Margery A. Morstein v. National Insurance Services, Inc. Pan American Life Insurance Company the Shaw Agency Scott Hankins

93 F.3d 715, 20 Employee Benefits Cas. (BNA) 1729, 1996 U.S. App. LEXIS 20848, 1996 WL 468471
Court of Appeals for the Eleventh Circuit·Decided August 19, 1996·No. 94-9152·Published·Cited by 94 cases

Opinion

BIRCH, Circuit Judge:

This case was taken en banc to clarify the law in our circuit regarding state law preemption by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001-1461 (1988). In this appeal, we must decide whether state law claims asserted against an independent insurance agent and his agency for fraudulent inducement to purchase and negligence in processing an application for an ERISA-governed insurance plan sufficiently relate to an employee benefit plan within the meaning of section 514(a) of ERISA, 29 U.S.C. § 1144(a), so as to be preempted. Because we find that the state law claims in this case do not sufficiently relate to the employee benefit plan to be preempted by ERISA, we reverse the district court’s grant of summary judgment in favor of the insurance agent and his agency.

I. FACTS

Plaintiff-appellant, Margery Morstein, is the president, director, and sole shareholder of Graphic Promotions, Inc. (“Graphic”). At all times relevant to this appeal, Morstein was one of two employees of Graphic. In 1991, Morstein met with Scott Hankins, an insurance broker and employee of the Shaw Agency, for the purpose of obtaining a replacement policy of major medical insurance for herself and Graphic’s other employee. The policy was to be administered by National Insurance Services, Inc. (“National”) and underwritten by Pan-American Life Insurance Company (“Pan-American”). 1 Morstein alleges that, during her meeting with Han-kins, she advised him that any policy of major medical insurance that would replace *717 her current policy would be unacceptable if it excluded from coverage medical treatment related to any preexisting medical condition. Morstein asserts that Hankins assured her that the policy that he proposed would provide the same coverage for preexisting conditions as her current policy. The policy offered by Hankins was issued to Graphic, and Graphic paid the initial premium.

Over one year after the policy was issued, Morstein underwent total hip replacement surgery. When she submitted a claim for payment for this procedure, National refused payment because it asserted that Morstein’s surgery treated a preexisting condition, which she failed to disclose during the application process. National then rescinded the policy and refunded to Graphic the premium payments that were made on behalf of Morstein. Morstein claims that Hankins and the Shaw Agency fraudulently induced her to purchase a policy of major medical insurance and, therefore, that she allowed a separate full-coverage insurance policy to lapse. She further alleges that Hankins and the Shaw Agency were negligent in processing her application for insurance and that she has state law claims against them for negligence and fraud. 2

Morstein filed an action in state court and alleged negligence, malfeasance, misrepresentations, and breach of contract. Defendants removed the action to federal court on the basis that Morstein’s claims were governed by ERISA. The district court denied Morstein’s motion to remand and found that defendants were entitled to summary judgment as to the state law claims against them. The district court concluded that Morstein’s claims “clearly relate to the employee benefit plan established by Graphic Promotions; therefore, those claims are preempted by ERISA.” R2-29-3. Morstein appealed the district court’s grant of summary judgment, and the original appellate panel in this case reluctantly affirmed the district court’s grant of summary judgment and held that it was bound by our decision in Farlow v. Union Cent. Life Ins. Co., 874 F.2d 791 (11th Cir. 1989). Morstein v. National Ins. Servs., Inc., 74 F.3d 1135, 1138-39 (11th Cir.), vacated and reh’g en banc granted, 81 F.3d 1031 (11th Cir.1996).

The original panel found the facts in this case to be duplicative of the facts in Farlow 3 Id. at 1137. The panel, therefore, was bound to adhere to the holding of Farlow that ERISA preempted a designated beneficiary’s state law misrepresentation and negligence claims against an insurance company and its agent. 4 Following our decision in Farlow, several district courts in our circuit were faced with similar state law claims and attempted to distinguish their cases from Farlow. See Wiesenberg v. Paul Revere Life Ins. Co., 887 F.Supp. 1529, 1532-33 (S.D.Fla.1995) (reasoning that the decision in Farlow was ambiguous with regard to whether its *718 holding applied to independent insurance agent as well as the insurance company, and turning to law in other circuits to support its holding that Wiesenberg’s state law fraud claims against the insurance agency and its agent were not preempted by ERISA); Barnet v. Wainman, 830 F.Supp. 610, 611-12 (S.D.Fla.1993) (finding no preemption of plaintiffs claims against insurance agent for fraudulent misrepresentation because, unlike Farlow, the scope of coverage of plaintiffs claim would not be the focus of the litigation); Martin v. Pate, 749 F.Supp. 242, 246-47 (S.D.Ala.1990) (finding “the applicability of Farlow to the facts of this case” to be “questionable” and holding that plaintiffs state law claim of fraudulent misrepresentation of coverage of policy was not preempted), af f'd, mem. sub nom. Martin v. Continental Investors, 934 F.2d 1265 (11th Cir.1991).

Our decisions in the ERISA preemption area have been neither consistent nor clear. Since Farlow was decided, the Supreme Court and several other circuit courts have issued opinions that clarify the purpose and intent of the ERISA state law preemption doctrine. Furthermore, the conflict among the district courts in our circuit demands that we revisit this issue and attempt to provide some clear guidance in the morass of ERISA preemption law. We find it helpful, therefore, to trace the development of the preemption doctrine before applying the words of the statute to this case.

II. ANALYSIS

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Margery A. Morstein v. National Insurance Services, Inc. Pan American Life Insurance Company the Shaw Agency Scott Hankins, 93 F.3d 715, 20 Employee Benefits Cas. (BNA) 1729, 1996 U.S. App. LEXIS 20848, 1996 WL 468471 (11th Cir. 1996).

93 F.3d 715 (Margery A. Morstein v. National Insurance Services, Inc. Pan American Life Insurance Company the Shaw Agency Scott Hankins) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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