Hicks v. Amerman

38 Pa. D. & C.4th 121, 1997 Pa. Dist. & Cnty. Dec. LEXIS 148
CourtPennsylvania Court of Common Pleas, Lebanon County
DecidedJuly 10, 1997
Docketno. 95-00149
StatusPublished

This text of 38 Pa. D. & C.4th 121 (Hicks v. Amerman) is published on Counsel Stack Legal Research, covering Pennsylvania Court of Common Pleas, Lebanon County primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hicks v. Amerman, 38 Pa. D. & C.4th 121, 1997 Pa. Dist. & Cnty. Dec. LEXIS 148 (Pa. Super. Ct. 1997).

Opinion

EBY, P.J.,

— The question raised in the instant case is under what circumstances the jurisdictional provisions of the federal Employee Retirement Income Security Act prohibit this court from entertaining a claim.

Michelle Hickman, an employee of Amerman & Co., an accounting firm, relied on an outdated employee medical benefits handbook when deciding to undergo elective surgery to treat a chronic gall bladder problem. Prior to the procedure, she examined the booklet, called the health care insurance company that provided coverage, had the surgery “pre-certified,” underwent the surgery, and submitted her claim to her employer’s health care insurer. She then learned her employer’s health plan did not cover the procedure. Consequently, she sued her employer for the cost of the surgery and follow-up care, asserting that by directing her to an outdated benefits handbook when she asked about benefits, her employer became liable for the medical expenses she had incurred in reliance on the handbook.

[123]*123Her employer, correctly asserting that ERISA governs creation and administration of employee health plans, argues that ERISA provides that any claims arising out of such a plan must be litigated in federal court, and has asked for leave to file a motion for summary judgment. At a pretrial conference, we directed the parties to address the issue, by brief and oral argument, of whether ERISA governs defendant’s health plan and so restricts plaintiff to sue in federal court.

Section 1451(c) of ERISA, 29 U.S.C. § 1451(c), bestows upon federal district courts exclusive jurisdiction over ERISA claims. We note, however, that ERISA applies to all employers “engaged in commerce or in any industry or activity affecting commerce.” 29 U.S.C. § 1003(a)(1) (West 1985). “Commerce” is “trade, traffic, commerce, transportation, or communication between any state and any place outside thereof.” 29 U.S.C. §1002(11) (West 1996 Supp.). “Industry or activity affecting commerce” is “any activity, business, or industry in commerce or in which a labor dispute would hinder or obstruct commerce or the free flow of commerce, and includes any activity or industry ‘affecting commerce’ within the meaning of the Labor Management Relations Act, 1947 [29 U.S.C. §141 et seq.], or the Railway Labor Act [45 U.S.C. §151 et seq.].” 29 U.S.C. §1002(12) (West 1996 Supp.).

Although there is no evidence of record on this issue, Amerman & Co. appears to be an accounting firm with but one office, in Palmyra, Pa. We did not have enough facts at the time of the pretrial conference to determine whether the firm actually engages in “interstate commerce” and thus whether the claim may fall under ERISA. Unfortunately, neither party has given us further guidance on the issue of whether Amerman & Co. engages in “interstate commerce.”

Defendant repeats its prior argument that ERISA applies because an employee health plan is at issue, ap[124]*124parently taking that position that all employer-sponsored health plans fall under the Act, no matter the size of the employer, the nature of its business, or the nature of the claim. Plaintiff takes a slightly different position: she argues that defendants are not “employers” under ERISA because ERISA defines “employer” as “any person acting directly as an employer, or indirectly in the interest of an employer, in relation to an employee benefit plan.” Plaintiff argues that the Pa. Builders’ Association Benefits Trust, which administers the Amer-man health insurance plan, is the statutory “employer” that is immune from state court claims.

Plaintiff also argues that she is not asking us to interpret the obligations of the insurer or the plan administrator; she is asking us to determine whether her employer must pay a bill that she incurred because she relied on his statements. She asserts that her claim is a common-law claim which does not arise out of an ERISA-governed employee health plan.

There are no court cases on whether ERISA governs all pension and health benefit plans offered by all private employers in the United States, no matter what their size or the nature of their business. There are many cases in which ERISA’s preemption of state law claims have been discussed. In these cases, the defendant was patently an employer that engaged in interstate commerce, or a union subject to the Labor Management Relations Act. See e.g., Murzyn v. AMOCO, 925 F. Supp. 594 (N.D. Ind. 1995); Jung v. FMC Corp., 755 F.2d 708 (1985); Johnson v. Transworld Airlines Inc., 149 Cal.App.3d 518, 196 Cal.Rptr. 896 (1983). Still, there are cases in which an employer who did not appear to be involved in “interstate commerce” successfully asserted the ERISA preemption provisions.

In Holloway v. Doug Fisher Inc., 865 F. Supp. 412 (E.D. Mich. 1994), an employee sued his former employers, both personally and in their business personas, [125]*125for their failure to pay his health insurance premiums when their acts led him to believe they had done so. After the employee was injured, he submitted insurance reimbursement forms, and was told by the insurer that he was not covered under his employer’s health plan. He sued his two former employers, his current employer, and the principals of each, asserting negligence, fraud, breach of contract, unjust enrichment, and other common-law claims. The employee had paid health insurance premiums through paycheck deductions while he was employed by both employers, but because of employer errors, the premiums were not transmitted to the health insurer and the employee was not listed by the employer as a “covered employee” with its insurer.

The federal district court determined that because plaintiff’s claims against his second employer, Catalyst Inc., involved that employer’s failure to follow federal laws regarding continuation of health insurance coverage, those claims were preempted by ERISA. Id. 865 F. Supp. at 418. But because his claims against his first and third employers were not based on benefit plans, there was no preemption. The plaintiff claimed that his first and third employers committed fraud by promising him health coverage, deducting premiums from his paychecks, and then failing to provide coverage. He also alleged that his first and third employers converted his money by failing to pay premiums, and intentionally inflicted emotional distress upon him.1

The court in Holloway did not discuss whether the defendants engaged in interstate commerce. They appeared to ship books to schools within the state of Michigan. We turn to U.S. Supreme Court cases in an effort to find guidance.

[126]*126In Ingersoll-Rand v. McClendon,

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Bluebook (online)
38 Pa. D. & C.4th 121, 1997 Pa. Dist. & Cnty. Dec. LEXIS 148, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hicks-v-amerman-pactcompllebano-1997.