Hartford Fire Insurance v. E.A. Sween Co.

920 F. Supp. 1021, 1996 U.S. Dist. LEXIS 3988
CourtDistrict Court, D. Minnesota
DecidedMarch 26, 1996
DocketCivil 4-93-795
StatusPublished
Cited by1 cases

This text of 920 F. Supp. 1021 (Hartford Fire Insurance v. E.A. Sween Co.) is published on Counsel Stack Legal Research, covering District Court, D. Minnesota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hartford Fire Insurance v. E.A. Sween Co., 920 F. Supp. 1021, 1996 U.S. Dist. LEXIS 3988 (mnd 1996).

Opinion

DOTY, District Judge.

This matter is before the court on the cross-motions of Third-Party Defendant Blue Cross-Blue Shield of Minnesota (“BCBS”) and Defendants and Third-Party Plaintiffs E.A. Sween Company and E.A. Sween Company Employee Health Protection Plan, CS 451 (collectively “Sween”) for summary judgment and Plaintiffs’ Hartford Insurance Company and ITT Comprehensive Employee Benefits Service Company (collectively “Hartford”) motion for summary judgment against Sween. Based on a review of the file, record and proceedings herein, and for the reasons stated below, the motions of BCBS and Hartford are granted and the motion of Sween is denied.

BACKGROUND 1

In 1984, Sween established a self-funded medical plan (the “Plan”) to provide medical benefits to employees and their dependents. The plan is a self-insured employee welfare benefits plan under the Employee Retire *1023 ment Income Security Act (“ERISA”). 29 U.S.C. § 1002(1). Sween is the administrator and sponsor of the Plan. 29 U.S.C. 1002(16)(A) & (B). From 1984 through 1991 BCBS provided claims administration services to the Plan. Under the terms of the 1991 Servicing Plan Agreement (“SPA”) BCBS provided claims administration services for the Plan and “stop-loss” coverage for Sween.

As claims administrator, BCBS processed and paid medical claims submitted by Plan members and Sween reimbursed BCBS for the claims it paid through automated funds transfers from Sween’s bank account. Under the Specific Stop-Loss provisions of the SPA, Sween’s liability was limited to first $50,000 of claims paid for each Plan member and his or her dependents for the service year. BCBS indemnified Sween for any claims Sween paid for any individual Plan member in excess of $50,000 within the service year. Under the Aggregate Stop-Loss provisions of the SPA, BCBS indemnified Sween for any claims beyond the stop-loss aggregate. The aggregate stop-loss was calculated at the beginning of the service year and was based on 120 percent of expected claims.

By virtue of Bradley Scott’s employment at Sween, his dependents are beneficiaries of the Plan. On October 5,1991, Jill Scott gave birth to premature twin girls at Rapid City Regional Hospital in Rapid City, South Dakota. The twins were transferred to the Sioux Valley Hospital (“Sioux Valley”) in Sioux Valley, South Dakota. One baby died shortly after birth; Regan Scott survived but required months of medical treatment and hospitalization. The Scotts’ claims for medical expenses incurred between October 1991 and April 1992 (the “Scott claim”) were denied and Sioux Valley sued the Scotts.

Although unrelated to the Scott’s hospitalization, in October 1991 BCBS announced it was raising its rates and fees. As a result, Sween decided to replace BCBS. After a series of meetings and negotiations, it was agreed that Hartford would provide third-party claims administration services to the Plan. On December 27, 1991, Stephen L. Hoese, senior vice president of Sween; terminated Sween’s contract with BCBS effective December 31, 1991. 2 Effective January 1, 1992, Sween entered into an Employee Benefit Administration Agreement with Hartford. 3

In December 1991, Jill Scott learned that Sween intended to switch from BCBS to Hartford. Scott contacted Hartford to verify that coverage existed beginning January 1, 1992. Scott spoke with a Hartford representative. She explained her situation and the magnitude of the Scott’s medical bills. According to Mrs. Scott, Hartford allegedly assured her that coverage existed and that all hospital and medical expenses would be paid.

Sioux Valley submitted several claims to BCBS and Hartford between December 1991 and April 1992. 4 BCBS refused to pay for the Scott’s medical bills, which were incurred and which it received during 1991 but which it processed on or after January 1, 1992, under the Stop-Loss provisions of the SPA. Hartford denies responsibility for medical expenses incurred by the Scotts between January and April 1992, asserting that Regan Scott was not eligible for coverage until she remained out of the hospital for 30 consecutive days. Hartford filed this action for declaratory relief on August 19, 1993, to determine the liability of the parties for payment of the Scott’s medical expenses.

*1024 DISCUSSION

The court should grant summary judgment “if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(c). This standard mirrors the standard for judgment as a matter of law under Federal Rule of Civil Procedure 50(a), which requires the trial court to enter judgment as a matter of law if there can be but one reasonable conclusion as to the verdict. See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 250, 106 S.Ct. 2505, 2511, 91 L.Ed.2d 202 (1986). There is no issue for trial unless there is sufficient evidence favoring the non-moving party for a jury to return a verdict for that party. Id. at 249, 106 S.Ct. at 2510-11.

On a motion for summary judgment, the court views the evidence in favor of the non-moving party and gives that party the benefit of all justifiable inferences that can be drawn in its favor. Id. at 250, 106 S.Ct. at 2511. The nonmoving party, however, cannot rest upon mere denials or allegations in the pleadings. Nor may the nonmoving party simply argue facts supporting its claims will be developed later or at trial. Rather, the non-moving party must set forth specific facts, by affidavit or otherwise, sufficient to raise a genuine issue of fact for trial. Celotex Corp. v. Catrett, 477 U.S. 317, 324, 106 S.Ct. 2548, 2553, 91 L.Ed.2d 265 (1986). An issue of material fact is genuine if it has a real basis in the record. See Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 586-87, 106 S.Ct. 1348, 1355-56, 89 L.Ed.2d 538 (1986). If reasonable minds could differ as to the import of the evidence, judgment as a matter of law should not be granted. See Anderson, 477 U.S. at 250-51, 106 S.Ct. at 2511-12. With these principles in mind, the court will consider the parties motions.

I. Blue Cross-Blue Shield of Minnesota

Sween alleges that BCBS was a fiduciary of the Plan.

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920 F. Supp. 1021, 1996 U.S. Dist. LEXIS 3988, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hartford-fire-insurance-v-ea-sween-co-mnd-1996.