Lincoln Mutual Casualty Co. v. Lectron Products, Inc. Employee Health Benefit Plan

823 F. Supp. 1385, 1993 U.S. Dist. LEXIS 8245
CourtDistrict Court, E.D. Michigan
DecidedJune 15, 1993
DocketNo. 90-71372
StatusPublished
Cited by3 cases

This text of 823 F. Supp. 1385 (Lincoln Mutual Casualty Co. v. Lectron Products, Inc. Employee Health Benefit Plan) is published on Counsel Stack Legal Research, covering District Court, E.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lincoln Mutual Casualty Co. v. Lectron Products, Inc. Employee Health Benefit Plan, 823 F. Supp. 1385, 1993 U.S. Dist. LEXIS 8245 (E.D. Mich. 1993).

Opinion

ORDER ADOPTING, IN PART, AND REJECTING IN PART, THE MAGISTRATE JUDGE’S REPORT AND RECOMMENDATION, GRANTING SUMMARY JUDGMENT IN FAVOR OF DEFENDANT, AND DISMISSING THIS ACTION IN ITS ENTIRETY, WITH PREJUDICE

ROSEN, District Judge.

This matter is presently before the Court on the April 26, 1993 Report and Recommendation of United States Magistrate Judge Virginia M. Morgan, recommending that the Court grant summary judgment in favor of the Defendant employee health benefit plan and dismiss Plaintiffs Complaint in its entirety on waiver grounds or, in the alternative, on the basis of application of federal common law.1

The Court has reviewed the Magistrate Judge’s Report and Recommendation, Plaintiffs Objections to the Report and Recommendation, Defendant’s Response to Plaintiffs Objections, the Sixth Circuit’s July 29, 1992 Opinion in this case, and the Court’s entire file of this matter.2 Based upon that review, the Court agrees with Plaintiffs assertion at page 5 of its Objections that the Court of Appeals made it clear that it wants the conflict between Plaintiffs no-fault policy and the Defendant plan resolved “based on federal common law.” For this reason, the Court finds no merit in the Defendant plan’s argument that Plaintiff Lincoln Mutual is precluded — by application of the doctrine of waiver — from arguing a basis for recovery in this action under federal common law. Moreover, ERISA decisional law in this Circuit suggests that a litigant whose state-law claim is determined to be preempted should be afforded an opportunity to have his claim considered on the merits under ERISA or be allowed to amend his complaint to attempt to assert a federal law-based ERISA claim. See Miller v. Metropolitan Life Ins. Co., 925 F.2d 979, 982-983 (6th Cir.1991).

For these reasons, the Court rejects that portion of Magistrate Judge Morgan’s Report and Recommendation [pp. 5-7 of the R & R] recommending that the Defendant Plan’s motion for summary judgment be granted on the basis of waiver.

On the other hand, the Court finds the rest of the Magistrate Judge’s April 26, 1993 R and R to be well-reasoned to fully address the issues as specifically ordered by the Court of Appeals. Therefore, the Court AC[1387]*1387CEPTS and ADOPTS Magistrate Judge Morgan’s very thorough and thoughtful Report and Recommendation on the application of federal common law, and will GRANT summary judgment in favor of the Defendant on the basis of application of federal common law as detailed by Magistrate Judge Morgan.

NOW, THEREFORE,

For the foregoing reasons and for the reasons stated by the Magistrate Judge in her April 26, 1993 Report and Recommendation,

IT IS HEREBY ORDERED that the April 26, 1993 Report and Recommendation of Magistrate Judge Virginia M. Morgan is ADOPTED AND ACCEPTED, in part, and REJECTED, in part, as set forth above in this Order.

IT IS FURTHER ORDERED that for the reasons stated by the Magistrate Judge in her Report and Recommendation, summary judgment is hereby GRANTED in favor of the Defendant employee health benefit plan, and this case, accordingly, is hereby, DISMISSED in its entirety, with prejudice. ■

Let Judgment be entered accordingly.

REPORT AND RECOMMENDATION

MORGAN, United States Magistrate Judge.

This matter is before the court following an order of remand from the Sixth Circuit. The defendant has filed a motion for summary judgment to which plaintiff has responded. This case involves a dispute over the impact of the Employee Retirement Security Income Act of 1974 (ERISA), 29 U.S.C. §§ 1001-1461, on the parties’ liability for an insured’s medical expenses resulting from an automobile accident. The plaintiff is Lincoln Mutual Casualty Company (“Lincoln”), a Michigan insurance company; defendant is Lectron Products, Inc. Employee Health Benefit Plan (“Plan”), an ERISA-qualified health and welfare benefit plan. Plaintiff had claimed that it was due reimbursement from the Plan pursuant to a state statute. This court granted summary judgment to the Plan, and dismissed the case, finding that ERISA preempted application of the state statute: MCLA § 500.3109a. Under that statute and the case law interpreting it, primary liability was allocated to the health insurer as against an automobile insurance carrier with respect to claims for injuries to an insured arising out of an automobile accident.

The Court of Appeals affirmed the district court’s finding of preemption, but held that the finding of preemption did not resolve the case. The court remanded the case for “the district court to resolve the conflict between the incompatible COB [coordination of benefits] clauses of the no-fault policy and the plan.” 970 F.2d 206, 211 (6th Cir.1992). The Court of Appeals found that the Plan and Lincoln Mutual each had valid, unambiguous, and irreconcilable clauses. The court stated:

“Because no federal statutory law addresses the issue of how to resolve the conflict between the clauses, this case must be resolved by applying federal common law. See [Auto Club Insurance Association v. Health and Welfare Plans, Inc., 961 F.2d 588 (6th Cir.1992) ]; see Winstead v. Indiana Ins. Co., 855 F.2d 430,433-34 (7th Cir.1988) cert. denied, 488 U.S. 1030, 109 S.Ct. 839, 102 L.Ed.2d 971 (1989).”

970 F.2d at 211.

The parties had not raised the issue of the application of federal common law in the district court. The defendant has on remand filed a second motion for summary judgment to which the plaintiff has responded.1

[1388]*1388The Plan argues that Lincoln Mutual has waived federal common law as a basis of recovery against the Plan where it failed to raise the claim until it filed its reply brief in the appellate court. The Plan argues further that federal common law may only be used to allocate medical expenses to which ERISA’s indirect regulation applies, i.e. to that portion of the medical expenses which the Plan would pay through “stop loss” insurance.

For the reasons discussed in this Report, it is recommended that the motion be granted on the issue of waiver, but if no waiver, then federal common law should apply to the totality of the expenses. It is further recommended that pursuant to such application the Plan would be entitled to summary judgment.

FACTS

In 1989, Charles and Diane Sisson and their six children were injured in an automobile accident. Mr. Sisson was insured under a no-fault automobile insurance policy issued by Lincoln. Mrs. Sisson was an employee of Lectron Products and as such, she and her family were covered by the defendant ERISA-qualified employee health benefit plan. The Plan contained the following language:

“General Exclusions: The calculation of benefits payable under this Plan shall not include or be based on any charge made for or in connection with any Hospital Confinement, or any examination, or any surgical, medical or other treatment, or any service or supply:
(1) which is for expenses incurred ...

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Cite This Page — Counsel Stack

Bluebook (online)
823 F. Supp. 1385, 1993 U.S. Dist. LEXIS 8245, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lincoln-mutual-casualty-co-v-lectron-products-inc-employee-health-mied-1993.