Kelly v. Blue Cross & Blue Shield of Rhode Island

814 F. Supp. 220, 16 Employee Benefits Cas. (BNA) 1809, 1993 U.S. Dist. LEXIS 2270, 1993 WL 51477
CourtDistrict Court, D. Rhode Island
DecidedFebruary 24, 1993
DocketCiv. A. 91-0005L
StatusPublished
Cited by20 cases

This text of 814 F. Supp. 220 (Kelly v. Blue Cross & Blue Shield of Rhode Island) is published on Counsel Stack Legal Research, covering District Court, D. Rhode Island primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Kelly v. Blue Cross & Blue Shield of Rhode Island, 814 F. Supp. 220, 16 Employee Benefits Cas. (BNA) 1809, 1993 U.S. Dist. LEXIS 2270, 1993 WL 51477 (D.R.I. 1993).

Opinion

MEMORANDUM AND ORDER

LAGUEUX, Chief Judge.

This matter is before the Court on the motion of defendant Blue Cross & Blue Shield of Rhode Island (“Blue Cross”) for partial summary judgment pursuant to Rule 56 of the Federal Rules of Civil Procedure. Specifically, Blue Cross seeks to strike the state law claims and jury demand asserted by plaintiff, Michael A. Kelly, in Counts I, II, and III of the Amended Complaint. Blue Cross argues that the underlying case, arising from Blue Cross’s decision to deny reimbursement for Regina Kelly’s medical treatment, is controlled by the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 et seq. (1992). It, therefore, contends that plaintiff’s state law claims are preempted and his demand for a jury is unavailing. Despite claims under ERISA in Count IV of the Amended Complaint, plaintiff now asserts, in response to defendant’s motion, that ERISA is inapplicable and defendant’s motion should be denied.

BACKGROUND

At its core, this litigation involves a dispute over a health care insurance contract between Blue Cross and Regina Kelly, plaintiffs late wife. The present motion is to determine whether the means for resolving that dispute are confined to those available under ERISA or, if instead, state laws apply.

In 1989, Regina Kelly, a citizen of South Carolina, discovered she had breast cancer. In May of that year, Mrs. Kelly underwent a bone marrow rescue procedure called an Au-tologous Bone Marrow Transplant (“ABMT”) at the Medical University of South Carolina. Essentially, doctors withdrew her bone marrow, preserved the marrow under extreme cold (cryopreservation), and then administered chemotherapy. After the chemotherapy was completed, the patient’s own preserved marrow was reinfused into her bones.

*222 At the time of this treatment, Regina Kelly had a health care insurance contract with defendant, Blue Cross. This coverage was paid for entirely by Academic Enterprises, Incorporated, a corporation which owns and operates several schools located in Rhode Island and Connecticut. Academic Enterprises has paid since 1975, and presently plans to continue paying, one hundred percent of the Blue Cross premiums for its eligible employees. 1 An employee’s eligibility for the health care insurance coverage, as well as for the dental, life, and long term disability insurance offered by the corporation, is based on the number of hours the employee works, as determined by the formula devised by the owner of the corporation. Regarding health care, the eligible employee may choose from one of several group plans offered by the corporation, including the corporation’s group plan with Blue Cross. 2 Regina Kelly was the sole owner and Chairman of the Board of Academic Enterprises, and, thus, the corporation considered her a full-time employee eligible for the benefits.

After her ABMT, the Medical University of South Carolina submitted a claim on Regina Kelly’s behalf for reimbursement from Blue Cross for her medical treatment. On October 16, 1989, Blue Cross rejected Mrs. Kelly’s claim. Despite her objection, Blue Cross declined to reimburse her for the costs of the ABMT, characterizing the treatment as investigative and/or experimental and, therefore, not covered by her agreement with Blue Cross. Regina Kelly appealed that decision within defendant’s corporate structure in accordance with the contractual requirements of the agreement. Defendant refused to reverse its determination and denied the appeal.

Unable to resolve the dispute, Regina Kelly filed suit in this Court on January 4,1991. Jurisdiction, was based on the diversity between the South Carolina plaintiff and the Rhode Island defendant and an amount in controversy allegedly exceeding $50,000. The two count Complaint alleged that defendant breached its contractual duties and intentionally or negligently inflicted mental and emotional harm on Regina Kelly. In the Complaint, Regina Kelly sought compensatory and punitive damages and also claimed a trial by jury under each count.

Subsequent to the commencement of this action, Regina Kelly died. In the Amended Complaint, filed on March 6,1992, Michael A Kelly, Regina’s husband, who was also a citizen of South Carolina, was substituted as plaintiff, individually and as personal representative of the estate of Regina Kelly. The Amended Complaint asserted claims by Michael Kelly against Blue Cross for negligent breach of contract, for infliction of mental and emotional harm upon Michael and Regina Kelly, and for both a declaratory judgment of Blue Cross’s responsibility to pay for Regina Kelly’s treatment and a claim for attorney’s fees under ERISA In response, Blue Cross filed this motion for partial summary judgment seeking to strike plaintiffs state law claims and jury demand. Blue Cross first argues that ERISA applies. It then contends both that ERISA supersedes state laws, such as the ones relied on by plaintiff, which relate to any ERISA employee benefit plan and that the application of ERISA requires a decision in equity by the Court, thus eliminating plaintiffs right to a jury.

After hearing oral arguments, the Court took this matter under advisement. It is now in order for decision. The Court concludes that ERISA does not apply to plaintiffs claims. Therefore, the Court denies defendant’s motion for partial summary adjudication and to strike plaintiff’s jury demand.

DISCUSSION

I. Partial Summary Judgment Standard

Defendant has moved for summary judgment on the first three counts of the Amend *223 ed Complaint and to strike plaintiffs demand for a jury trial. Rule 56(c) of the Federal Rules of Civil Procedure sets forth the standard for ruling on a summary judgment motion:

The judgment sought shall be rendered forthwith 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 a judgment as a matter of law.

In determining whether summary adjudication is appropriate, the court must view the facts on the record and all inferences therefrom in the light most favorable to the non-moving party. Continental Casualty Co. v. Canadian Universal Ins. Co., 924 F.2d 370, 373 (1st Cir.1991). Additionally, the moving party bears the burden of showing that no evidence supports the non-moving party’s position. Cel otex Corp. v. Catrett, 477 U.S. 317, 325, 106 S.Ct. 2548, 2554, 91 L.Ed.2d 265 (1986). In this case, defendant must prove the facts necessary to establish that ERISA preempts plaintiffs state law claims. Kanne v. Connecticut General Life Ins. Co.,

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

Related

Bertoni v. Stock Bldg. Supply
989 So. 2d 670 (District Court of Appeal of Florida, 2008)
Holm v. LIBERTY MUTUAL LIFE ASSUANCE COMPANY OF BOSTON
441 F. Supp. 2d 389 (D. Rhode Island, 2006)
Vega v. National Life Ins
145 F.3d 673 (Fifth Circuit, 1999)
Canis v. Coca-Cola Enterprises, Inc.
49 F. Supp. 2d 73 (D. Rhode Island, 1999)
C.C. Mid West, Inc. v. McDougall
990 F. Supp. 914 (E.D. Michigan, 1998)
Taylor v. Carter
948 F. Supp. 1290 (W.D. Texas, 1996)
Engelhardt v. Paul Revere Life Insurance
951 F. Supp. 1003 (M.D. Alabama, 1996)
Welsh v. Quabbin Timber Inc.
943 F. Supp. 98 (D. Massachusetts, 1996)
Loudermilch v. New England Mutual Life Insurance
942 F. Supp. 1434 (S.D. Alabama, 1996)
Kaler v. Craig (In Re Craig)
204 B.R. 750 (D. North Dakota, 1996)
Finn v. Nachreiner Boie Art Factory
549 N.W.2d 273 (Court of Appeals of Wisconsin, 1996)
Harris v. TMG Life Insurance
915 F. Supp. 869 (S.D. Texas, 1996)
Eichhorn, Eichhorn & Link v. Travelers Ins. Co.
896 F. Supp. 812 (N.D. Indiana, 1995)
National Credit Union Administration v. Ticor Title Insurance
873 F. Supp. 718 (D. Massachusetts, 1995)
Brech v. Prudential Insurance Co. of America
845 F. Supp. 829 (M.D. Alabama, 1993)
Madden v. Country Life Insurance
835 F. Supp. 1081 (N.D. Illinois, 1993)
State v. Therrien
633 A.2d 272 (Supreme Court of Vermont, 1993)

Cite This Page — Counsel Stack

Bluebook (online)
814 F. Supp. 220, 16 Employee Benefits Cas. (BNA) 1809, 1993 U.S. Dist. LEXIS 2270, 1993 WL 51477, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kelly-v-blue-cross-blue-shield-of-rhode-island-rid-1993.