David F. Alexander v. Anheuser-Busch Companies, Inc. Anheuser-Busch Long Term Disability Income Insurance Plan

990 F.2d 536, 17 Employee Benefits Cas. (BNA) 1425, 1993 U.S. App. LEXIS 6715, 1993 WL 92438
CourtCourt of Appeals for the Tenth Circuit
DecidedApril 1, 1993
Docket92-6039
StatusPublished
Cited by54 cases

This text of 990 F.2d 536 (David F. Alexander v. Anheuser-Busch Companies, Inc. Anheuser-Busch Long Term Disability Income Insurance Plan) is published on Counsel Stack Legal Research, covering Court of Appeals for the Tenth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
David F. Alexander v. Anheuser-Busch Companies, Inc. Anheuser-Busch Long Term Disability Income Insurance Plan, 990 F.2d 536, 17 Employee Benefits Cas. (BNA) 1425, 1993 U.S. App. LEXIS 6715, 1993 WL 92438 (10th Cir. 1993).

Opinion

WESLEY E. BROWN, Senior District Judge.

Plaintiff-appellant David F. Alexander appeals the district court’s entry of judgment in favor of Anheuser-Busch Companies, Inc. (Anheuser-Busch), and Anheuser-Busch Long Term Disability Income Insurance Plan (Plan), denying his claims brought pursuant to the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001-1461 (ERISA). He also appeals the dismissal of his state law claim for breach of the covenant of good faith and fair dealing in an insurance contract. Because we hold that the district court lacked jurisdiction to decide Alexander’s claims, we vacate the judgment and remand with directions to dismiss the complaint. 1

Alexander was employed as a plant supervisor for a wholly owned subsidiary of Anheuser-Busch from July 1982 until March 1989. Alexander was diagnosed with coronary heart disease in 1985, underwent triple bypass surgery in 1986, was diagnosed with kidney disease in 1986 and diabetes in 1987, and was hospitalized for diabetes mellitus in May 1988. Because of his poor health, Alexander was not able to obtain long-term disability insurance.

On June 6, 1988, Anheuser-Busch sent a letter to all employees not. currently enrolled in a long-term disability plan, announcing the opportunity to join a new plan. The letter explained that coverage might be limited during the first twelve months for certain conditions, stating “[bjenefits are unavailable for disabilities occurring during the first twelve months of coverage caused by a condition that developed within a three month period prior to the effective date of the new coverage.” Appellant’s App. at 101. The new plan *538 went into effect July 1, 1988. Because Alexander’s conditions had developed more than three months prior to that date, he applied for coverage and began paying premiums.

Although the introductory letter mentioned that a summary plan description would follow, such description was not sent to employees until a year and a half later. The letter also directed participants to contact two named individuals if they had further questions. Alexander never contacted these individuals to determine whether his conditions were covered by the plan.

In March 1989, Alexander’s physician recommended that he take medical leave due to his poor health. Alexander contacted the human resources director at his plant and requested a copy of the long-term disability insurance policy. The human resources director led Alexander to believe that the policy was unavailable because the language was not yet agreed upon. In fact, it was the summary plan description which had not yet been printed. The actual policy was available from the effective date of the plan.

Believing that his conditions were covered, Alexander took medical leave and applied for benefits. Alexander’s claim was denied because his disability was caused by a preexisting condition, and because he was not sufficiently disabled. The policy defined “preexisting condition” as “a sickness or injury for which you received medical treatment, consultation, care or services including diagnostic measures, or had taken prescribed drugs or medicines in the three months prior to your effective date.” Id. at 75. Because Alexander had been treated for diabetic kidney disease during this time period, his condition was excluded under the policy definition.

Alexander attempted to return to work but was not permitted to do so because he could not obtain a full medical release. Even after obtaining such a release in October 1989, Anheuser-Busch rejected his application on the ground that there were no positions available. Since then, Alexander has worked as a cashier and an apprentice electrician’s helper.

Alexander brought suit against Anheu-ser-Busch, as Plan administrator, and against the Plan itself, alleging several causes of action: (1) a state law claim for breach of the covenant of good faith and fair dealing in an insurance contract; (2) an action for benefits pursuant to ERISA, based on the employer’s misrepresentations; and (3) an ERISA action for breach of fiduciary duty, based on the employer’s misrepresentations and failure to provide information. The district court dismissed the state law claim, finding it preempted by ERISA. After trial, the court held in favor of Anheuser-Busch and the Plan on the ERISA claims, finding that Alexander’s diabetic condition was preexisting and thus not covered by the long-term disability plan. This appeal followed.

In reviewing Alexander’s ERISA claims, we raise, sua sponte, the question whether he has standing to bring such claims. The issue of standing is jurisdictional in nature. Western Nuclear, Inc. v. Huffman, 825 F.2d 1430, 1435 (10th Cir.1987), rev’d on other grounds, 486 U.S. 663, 108 S.Ct. 2087, 100 L.Ed.2d 693 (1988); Citizens Concerned for Separation of Church & State v. City & County of Denver, 628 F.2d 1289, 1294 (10th Cir.1980), cert. denied, 452 U.S. 963, 101 S.Ct. 3114, 69 L.Ed.2d 975 (1981). Whether or not raised by the parties, we are obligated to satisfy ourselves as to our own jurisdiction at every stage of the proceeding. Western Nuclear, 825 F.2d at 1434; Citizens, 628 F.2d at 1301; see also Bender v. Williamsport Area Sch. Dist., 475 U.S. 534, 541, 106 S.Ct. 1326, 1331, 89 L.Ed.2d 501 (1986). This obligation extends to an examination of the district court’s jurisdiction as well. Id.

Pursuant to 29 U.S.C. § 1132, a “participant” has standing to bring a civil action to enforce his rights under the terms of an ERISA plan or to enforce ERISA’s provisions. 2 Raymond v. Mobil Oil Corp., *539 983 F.2d 1528, 1532 (10th Cir.1993). To be a “participant,” a plaintiff must either be (1) an employee in, or reasonably expected to be in, currently covered employment; (2) a former employee with a reasonable expectation of returning to covered employment; (3) a former employee with a colorable claim that he will prevail in a suit for benefits; or (4) a former employee with a colorable claim that eligibility requirements will be fulfilled in the future. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 117-18, 109 S.Ct. 948, 957-58, 103 L.Ed.2d 80 (1989); Raymond, 983 F.2d at 1532-33; 29 U.S.C. § 1002(7).

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990 F.2d 536, 17 Employee Benefits Cas. (BNA) 1425, 1993 U.S. App. LEXIS 6715, 1993 WL 92438, Counsel Stack Legal Research, https://law.counselstack.com/opinion/david-f-alexander-v-anheuser-busch-companies-inc-anheuser-busch-long-ca10-1993.