Clayton Group Services, Inc. v. First Allmerica Financial Life Insurance

166 F. Supp. 2d 566, 26 Employee Benefits Cas. (BNA) 2830, 2001 U.S. Dist. LEXIS 16052, 2001 WL 1172751
CourtDistrict Court, E.D. Michigan
DecidedSeptember 28, 2001
Docket2:00-cv-74486
StatusPublished
Cited by2 cases

This text of 166 F. Supp. 2d 566 (Clayton Group Services, Inc. v. First Allmerica Financial Life Insurance) is published on Counsel Stack Legal Research, covering District Court, E.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Clayton Group Services, Inc. v. First Allmerica Financial Life Insurance, 166 F. Supp. 2d 566, 26 Employee Benefits Cas. (BNA) 2830, 2001 U.S. Dist. LEXIS 16052, 2001 WL 1172751 (E.D. Mich. 2001).

Opinion

OPINION AND ORDER GRANTING DEFENDANTS’ MOTIONS TO DISMISS AND FOR SUMMARY JUDGMENT

ROSEN, District Judge.

I. INTRODUCTION

This action arises out of a dispute between Plaintiff Clayton Group Services, Inc. (“Clayton”) and Defendants First Allmerica Financial Life Insurance Company (“First Allmerica”), Robert Schechter & Associates (“Schechter”), and Group Perks, Inc. (“Group Perks”) concerning the calculation of premiums charged by First Allmerica on a group health insur-anee policy issued to Clayton. Schechter and Group Perks are insurance agencies that have served as Clayton’s agents concerning insurance, financial and employee benefits matters.

On June 29, 1999 Plaintiff sued these same Defendants in Michigan state court. Plaintiffs state court complaint alleged verbatim three of the four claims alleged by Plaintiff in the instant action: misrepresentation, breach of contract, and negligence. [Compare Counts I, II and III of Plaintiffs Complaint in this action with Plaintiffs state court complaint, Defendants Group Perks/Schechter’s Brief, Ex. E.] 1 On February 9, 2000, Oakland County Circuit Judge Steven Andrews granted Defendant First Allmerica’s motion for summary disposition in the state court action and dismissed Plaintiffs claims against this defendant. Then, on March 28, 2000, the Oakland County Circuit Court granted Defendants’ Schechter’s and Group Perks’ motion for summary disposition, and entered a judgment of dismissal on the merits in favor of all the Defendants. Plaintiff filed an appeal of right with the Michigan Court of Appeals. 2

Meanwhile, after the Oakland County Circuit Court rendered its decision dismissing Plaintiffs state court complaint and during the pendency of Plaintiffs state appeal to the Michigan Court of Appeals, Plaintiff filed the instant action in this Court.

Defendants now have moved for summary judgment and dismissal of Plaintiffs Complaint in its entirety on res judicata and/or Rooker-Feldman grounds. Plaintiff has responded to Defendants’ motions *569 and has also cross-moved for summary judgment in its favor. Having reviewed and considered the parties’ motions, briefs and supporting documents the Court has determined that oral argument is not necessary. Therefore, pursuant to Eastern District of Michigan Local Rule 7.1(e)(2), this matter will be decided “on the briefs.” This Opinion and Order sets forth the Court’s ruling.

II. FACTUAL BACKGROUND

Plaintiff Clayton Group Services, Inc. is an environmental safety consulting company with approximately 500 employees throughout the United States. As of January 1, 1997, Plaintiffs employees were insured under a group health care policy issued by First Allmerica. Because of its significant claims history, Plaintiffs premiums with First Allmerica for policy year 1998 would have been substantially larger that those which Plaintiff paid in 1997. Plaintiff, therefore, decided to examine the possibility of switching health care programs, and consulted Group Perks/Schechter, who investigated the availability of HMO coverage. Because of logistical problems presented by Plaintiffs far-reaching operations, it was determined that it would be impossible to enroll all of Plaintiffs employees into an HMO plan before the termination of the First Allmer-ica plan. Therefore, certain employees were left on the First Allmerica policy until their HMO policies could be put into effect.

Plaintiff and Group Perks/Schechter were concerned about the effect that leaving employees on the First Allmerica policy would have on the premium that First Allmerica would charge. At Plaintiffs request, Group Perks/Schechter contacted First Allmerica. According to Plaintiff, Peter Mendler of Group Perks/Schechter and Joseph Graham, the sales manager of First Allmerica discussed the language of the Group Policy, and Mr. Graham erroneously stated that the maximum premium for any given month was based on the number of Plaintiffs employees covered under the plan that month. Thus, Mr. Mendler was assured that Plaintiff would only be charged for the employees that were left on the First Allmerica plan. [See Mendler Dep., Plaintiffs Ex. B, pp. 28-29.]

Based on these assurances, Plaintiff alleges that it switched the majority of its employees to separate insurance contracts with HMOs in February 1998. However, First Allmerica still charged Clayton premiums reflecting coverage for the employees that had been switched to HMOs. Plaintiff subsequently learned that premiums for the First Allmerica policy were actually determined on a three-month “lag” time, i.e., based on the number of employees that were covered under the plan in the third preceding month, not how many employees were currently covered under the plan. Plaintiff asked Allmerica to refund what it considered to be an overcharge of $113,304.78, reflecting premiums it was charged for employees no longer covered under the First Allmerica policy, but this'request was refused.

THE STATE COURT ACTION

When First Allmerica refused to reimburse Plaintiff for the alleged overcharge, Plaintiff filed suit in Oakland County Circuit Court, alleging that First Allmerica “carelessly, negligently and/or purposely” misled Plaintiff regarding “the interpretation of the Group Policy to the detriment of the Plaintiff.” Plaintiff further alleged that First Allmerica breached the insurance contract by violated the policy provisions concerning the requisite notice for premium rate increases. Plaintiff also asserted claims of negligence and misrepresentation against its agent Group Perks/Schechter based upon Peter Men- *570 dler’s alleged misinterpretation of the premium provisions of the policy.

After the completion of substantial discovery in the state court case, the Circuit Court granted Defendants’ motions for summary disposition. The state court found that “Plaintiffs cause of action stems from the terms of the Plan regarding the monthly claim limit and the rate notice provision,” and that “plaintiffs claims [against First Allmerica’] have their genesis in the Plan.” Therefore, the state judge held that Plaintiffs claims were preempted by ERISA. [See Plaintiffs Brief, Ex. F.] The court subsequently granted Group Perks/Schechter’s motion for summary disposition on the same grounds that it granted First Allmerica’s motion, finding that Plaintiffs negligence and misrepresentation claims against these Defendants were sufficiently related to an ERISA Plan to be preempted. [See Group Perks/Sehechter Brief, Ex. G.] Plaintiff also filed a motion for reconsideration and/or clarification asking the state court to declare that, because its decision was predicated upon ERISA preemption, it was not a ruling “on the merits.” Judge Andrews refused to so modify or clarify his prior rulings and, instead, specifically held that his rulings “constituted a dismissal on the merits of Plaintiffs state claims....” Id. at p. 4. Plaintiff appealed Judge Andrews’ decisions to the Michigan Court of Appeals. That appeal is still pending.

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166 F. Supp. 2d 566, 26 Employee Benefits Cas. (BNA) 2830, 2001 U.S. Dist. LEXIS 16052, 2001 WL 1172751, Counsel Stack Legal Research, https://law.counselstack.com/opinion/clayton-group-services-inc-v-first-allmerica-financial-life-insurance-mied-2001.