Lutheran Hospital of Indiana, Inc. v. Business Men's Assurance Co. of America

51 F.3d 1308, 1995 WL 115873
CourtCourt of Appeals for the Seventh Circuit
DecidedMarch 20, 1995
DocketNo. 94-2731
StatusPublished
Cited by1 cases

This text of 51 F.3d 1308 (Lutheran Hospital of Indiana, Inc. v. Business Men's Assurance Co. of America) is published on Counsel Stack Legal Research, covering Court of Appeals for the Seventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lutheran Hospital of Indiana, Inc. v. Business Men's Assurance Co. of America, 51 F.3d 1308, 1995 WL 115873 (7th Cir. 1995).

Opinions

CUMMINGS, Circuit Judge.

The issue in this case is whether a laid-off employee is ineligible for COBRA continuation health care coverage because of her preexisting coverage under the group health plan provided by her husband’s employer.

Background

In 1986 Congress passed the Consolidated Omnibus Budget Reconciliation Act (“COBRA”), which amended the Public Health Service Act (“PHSA”), the Employee Retirement Income Security Act (“ERISA”) and the Internal Revenue Code (“the Code”). The COBRA amendments to ERISA, 29 U.S.C. §§ 1161-1168, provide that individuals who lose coverage under their employer’s group health plan due to certain qualifying events, e.g., lay-off or reduction in hours, may continue their coverage in the group health plan at their own expense for a period of 18 or 36 months depending on the qualifying event. The continuation coverage must be identical to that received by any “similarly situated beneficiaries under the plan” who have not had a qualifying event. 29 U.S.C. § 1162(1).

The critical provision for the present case, 29 U.S.C. § 1162(2), provides in relevant part that:

The coverage must extend for at least the period beginning on the date of the qualifying event and ending not earlier than the earliest of the following
(D) The date on which the qualified beneficiary first becomes, after the date of election—
(i) covered under any other group health plan (as an employee or otherwise) “which does not contain any exclusion or limitation with respect to any pre-existing condition of such beneficiary.’

As originally passed in April of 1986, 29 U.S.C. § 1162(2)(D)(i) read, “a covered employee under any other group health plan.” COBRA Pub.L. No. 99-272, § 10002(a), 100 Stat. 82, 228. In October of 1986 it was amended to read, “covered under any other group health plan (as an employee or otherwise).” Tax Reform Act, Pub.L. No. 99-514, § 1895(d)(4)(B)(ii), 100 Stat. 2085, 2938. Finally in 1989 Congress amended the statute again, adding the ‘“which does not contain any exclusion or limitation with respect to any preexisting condition of such beneficiary’” language, bringing it to its present form. The “first becomes, after the date of the election” qualifying language was in the original statute and has remained unchanged through this series of amendments.

The facts in this case were largely stipulated by the parties. Mary Isch was admitted to Wells Community Hospital of Bluffton, Indiana, on April 28, 1991.1 She was transferred to Lutheran Hospital of Indiana two days later and transferred again to St. Joseph Medical Center on September 26, 1991, and discharged December 27, 1991. At the time of her hospitalization, she was a teacher at Community and Family Services, Inc. (“Community”) and received group health insurance under the Community group health insurance plan provided through Business Men’s Assurance Company of America (“BMA”). She was also a covered dependent under her husband’s group health insurance provided by the Teamsters Local 135 Welfare Fund (“Teamsters”).

On May 1,1991, Mary Isch took a leave of absence from her employment because of her illness. On May 25, 1991, Mary Isch and the other teachers at Community were laid off for the summer. Effective June 1, 1991, Community switched insurers from BMA to Associated. In early June 1991, an Associated representative told Community that Mary Isch would not be eligible for COBRA coverage because of her coverage under the Teamsters’ plan.

Plaintiffs brought suit in the Northern District of Indiana on July 13, 1992, seeking a declaratory judgment as to which if any of [1311]*1311the four named defendants2 was responsible for providing benefits to Mary Isch after June 1, 1991. St. Joseph Medical Center intervened in the action on June 14, 1993, with a complaint against the Isches and all defendants. All parties filed motions for summary judgment on July 17, 1993. The district court granted summary judgment against Teamsters and in favor of the other defendants, finding that Mary Isch had lost her coverage due to a qualifying event but was not entitled to COBRA continuation coverage because of her preexisting coverage under the Teamsters’ plan. 845 F.Supp. 1275 (N.D.Ind.1994).3 Teamsters appeal the district court’s ruling holding them exclusively liable for Mary Isch’s medical costs. Plaintiffs appeal the district court’s ruling, that Acordia and Associated are not also liable. Both plaintiffs and Teamsters contend that Associated is primarily and Teamsters secondarily liable for Mary Isch’s medical expenses.

Discussion

Three other Circuits have addressed this issue with differing results.4 In Oakley v. City of Longmont, 890 F.2d 1128 (10th Cir.1989), certiorari denied, 494 U.S. 1082, 110 S.Ct. 1814,108 L.Ed.2d 944, the plaintiff was covered under both his employer’s and his wife’s group health plans. Plaintiff suffered a serious head injury in an auto accident. His employer ultimately terminated him and discontinued his health coverage. His employer also denied plaintiff continuation coverage because of his preexisting coverage under his wife’s, health plan. The Tenth Circuit held that the clear language of the statute “cannot be construed to include a spouse’s preexisting group plan as a condition to terminate continuation coverage.” Id. at 1132. Consequently the defendant city was required to provide continuation coverage to its previously covered plaintiff employee. Because the plaintiff needed expensive rehabilitation not covered by his wife’s plan, the court noted that

[sjurely the facts of this case illustrate the precise gap in coverage which troubled Congress. Mr. Oakley was terminated because of a catastrophic event which otherwise would have put his family at risk and jeopardized his treatment had the continuation rules not been in effect to maintain his rehabilitation for a limited period of time. (Emphasis supplied.).

Id. at 1133.

In Brock v. Primedica, Inc., 904 F.2d 295 (5th Cir.1990), the Fifth Circuit ignored the clear holding of the Oakley court and fastened instead on the above-quoted reference to a “gap,” holding that since the plaintiff, Karen Brock, suffered no gap between her employer’s plan and her preexisting coverage under her husband’s plan she was not entitled to continuation coverage.

The Eleventh Circuit in National Companies Health P. v. St. Joseph’s Hosp., 929 F.2d 1558 (11th Cir.1991), recognized the conflict between Oakley and Brock

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51 F.3d 1308, 1995 WL 115873, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lutheran-hospital-of-indiana-inc-v-business-mens-assurance-co-of-ca7-1995.