Krystyniak v. Lake Zurich Community Unit District No. 95

783 F. Supp. 354, 73 Educ. L. Rep. 50, 1991 U.S. Dist. LEXIS 16788
CourtDistrict Court, N.D. Illinois
DecidedNovember 8, 1991
Docket91 C 6992
StatusPublished
Cited by8 cases

This text of 783 F. Supp. 354 (Krystyniak v. Lake Zurich Community Unit District No. 95) is published on Counsel Stack Legal Research, covering District Court, N.D. Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Krystyniak v. Lake Zurich Community Unit District No. 95, 783 F. Supp. 354, 73 Educ. L. Rep. 50, 1991 U.S. Dist. LEXIS 16788 (N.D. Ill. 1991).

Opinion

REPORT AND RECOMMENDATION

JOAN HUMPHREY LEFKOW, United States Magistrate Judge:

This matter was referred to determine whether the court has subject matter jurisdiction and, if so, to hold an expedited hearing on plaintiff’s, Marilyn Krystyn-iak’s, emergency motion for preliminary injunction.

FACTS

The complaint purports to state a claim under the Federal Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. §§ 1001 et seq. The complaint alleges that plaintiff is a full-time, salaried employee of defendant Lake Zurich Community Unit District No. 95 (“District 95”). Plaintiff is a breast cancer patient. She seeks an injunction to require defendants District 95, Gallagher-Bassett Services, Inc. and Northern Illinois Health Insurance Program (“NIHIP”) to authorize and fund treatment characterized as “high-dosage chemotherapy/autologous bone marrow transplant” under an employee benefit plan adopted by District 95. Plaintiff proffers the opinion of a variety of physicians who *355 believe that plaintiffs best chance of survival is immediate treatment with the therapy sought in this lawsuit. Defendants, however, have moved to dismiss the complaint on the grounds that the court lacks subject matter jurisdiction because the Plan at issue is not governed by ERISA.

It is uncontroverted that District 95 is an Illinois municipal corporation, specifically a community unit school district, located in Lake Zurich, Illinois. District 95 has established and sponsors an employee welfare benefit plan (“the Plan”) which provides medical, surgical and hospitalization for employees. It is uncontroverted that NI-HIP is an intergovernmental cooperative agency organized under Article VII, Section 10 of the 1970 Constitution of the State of Illinois and the Illinois Intergovernmental Cooperation Act, Ill.Rev.Stat. ch. 127, UH 741 et seq. As applicable here, member school districts of NIHIP, including District 95, have joined together for the purpose of establishing a self-insurance program to provide benefits for their employees and employees’ dependents, including medical, surgical and hospitalization benefits. Each member school district has a member on the board of directors of NIHIP. The NIHIP board is empowered to carry out the purposes and duties of the cooperative as set out in an intergovernmental cooperative agreement. Each member school district makes financial contributions from its general corporate funds to pay for the benefits. NIHIP has established a self-insured loss fund out of which the eligible claims of its member employees and employees’ dependents are paid. NI-HIP also purchases with these member contributions excess insurance for individual stop-loss and aggregate excess insurance.

NIHIP has contracted with Gallagher-Bassett Services, Inc., to provide claims administration under the agreement. Employees such as plaintiff submit claims directly to Gallagher-Bassett for an initial determination of whether the claim is covered and if covered, for payment of benefits. Any participant in the NIHIP plan who has been denied a benefit is entitled to request a review by the NIHIP board of directors. According to defendants, the decision of the board of directors is final. The members of NIHIP are limited to Illinois public school districts; District 95 is a member of NIHIP.

Since 1983, the following statement has been included in the Plan for District 95:

The Employer or Plan Administrator is hereby designated the named fiduciary with respect to the administration of the Plan for the purposes of the Employee Retirement Income Security Act of 1974 (hereinafter called ERISA) and the Trustee is designated as the named fiduciary with respect to the investment and management of the assets of the Plan.

OPINION

ERISA is comprehensive legislation with a purpose to protect “the interests of participants in employee benefit plans.” 29 U.S.C. § 1001(b). It preempts “any and all State laws insofar as they now or hereafter relate to any employee benefit plan....” 29 U.S.C. § 1144(a). ERISA regulates employee benefit plans such as the plan at issue. 29 U.S.C. § 1002(1). A “governmental plan”, however, is exempted from ERISA regulation. A governmental plan is defined at § 1002(32) as, “a plan established or maintained for its employees by the ... government of any State or any political subdivision thereof, or by any agency or instrumentality of any of the foregoing....” Section 1003(b) states, “The provisions of this subchapter shall not apply to any employee benefit plan if ... such plan is a governmental plan (as defined in § 1002(32) of this Title).... ”

Defendants simply contend that the Plan is a governmental plan, which is not subject to ERISA; therefore the court lacks jurisdiction over the subject matter of the lawsuit. Plaintiff concedes that the plan at issue is a governmental plan but argues that NIHIP and its members have waived their exemption by the provision in the Plan designating the fiduciary “for the purposes of [ERISA].”

Plaintiff relies on Livolsi v. City of New Castle, 501 F.Supp. 1146 (W.D.Pa.1980); *356 Brooks v. Chicago Housing Authority, 1990 WL 103572, LEXIS No. 8233 (N.D.Ill.1990); and Lovelace v. Prudential Insurance Company of America, 775 F.Supp. 228 (S.D.Ohio 1991). In Livolsi, the court held that multi-employer welfare fund to which various employers, both private and public, contributed was not within the governmental plan exemption. The basis of the court’s ruling was that the local governmental body had chosen a private welfare benefit plan for its employees and by accepting a private plan, it could not later complain that ERISA regulation of that plan invaded its sovereignty. Similarly, in Brooks, the court ruled, relying on Livolsi, that where the local government body voluntarily chose to participate in a private benefit plan for its employees, it could not claim the exemption. The court stated, “[A] whole plan should not be exempt from ERISA merely because a governmental body participates in the plan.” In Lovelace, the court held that a health insurance plan was a governmental plan where all participants were local governmental entities, even though private employers were eligible to participate in the plan. All of these cases stand for the proposition that the participation by a non-governmental employer takes a plan out of the definition of governmental plan of § 1002(32).

Defendants rely on Feinstein v. Lewis, 477 F.Supp. 1256 (S.D.N.Y.1979), aff'd in unpublished opinion, 622 F.2d 573 (2d Cir.1980); Shirley v. Maxicare Texas, Inc., 921 F.2d 565 (5th Cir.1991); Roy v.

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

Related

Cite This Page — Counsel Stack

Bluebook (online)
783 F. Supp. 354, 73 Educ. L. Rep. 50, 1991 U.S. Dist. LEXIS 16788, Counsel Stack Legal Research, https://law.counselstack.com/opinion/krystyniak-v-lake-zurich-community-unit-district-no-95-ilnd-1991.