insurance”, but an “employee benefit plan” which, under ERISA, is allegedly exempt from all state regulation.

FACTUAL BACKGROUND

ESBA’s brochure announces that ESBA is offering “A New Concept in ‘MEMBER EMPLOYEE BENEFIT PLANS’”. The brochure indicates that the program is a “Major Medical Expense and Graded Death Benefit Plan For Members and Member’s Families.” By way of further description, the brochure describes the program in these terms: “This is a Self-funded, Self-adjusting Employee Benefit Plan established under Public Law 93-406. ‘Employee Retirement Income Security Act of 1974.’ ”

Article 3, Section 1 of ESBA’s Articles of Association indicates that membership in ESBA is available to any employee in reasonably good health who has been employed in a common work unit for at least one month, and who pays a $10 membership fee.

Any fair evaluation of the product offered by ESBA must lead to the conclusion that this “employee benefit plan” is substantially similar to major medical and death benefit coverage offered by insurance companies generally. (See Quine deposition, p. 10)

The organizers of ESBA are individuals with substantial experience in the insurance field. ESBA employs insurance agents to solicit members. ESBA markets its program through D.M.A., Inc., an agency organized by two of ESBA’s officers which receives 50% of first year member contributions and Tim of contributions on renewal of the coverage. Administrative services are provided to ESBA by Benefit Services Corporation, a corporation organized by individuals with substantial ties to the organizers of ESBA. Benefit Services Corporation receives 22% of first year and renewal *385 member contributions as a fee for its services.

In Kansas ESBA has enrolled as members of its plan, individuals from a variety of occupations. For example, ESBA has enrolled a self-employed carpenter, an insurance agent, a domestic, a self-employed truck driver, a teacher’s aide, a sewer department employee of a large city, a sole proprietor, and a contractor.

The two legal issues which we feel are of primary importance to the resolution of this dispute are: (1) What is the scope of the ERISA preemption? (2) Is ESBA’s program “insurance” or an “employee benefit plan”?

I. WHAT IS THE SCOPE OF THE ERI-SA PREEMPTION?

As the culmination of long investigation and study, Congress passed the Employee Retirement Income Security Act of 1974, P.L. 93-406, codified at 29 U.S.C. § 1001 et seq. ERISA was intended to make basic reforms in the area of employee pensions and other employee benefit programs.

Congress has the power, when it desires to exercise it, to occupy a field and, under the Supremacy Clause of the Constitution, preempt application of state law. Florida Lime & Avocado Growers, Inc. v. Paul, 373 U.S. 132, 146-147, 83 S.Ct. 1210, 10 L.Ed.2d 248 (1963).

We believe that such intent is demonstrated by the wording of 29 U.S.C. § 1144:

(a) Except as provided in subsection (b) of this section, the provisions of this sub-chapter and subchapter III of this chapter shall supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan described in section 1003(a) of this title and not exempt under section 1003(b) of this title. This section shall take effect on January 1, 1975.
(b) (1) This section shall not apply with respect to any cause of action which arose, or any act or omission which occurred, before January 1, 1975.
(2)(A) Except as provided in subparagraph (B), nothing in this subehapter shall be construed to exempt or relieve any person from any law of any State which regulates insurance, banking, or securities.
(B) Neither an employee benefit plan described in section 1003(a) of this title, which is not exempt under section 1003(b) of this title (other than a plan established primarily for the purpose of providing death benefits), nor any trust established under such a plan, shall be deemed to be an insurance company or other insurer, bank, trust company, or investment company or to be engaged in the business of insurance or banking for purposes of any law of any State purporting to regulate insurance companies, insurance contracts, banks, trust companies, or investment companies.
(3) Nothing in this section shall be construed to prohibit use by the Secretary of services or facilities of a State agency as permitted under section 1136 of this title.
(4) Subsection (a) of this section shall not apply to any generally applicable criminal law of a State.

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Bluebook (online)
437 F. Supp. 382, 1 Employee Benefits Cas. (BNA) 1703, 1977 U.S. Dist. LEXIS 14360, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bell-v-employee-security-benefit-assn-ksd-1977.