Estate of Coggins Ex Rel. Madis v. Wagner Hopkins, Inc.

183 F. Supp. 2d 1126, 27 Employee Benefits Cas. (BNA) 1210, 2001 U.S. Dist. LEXIS 22768, 2001 WL 1771450
District Court, W.D. Wisconsin·Decided December 13, 2001·No. 01-C-199-C·Published·Cited by 2 cases

Opinion

OPINION AND ORDER

CRABB, Chief Judge.

In this civil action for monetary and injunctive relief, plaintiff Estate of Joan Audrey Coggins, by her personal representative and daughter Kelly Sue Madis, contends that defendants Wagner Hopkins, Inc., United Wisconsin Life Insurance Co. and American Medical Security, Inc. denied coverage of Coggins’s health insurance benefits and breached their fiduciary duty in violation of the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001-1461. Jurisdiction is present under 28 U.S.C. § 1331.

In an order entered on August 3, 2001, plaintiff was granted leave to amend its original complaint in which it had asserted claims for bad faith, negligent infliction of emotional distress and violation of Wis. Admin. Code § INS 8.68 in order to state a cause of action under ERISA. In the same order, I granted defendants’ motion to dismiss plaintiffs claim for violation of § INS 8.68 on the ground that the statute does not provide a private cause of action. On August 22, 2001, plaintiff filed its amended complaint in which it recharac-terized its remaining claims under ERISA.

Presently before the court are cross-motions for summary judgment filed by plaintiff and defendants United and American. (I am disregarding the two motions for summary judgment filed by defendant Wagner and defendants American and United before plaintiff amended its complaint because they are based on the original complaint.) Because I find that defendants must pay only those medical expenses that Coggins actually incurred between the time defendants terminated her insurance coverage and the time she was able to obtain insurance through the state and that Coggins must pay a premium in order to recover those denied benefits, I will grant plaintiffs motion for summary judgment in part and grant defendants’ motion for summary judgment in part. If plaintiff chooses to pay defendants American and United $633.47 in premiums for the six-week pe *1129 riod during which Coggins did not have insurance, it may recover benefits that Coggins actually incurred during that period. In addition, because I find that defendants do not owe plaintiff a fiduciary duty under ERISA, I will grant defendants’ motion for summary judgment as to this claim. Finally, plaintiffs request for attorney fees will be denied.

From the proposed findings of fact submitted by the parties, I find the following facts to be material and undisputed.

FACTS

Plaintiff Estate of Joan Audrey Coggins is represented by Coggins’s daughter, Kelly Sue Madis. Coggins was an employee of defendant Wagner Hopkins, Inc., a Wisconsin corporation that owned and operated two bowling alleys (Wagner’s East and Wagner’s West) in Eau Claire, Wisconsin. Defendant United Wisconsin Life Insurance Co. is an insurance company providing group health insurance policies. Defendant American Medical Security, Inc. administers group health insurance plans issued by defendant United.

Coggins worked as a bartender at Wagner’s East for 22 years. In 1999, Coggins was an insured under defendant Wagner’s group health insurance policy, which provided coverage for medical and prescription drug expenses. Defendant United was the insurer of the policy and defendant American was the administrator. In June 1999, Coggins was diagnosed with cancer. In September 1999, she resigned from defendant Wagner after she learned that her cancer was terminal.

Coggins notified defendants Wagner and American that she wanted to continue her health insurance coverage by exercising her rights under the Comprehensive Omnibus Budget Rehabilitation Act and Wis. Stat. § 632.897. Defendants Wagner and American confirmed with Coggins that she was eligible to continue her health insurance coverage under COBRA and defendant American agreed to administer Coggins’s COBRA benefits. Coggins’s monthly premium for her continuation coverage was $422.31. Coggins remained current on her health insurance premiums through May 2000.

On April 30, 2000, defendant Wagner terminated its group health insurance coverage with defendants United and American. On May 15, 2000, defendant American sent Coggins a letter, stating that it had terminated her health insurance coverage effective April 30, 2000. Defendant American refunded to Coggins all premium payments made on her behalf that it had received after April 30, 2000.

At the time that Coggins received the termination of insurance letter, she was nearing the recommended peak dosage for Thalomid. After receiving the letter, Cog-gins became concerned that she could no longer afford to pay for her medical care and medication without health insurance benefits. As a result, Coggins canceled doctor’s appointments and reduced her doses of pain medication and Thalomid, a medication that slows the growth of cancerous tumors.

After defendant American notified Cog-gins that it had terminated her health insurance coverage, Coggins’s family members contacted counsel for defendant Wagner, who provided Coggins with information about the Wisconsin Health Insurance Risk Sharing Plan. Coggins applied for coverage immediately but did not receive confirmation that she was approved for the plan until June 2000, after six weeks without insurance.

On June 13, 2000, Coggins filed a complaint with the State of Wisconsin Office of the Commissioner of Insurance, stating that defendant Wagner had terminated *1130 her health insurance coverage improperly. On or about July 11, 2000, defendant American sent Coggins a letter in which it demanded payment of $1330.20 by July 31, 2000. On July 20, Coggins paid the sum. In a letter dated September 27, 2000, the Office of the Commissioner of Insurance asked defendants United and American to reinstate Coggins’s continuation coverage retroactively. In a letter to Coggins dated October 6, 2000, defendant American acknowledged that it had acted improperly in terminating her continuation under COBRA and offered to reinstate her continuation coverage retroactively. On November 3, 2000, Coggins died without having responded to defendant American’s offer of reinstatement.

OPINION

A. Summary Judgment Standard

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Estate of Coggins Ex Rel. Madis v. Wagner Hopkins, Inc., 183 F. Supp. 2d 1126, 27 Employee Benefits Cas. (BNA) 1210, 2001 U.S. Dist. LEXIS 22768, 2001 WL 1771450 (W.D. Wis. 2001).

183 F. Supp. 2d 1126 (Estate of Coggins Ex Rel. Madis v. Wagner Hopkins, Inc.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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