Foster v. Blue Cross and Blue Shield of Michigan

969 F. Supp. 1020, 21 Employee Benefits Cas. (BNA) 1450, 1997 U.S. Dist. LEXIS 8823, 1997 WL 348474
CourtDistrict Court, E.D. Michigan
DecidedJune 23, 1997
Docket95-70501
StatusPublished
Cited by7 cases

This text of 969 F. Supp. 1020 (Foster v. Blue Cross and Blue Shield of Michigan) 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
Foster v. Blue Cross and Blue Shield of Michigan, 969 F. Supp. 1020, 21 Employee Benefits Cas. (BNA) 1450, 1997 U.S. Dist. LEXIS 8823, 1997 WL 348474 (E.D. Mich. 1997).

Opinion

MEMORANDUM OPINION AND ORDER GRANTING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT AND DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT

EDMUNDS, District Judge.

This matter comes before the Court on cross motions for summary judgment. Defendant filed its motion on April 15, 1997, claiming that all of Plaintiffs state law claims are preempted by ERISA. Plaintiff concedes that most of his state law claims are preempted. However, he seeks summary judgment on his claim under the Nonprofit Health Care Corporation Reform Act, Michigan Handicapper’s Civil Rights Act, and in the alternative, under ERISA. For the reasons stated below, this Court finds that all of Plaintiff’s claims are preempted py ERISA, with the exception of a claim under portions of the Nonprofit Health Care Corporation Act. The Court also finds that Defendant is entitled to summary judgment on that remaining claim and on any claim under ERISA.

*1023 I. Facts

Plaintiff Lance Foster is suing personally and as the personal representative of the estate of his wife, Shelly Foster. Mrs. Foster was diagnosed with breast cancer, and in August of 1992, her physician prescribed high-dose chemotherapy with peripheral stem cell rescue and autologous bone marrow transplantation. Mrs. Foster had health insurance through Defendant Blue Cross. Blue Cross refused to pay for this treatment, claiming that it was experimental or investigational in nature and it was excluded under policy Riders BMT and GLE-1. After Blue Cross denied the request for payment, Mrs. Foster did not receive the treatment and died. Her husband brought suit against Blue Cross under a number of different state law theories. Blue Cross removed this case based on a federal question under ERISA.

II. Standard for Summary Judgment

Summary judgment is appropriate only when there is no genuine issue as to any material fact and the moving party is entitled to judgment as a matter of law. Fed. R.Civ.P. 56(e). The central inquiry is “whether the evidence presents a sufficient disagreement to require submission to a jury or whether it is so one-sided that one party must prevail as a matter of law.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 251-52, 106 S.Ct. 2505, 2512, 91 L.Ed.2d 202 (1986). After adequate time for discovery and upon motion, Rule 56(c) mandates summary judgment against a party who fails to establish the existence of an element essential to that party’s ease and on which that party bears the burden of proof at trial. Celótex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 2552, 91 L.Ed.2d 265 (1986).

The movant has an initial burden of showing “the absence of a genuine issue of material fact.” Celotex, 477 U.S. 317, 323, 106 S.Ct. 2548, 2553. Once the movant meets this burden, "the non-movant must come forward with specific facts showing that there is a genuine issue for trial. Matsushita Electric Industrial Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 587, 106 S.Ct. 1348, 1356, 89 L.Ed.2d 538 (1986). To demonstrate a genuine issue, the non-movant must present sufficient evidence upon which a jury could reasonably find for the non-movant; a “scintilla of evidence” is insufficient. Liberty Lobby, 477 U.S. at 252, 106 S.Ct. at 2512.

The court must believe the non-movant’s evidence and draw “all justifiable inferences” in the non-movant’s favor. Liberty Lobby, 477 U.S. at 255, 106 S.Ct. at 2513. The inquiry is whether the evidence presented is such that a jury applying the relevant evidentiary standard could “reasonably find for either the plaintiff or the defendant.” Liberty Lobby, 477 U.S. at 255, 106 S.Ct. at 2514.

III. Analysis

A. Standard for ERISA Preemption

Defendant moves for summary judgment on Plaintiffs state law claims due to ERISA preemption. ERISA supersedes all state laws that relate to employee benefit plans. 29 U.S.C. § 1144(a); Metropolitan Life Ins. Co. v. Taylor, 481 U.S. 58, 107 S.Ct. 1542, 95 L.Ed.2d 55 (1987) (ERISA comprehensively regulates employee pension and welfare plans and expressly and broadly preempts state laws relating to plans governed by ERISA). Employee benefits plans are broadly defined as any plan, fund, or program which was established or maintained by an employer or by an employee organization for the purpose of providing medical and other benefits for its participants through the purchase of insurance or otherwise. 29 U.S.C. § 1002(1).

The Supreme Court recently acknowledged that the “relate to” language of ERISA’s preemption clause is “unhelpful.” New York State Conference of Blue Cross & Blue Shield Plans v. Travelers Ins. Co., 514 U.S. 645, 646-49, 115 S.Ct. 1671, 1673, 131 L.Ed.2d 695 (1995). However, “ERISA’s preemption provision is clearly expansive.” California Div. of Labor Standards Enforcement v. Dillingham Const., N.A., Inc., — U.S. -, -, 117 S.Ct. 832, 837, 136 L.Ed.2d 791 (1997). To determine if a law is preempted by ERISA, the Supreme Court looks at two factors: “A law relates to a covered employee benefit plan for purposes of § 514(a) if it (1) has a connection with or *1024 (2) reference to such a plan.” Id. (citations omitted).

If a law relates to ERISA, it may-still be saved from preemption by virtue of the insurance savings clause, 29 U.S.C. § 1144(b)(2)(A) State laws regulating insurance are not preempted for underwritten plans like those in this case. In evaluating whether or not a particular law falls into the business of insurance, courts must evaluate the law to see if “common sense” dictates that it regulates insurance. Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 50, 107 S.Ct. 1549, 1554, 95 L.Ed.2d 39 (1987). Courts must also evaluate the law under three criteria, derived from the McCarran-Ferguson Act, 15 U.S.C. § 1011

Free access — add to your briefcase to read the full text and ask questions with AI

Related

LKQ Corporation v. Rutledge
N.D. Illinois, 2022
Hollaway v. UNUM Life Insurance Co. of America
2003 OK 90 (Supreme Court of Oklahoma, 2003)
Graf v. Daimler Chrysler Corp.
190 F. Supp. 2d 1002 (E.D. Michigan, 2002)
Geissal v. Moore Medical Corp.
158 F. Supp. 2d 976 (E.D. Missouri, 2001)
Sluiter v. Blue Cross and Blue Shield of Michigan
979 F. Supp. 1131 (E.D. Michigan, 1997)

Cite This Page — Counsel Stack

Bluebook (online)
969 F. Supp. 1020, 21 Employee Benefits Cas. (BNA) 1450, 1997 U.S. Dist. LEXIS 8823, 1997 WL 348474, Counsel Stack Legal Research, https://law.counselstack.com/opinion/foster-v-blue-cross-and-blue-shield-of-michigan-mied-1997.