CONSUMER BEN. ASS'N OF US v. Lexington Ins. Co.

731 F. Supp. 1510
CourtDistrict Court, M.D. Alabama
DecidedFebruary 16, 1990
DocketCiv. A. No. 87-T-897-N
StatusPublished

This text of 731 F. Supp. 1510 (CONSUMER BEN. ASS'N OF US v. Lexington Ins. Co.) is published on Counsel Stack Legal Research, covering District Court, M.D. Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
CONSUMER BEN. ASS'N OF US v. Lexington Ins. Co., 731 F. Supp. 1510 (M.D. Ala. 1990).

Opinion

731 F.Supp. 1510 (1990)

CONSUMER BENEFIT ASSOCIATION OF the UNITED STATES, etc., Plaintiff,
v.
LEXINGTON INSURANCE COMPANY, etc., Defendant.

Civ. A. No. 87-T-897-N.

United States District Court, M.D. Alabama, N.D.

February 16, 1990.

*1511 Alvin Prestwood, Capouano, Wampold, Prestwood & Sansone, Montgomery, Ala., for plaintiff.

Sterling G. Culpepper, Jr., Balch & Bingham, Montgomery, Ala., for defendant.

ORDER

MYRON H. THOMPSON, District Judge.

With this lawsuit, the court again visits the often litigated issue of pre-emption under ERISA, the Employee Retirement Income Security Act of 1974, 29 U.S.C.A. §§ 1001-1461. The issue now before the court is whether ERISA pre-empts two state-law claims for breach of contract and fraud which arose out of a reinsurance contract. Plaintiff Consumer Benefit Association of the United States, a provider of group health insurance, has brought these two claims against its reinsurer, defendant Lexington Insurance Company. Lexington has responded with a motion for summary judgment, contending that the two claims are pre-empted. The court concludes, for reasons that follow, that ERISA does not pre-empt the two state-law claims and that thus Lexington's motion should be denied.

I. BACKGROUND

Lexington Insurance Company entered into a reinsurance agreement with Consumer Benefit Association of the United States, an association which offers group health insurance to employees of its member employers. The agreement provided that Lexington would indemnify the Association against losses exceeding $30,000 per person. According to the allegations of the complaint filed by the Association, the following then occurred: Lexington refused to cover excess losses suffered by the Association; the Association then withheld premiums; and Lexington responded by cancelling the reinsurance policy.

In its motion for summary judgment, Lexington contends, as stated, that the Association's two state-law claims of fraud and breach of contract are pre-empted by ERISA.

II. DISCUSSION

Congress passed ERISA to protect employees and their beneficiaries from the abuse and misuse of funds dedicated to finance "employee welfare benefit plans."[1] An employee welfare benefit plan includes, according to ERISA, any program that provides benefits for contingencies such as illness, accident, disability, death, or unemployment.[2] The statute contains elaborate provisions concerning reporting, disclosure, and fiduciary responsibility of such plans.[3] The Consumer Benefit Association and Lexington agree that the group health insurance *1512 plan provided by the Association is a welfare benefit plan covered by ERISA.[4]

With certain exceptions, ERISA pre-empts all state laws and claims that "relate to" an employee benefit plan covered by the statute.[5] Lexington contends that the Association's two state-law claims relate to the Association's health benefit plan and are thus pre-empted. There are, according to the Supreme Court, at least three considerations that should enter into an inquiry as to whether ERISA pre-empts a state-law claim: (1) the language of ERISA's pre-emption provision; (2) the underlying purpose of that provision; and (3) the overall objectives of ERISA itself. Fort Halifax Packing Company, Inc. v. Coyne, 482 U.S. 1, 7, 107 S.Ct. 2211, 2215, 96 L.Ed.2d 1 (1987). This court is convinced that, under the circumstances presented here, all three factors point against a finding of pre-emption.[6]

A. The Language of ERISA's Pre-emption Provision

The plain language of ERISA's pre-emption provision offers little guidance. The phrase "relate to" is too broad and imprecise to be of help outside the obvious case.[7] The court must therefore turn to how the phrase has been interpreted and applied.

1. The Language as Interpreted

The Supreme Court has stated that the words "relate to" in ERISA's pre-emption provision should be construed broadly. "[A] law `relates to' an employee benefit plan, in the normal sense of the phrase," according to the Court, "if it has a connection with or reference to such a plan." Shaw v. Delta Air Lines, Inc., 463 U.S. 85, 96-97, 103 S.Ct. 2890, 2900, 77 L.Ed.2d 490 (1983). The Court has also emphasized, however, that the pre-emption provision should be interpreted and applied with a "common sense" view of the matter. Metropolitan Life Insurance Company v. Massachusetts, 471 U.S. 724, 740, 105 S.Ct. 2380, 2389, 85 L.Ed.2d 728 (1985). Therefore, "some state actions," according to the Court, "may affect employee benefit plans in too tenuous, remote, or peripheral a manner to warrant a finding that a law `relates to' the plan," Shaw, 463 U.S. at 100 n. 21, 103 S.Ct. at 2901 n. 21. Furthermore, *1513 courts "must presume that Congress did not intend to pre-empt areas of traditional state regulation." Metropolitan Life, 471 U.S. at 740, 105 S.Ct. at 2389. This court, therefore, will follow a broad, but common sense, approach in determining whether the two state-law claims being pressed by Consumer Benefit Association "relate to," or have only a "tenuous, remote, or peripheral" impact on, the Association's benefit plan.

As stated, the Association's state-law claims arose out its reinsurance contract with Lexington. In order, therefore, to determine whether the claims which grew out of this contract relate to the Association's employee benefit plan, the court must understand the nature of the contract itself. The contract between the Association and Lexington was a traditional "stop-loss" or reinsurance contract. The contract allowed an original insurer to spread the risk of insurance and achieve greater financial stability by turning over to another insurer, the reinsurer, a portion of the risk in return for a premium. The general rule is that the contract of insurance and that of reinsurance remain totally distinct and unconnected. The reinsurance contract accords the original insured no rights against the reinsurer; rather, the insured has contractual rights against the insurer only, and any breaches between the reinsurer and insurer in no way affect the insured's entitlements under the original policy.[8] Appleman, 13A Insurance Law and Practice §§ 7681, 7693 (1976).

An insured under the Association's benefit plan, therefore, would have had no contractual rights against Lexington; and, moreover, the relationship which existed between the Association and Lexington could not be viewed as affecting the legal obligations of the Association to its insured. Lexington was, in short, a reinsurer of the Association as insurer of the plan, not of the Association's benefit plan, and Lexington therefore had no legal relationship to the plan.

To be sure, the reinsurance relationship between Lexington and the Association could be viewed as having had the potential to affect the benefit plan economically, in the sense that if the Association had become unable to pay claims the plan would have been adversely affected. But, as stated, an original insurer will usually seek reinsurance in order to shore up its own financially stability, not that of the plan. One commentator has described in some detail the reasons behind reinsurance, as follows:

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Related

Shaw v. Delta Air Lines, Inc.
463 U.S. 85 (Supreme Court, 1983)
Metropolitan Life Insurance v. Massachusetts
471 U.S. 724 (Supreme Court, 1985)
Pilot Life Insurance v. Dedeaux
481 U.S. 41 (Supreme Court, 1987)
Fort Halifax Packing Co. v. Coyne
482 U.S. 1 (Supreme Court, 1987)
MacKey v. Lanier Collection Agency & Service, Inc.
486 U.S. 825 (Supreme Court, 1988)
Firestone Tire & Rubber Co. v. Bruch
489 U.S. 101 (Supreme Court, 1989)
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Phillips v. Amoco Oil Co.
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Belasco v. W.K.P. Wilson & Sons, Inc.
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Bluebook (online)
731 F. Supp. 1510, Counsel Stack Legal Research, https://law.counselstack.com/opinion/consumer-ben-assn-of-us-v-lexington-ins-co-almd-1990.