Liberty Northwest Ins. Corp. v. Kemp

85 P.3d 871, 192 Or. App. 181, 32 Employee Benefits Cas. (BNA) 2178, 2004 Ore. App. LEXIS 171
CourtCourt of Appeals of Oregon
DecidedFebruary 18, 2004
Docket0103-02636; A118217
StatusPublished
Cited by7 cases

This text of 85 P.3d 871 (Liberty Northwest Ins. Corp. v. Kemp) is published on Counsel Stack Legal Research, covering Court of Appeals of Oregon primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Liberty Northwest Ins. Corp. v. Kemp, 85 P.3d 871, 192 Or. App. 181, 32 Employee Benefits Cas. (BNA) 2178, 2004 Ore. App. LEXIS 171 (Or. Ct. App. 2004).

Opinions

[183]*183SCHUMAN, J.

This case presents the following question: Does the Employment Retirement Income Security Act of 1974, commonly known as ERISA, preempt a common-law claim for breach of an employer-sponsored group medical insurance contract? In particular, the issue is whether ERISA preempts plaintiff, Liberty Northwest Insurance Corporation (Liberty), from enforcing a “Reimbursement and Subrogation” clause requiring defendant, a Liberty policyholder, to repay Liberty for any injury-related medical expenses paid to him by Liberty if he also recovers those expenses from the party that caused the injury. The trial court concluded that ERISA did not preempt the insurer’s breach of contract claim against defendant. We reverse.

I. FACTUAL, PROCEDURAL, AND LEGAL BACKGROUND

The following facts and conclusions are undisputed. Defendant held an employer-sponsored group health insurance policy issued by Liberty. The plan is an “employee benefit plan” under ERISA. 29 USC § 1002(1). One term of the policy provided,

“5.8 Reimbursement and Subrogation. When a Covered Person’s Injury appears to be the fault of another, benefits otherwise payable under the Plan for Covered Medical Expense incurred as a result of that Injury will not be paid unless the Covered Person or his/her legal representative agrees:
“(1) to repay Liberty for such benefits to the extent they are for losses for which compensation is paid to the Covered Person by or on behalf of the person at fault;
“(2) to allow Liberty a lien on such compensation and to hold such compensation in trust for Liberty!.]”

On February 3,1997, defendant was injured in a bicycle accident and received extensive medical treatment. He subsequently authorized his representative to sign an agreement on his behalf to reimburse Liberty according to the terms of the policy if he recovered from the party that injured him.

[184]*184Defendant brought an action against that party, resulting in a structured payment schedule valued at approximately $5,000,000. Following the settlement, Liberty asserted a lien to recover the $721,383.04 in benefits that it had paid on defendant’s behalf. Defendant refused to pay. Liberty then brought this action for breach of contract and moved for summary judgment. Defendant cross-moved for summary judgment, arguing that Liberty could not enforce its claim because ERISA preempted it. The court granted Liberty’s motion, denied defendant’s cross-motion, and entered a money judgment in favor of Liberty. Defendant appeals.

In 1992, Justice Stevens noted that the scope of ERISA’s preemption clause, ERISA section 514(a), 29 USC section 1144 (Section 514(a)), had come before state and federal courts in more than 2,800 reported cases since Congress enacted the statute in 1974. District of Columbia v. Greater Washington Board of Trade, 506 US 125, 135, 135 n 3, 113 S Ct 580, 121 L Ed 2d 513 (1992) (Stevens, J., dissenting). Today, according to a data base search, that number stands at more than 8,000. This profusion results at least partly from the expansive language of Section 514(a), which provides in part that ERISA “shall supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan” covered by the statute. A “state law” includes “all laws, decisions, rules, regulations, or other State action having the effect of law[.]” 29 USC § 1144(c)(1). “Other state action,” in turn, includes common-law claims. See, e.g., Pilot Life Ins. Co. v. Dedeaux, 481 US 41, 107 S Ct 1549, 95 L Ed 2d 39 (1987) (ERISA held to preempt state tort and contract claim against insurer). Thus, ERISA preemption is both broad and imprecise.

Further, the Supreme Court has developed a method for analyzing preemption under ERISA that appears to vary in at least its terminology from traditional preemption analysis. For decades, Supreme Court opinions on preemption have followed a template like the one described in Pacific Gas & Elec. v. Energy Resources Comm’n, 461 US 190, 203-04, 103 S Ct 1713, 75 L Ed 2d 752 (1983):

[185]*185“It is well established that within constitutional limits Congress may pre-empt state authority by so stating in express terms. Absent explicit pre-emptive language, Congress’ intent to supersede state law altogether may be found from a scheme of federal regulation so pervasive as to make reasonable the inference that Congress left no room for the states to supplement it, because the Act of Congress may touch a field in which the federal interest is so dominant that the federal system will be assumed to preclude enforcement of state laws on the same subject, or because the object sought to be obtained by the federal law and the character of obligations imposed by it may reveal the same purpose. Even where Congress has not entirely displaced state regulation in a specific area, state law is pre-empted to the extent that it actually conflicts with federal law. Such a conflict arises when compliance with both federal and state regulations is a physical impossibility, or where state law stands as an obstacle to the accomplishment and execution of the full purposes and objectives of Congress.”

(Internal quotation marks and citations omitted.) Thus, traditionally, preemption is either express or implicit. Implicit preemption, in turn, is either “occupying the field” preemption or “conflict” preemption. “Conflict” preemption occurs, under this analysis, when simultaneous compliance with federal and state law is physically impossible or when compliance with state law impedes implementation of federal law.

To the displeasure of at least one Supreme Court justice,1 analysis of Section 514(a) has not tracked the traditional template. The reason lies in the language of the provision itself. Although it is technically an express preemption provision, it is so expansive and vague that the task of interpreting its express scope is indistinguishable from the task of discerning precisely what “field” it occupies, thus blurring the distinction between express preemption and the “field” aspect of implied preemption. Further, the Court has held that another provision of ERISA, its civil enforcement section, ERISA section 502(a), 29 USC section 1132(a)(3) (Section 502(a)), contains a list of remedies that ERISA participants, beneficiaries, and fiduciaries can seek and that the list [186]*186is exclusive. Pilot Life Ins. Co., 481 US at 54. Because that holding appears to permit the inference that a remedy not authorized by ERISA both relates to and conflicts with it, the holding blurs the distinction between express preemption and the “conflict” aspect of implied preemption.

Thus, instead of using traditional preemption terms and templates, the Court determines whether the state law in question “has a connection with or reference to” an ERISA plan. Shaw v. Delta Air Lines, Inc., 463 US 85, 97, 103 S Ct 2890, 77 L Ed 2d 490 (1983). A law “has reference to” ERISA if, by its very terms, it names that statute. Mackey v. Lanier Collection Agency & Serv., 486 US 825, 829, 838 n 12, 108 S Ct 2182, 100 L Ed 2d 836 (1988). “Connection with” is more difficult. As a supposed amplification of the statutory phrase itself — “relates to” — it is a restatement and not a clarification. Egelhoff v. Egelhoff, 532 US 141, 147, 121 S Ct 1322, 149 L Ed 2d 264 (2001).

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85 P.3d 871, 192 Or. App. 181, 32 Employee Benefits Cas. (BNA) 2178, 2004 Ore. App. LEXIS 171, Counsel Stack Legal Research, https://law.counselstack.com/opinion/liberty-northwest-ins-corp-v-kemp-orctapp-2004.