Malan F. Johnston v. Paul Revere Life

CourtCourt of Appeals for the Eighth Circuit
DecidedFebruary 20, 2001
Docket00-1611
StatusPublished

This text of Malan F. Johnston v. Paul Revere Life (Malan F. Johnston v. Paul Revere Life) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eighth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Malan F. Johnston v. Paul Revere Life, (8th Cir. 2001).

Opinion

United States Court of Appeals FOR THE EIGHTH CIRCUIT ___________

No. 00-1611 ___________

Malan F. Johnston, * * Appellant, * * v. * Appeal from the United States * District Court for the Paul Revere Life Insurance Company, * District of Nebraska now known as Provident Insurance * Company, * * Appellee. * ___________

Submitted: October 24, 2000

Filed: February 20, 2001 ___________

Before McMILLIAN, LAY and ROSS, Circuit Judges. ___________

McMILLIAN, Circuit Judge.

Malan F. Johnston ("Johnston") appeals from a final judgment entered in the United States District Court for the District of Nebraska in favor of Paul Revere Life Insurance Company ("Paul Revere").1 See Johnston v. Paul Revere Life Insurance Co., No. 8:96CV305 (D. Neb. Jan. 21, 2000) (Judgment). For reversal, Johnston

1 The Honorable Joseph F. Bataillon, United States District Judge for the District of Nebraska. argues that: (1) the district court erred in holding that his state law claim for equitable relief pursuant to Neb. Rev. Stat. § 44-710.13 is preempted by the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1144(a), and (2) the district court erred in holding that, because it does not fall within the business of insurance, the Nebraska statute is not "saved" from ERISA preemption, pursuant to 29 U.S.C. § 1144(b)(2)(A); (3) the district court erred in finding that the Paul Revere was not a fiduciary within the meaning of ERISA, 29 U.S.C. § 1002(21), in regard to the administration of a disability plan in which he was a participant and erred in finding that Paul Revere did not breach the fiduciary duty imposed by ERISA, 29 U.S.C. § 1104(a). Johnston also argues that (4) the district court abused its discretion by striking four witnesses from his pre-trial order.

The district court had jurisdiction pursuant to 28 U.S.C. § § 1331 and 1332. We have jurisdiction pursuant to 28 U.S.C. § 1291. The notice of appeal was timely filed pursuant to Fed. R. App. P. 4(a). For the reasons stated below, we affirm the decision of the district court.

Background

The undisputed facts establish that Johnston was a professional pilot employed by Western Pathology Consultants, P.C. ("Western Pathology"). In 1991, Western Pathology decided to update its long term disability policy for its professional and supervisory employees and contacted Richard Mead, an insurance agent for Paul Revere, who had provided insurance services to Western Pathology for over twenty- five years.

The updated plan was designed to provide "own occupation" coverage to assure income during an employee's earning lifetime if the employee became disabled from performing his or her professional occupation. It was determined that benefits for plan participants would be provided through individual policies purchased by the employee

-2- and issued by Paul Revere.2 Eligible employees of Western Pathology met with Mead, who explained plan benefits and completed the necessary enrollment forms provided by Paul Revere. Employees were given the choice of paying the premiums themselves or having Western Pathology make their payments. To facilitate payment, Western Pathology was billed for monthly premiums, would pay the premiums in a lump sum, and then add the amount of each employee's individual premium to the employee's W-2 form at the end of the tax year. Also, Mead delivered policy forms to Western Pathology.

Prior to issuing a policy for Johnston, Paul Revere issued twelve policies for employees of Western Pathology, all of which included "own occupation" coverage. In 1991, Johnston met with Mead who explained the plan benefits and "own occupation" coverage. Mead also completed for Johnson a Paul Revere disability policy application, which Johnston signed. This application stated that "[a]cceptance by the Proposed Insured/Owner of any policy issued on this Application will ratify any changes listed under 'Corrections and Amendments (For Home Office Use Only).'" Paul Revere then generated a computer model showing premium benefit amounts for Johnson, with monthly premiums including "own occupation" coverage, billed at $94.40 a month.

After the policy was issued, Mead received a message from a Paul Revere representative stating that the policy was issued as submitted. However, on the policy as issued, a handwritten note in the comments portion of the application stated "delete

2 The policies purchased through Paul Revere were actually "wrap around" policies. Employees of Western Pathology could elect to participate in a short term disability policy issued by another insurance company; this policy would provide benefits during the first two years of disability. The long term disability policy purchased through Paul Revere was designed to provide minimal benefit during the first two years of disability, but would provide a larger benefit after that period until the participant reached the age of sixty-five. -3- own occ." Mead did not read the policy before delivering it to Western Pathology, nor did he communicate to Johnston that there was a change in the policy. Mead did, however, inform both Johnston and Western Pathology that the policy was issued as "applied for." In 1993, Johnston became disabled and submitted a claim to Paul Revere, which claim was honored, although own occupation coverage was denied. At this time he first learned that the policy application had been changed to delete own occupation coverage. 3

Procedural History

Johnston initially filed a claim in Nebraska state court seeking declaratory relief and alleging that Paul Revere wrongfully altered his application for disability insurance in violation of Neb. Rev. Stat. § 44-70.13.4 This statute prohibits the alteration of a written application for any policy for sickness insurance without the written consent of the applicant.5 In June 1996, Paul Revere filed an answer with affirmative defenses,

3 "Own occupation" coverage is desirable because, pursuant to such coverage, if Johnston were to generate sufficient income from other employment, his monthly benefit under the policy would not be reduced. Without such coverage, the benefit would be reduced. 4 After losing his medical certificate pursuant to the report of a flight physician, Johnston worked a variety of jobs. However, he did not generate sufficient income to effect a reduction in his monthly benefit under the terms of the policy as issued. Under these circumstances Johnson appropriately filed a complaint seeking declaratory judgment. See 28 U.S.C. § 2201. 5 Neb. Rev. Stat. § 44-710.13 states :

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Malan F. Johnston v. Paul Revere Life, Counsel Stack Legal Research, https://law.counselstack.com/opinion/malan-f-johnston-v-paul-revere-life-ca8-2001.