Marshall v. Bankers Life & Casualty Co.

832 P.2d 573, 2 Cal. 4th 1045, 10 Cal. Rptr. 2d 72, 92 Daily Journal DAR 9567, 15 Employee Benefits Cas. (BNA) 2018, 61 U.S.L.W. 2080, 92 Cal. Daily Op. Serv. 6101, 1992 Cal. LEXIS 3053
CourtCalifornia Supreme Court
DecidedJuly 9, 1992
DocketS022055
StatusPublished
Cited by36 cases

This text of 832 P.2d 573 (Marshall v. Bankers Life & Casualty Co.) is published on Counsel Stack Legal Research, covering California Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Marshall v. Bankers Life & Casualty Co., 832 P.2d 573, 2 Cal. 4th 1045, 10 Cal. Rptr. 2d 72, 92 Daily Journal DAR 9567, 15 Employee Benefits Cas. (BNA) 2018, 61 U.S.L.W. 2080, 92 Cal. Daily Op. Serv. 6101, 1992 Cal. LEXIS 3053 (Cal. 1992).

Opinions

Opinion

PANELLI, J.

We granted review in this case to determine whether an employer that purchases a group health insurance policy to cover its employees and their dependents, but whose involvement in administration of benefits under the policy is minimal, thereby establishes an “employee benefit plan” within the meaning of the Employee Retirement Income Security Act of 1974 (ERISA) (29 U.S.C. § 1001 et seq.), so that an action seeking damages under state law for the denial of a claim for policy benefits is preempted by federal law.1 We conclude that an employee benefit plan is established on these facts despite the employer’s minimal involvement in plan administration and complete noninvolvement in claims processing. An action seeking remedies under state law for an improper denial of benefits is, therefore, preempted. (Pilot Life Ins. Co. v. Dedeaux (1987) 481 U.S. 41, 47-57 [95 L.Ed.2d 39, 47-54, 107 S.Ct. 1549]; Commercial Life Ins. Co. v. Superior Court (1988) 47 Cal.3d 473, 484-485 [253 Cal.Rptr. 682, 764 P.2d 1059].)

Background

In 1983 Donald Marshall was employed by Miller Import Datsun, Inc. (Miller Import). Miller Import’s employee manual stated that all employees would be provided with group health insurance coverage. From March 1, 1983, to October 1, 1983, Miller Import provided its employees with health insurance coverage under a group health, life, and disability insurance policy issued by Bankers Life and Casualty Company (Bankers) and administered by Frank B. Hall & Company of Califomia/MIA Administrators (Hall/MIA). All of Miller Import’s employees were covered under the policy. Miller Import allowed its employees to enroll their dependents for coverage under the group policy, and Donald Marshall enrolled his wife, Linda. Miller Import paid the entire cost of premiums for its employees. It also paid the cost of premiums for covered dependents and then deducted those amounts from employees’ paychecks. Hall/MIA billed Miller Import for premiums on a monthly basis.

Miller Import’s role in administration of the policy was minor. It directed its employees to fill out enrollment cards and forms for changes of beneficiaries and dependent coverage; it then submitted the completed cards to [1050]*1050Hall/MIA. Miller Import received, and distributed to its employees, booklets entitled “Your Group Insurance Plan,” containing information about the policy and procedures for filing claims. Additionally, Miller Import gave its employees copies of a three-page letter, prepared by Hall/MIA, explaining coverage under the policy. Miller Import provided its employees with claim forms, which they or their health care providers submitted directly to Hall/MIA. Miller Import neither reviewed nor evaluated claim forms; Hall/ MIA made all determinations regarding eligibility for medical benefits. Miller Import employees were asked to contact Hall/MIA with any questions regarding the policy. However, when employees occasionally asked questions regarding enrollment, coverage changes, and claims, Miller Import personnel would try to respond before contacting Hall/MIA.

Miller Import did not intend to create an ERISA-governed benefit plan, and never filed any reports with the United States Department of Labor with respect to its group insurance policy.

The present suit arose out of the denial of Linda Marshall’s claim for medical benefits. The operative pleading (the fourth amended complaint) alleged that Linda Marshall suffered aftereffects of an aneurysm and brain surgery, requiring hospitalization, during the term of the Bankers policy. Although Hall/MIA confirmed coverage under the policy at the time of her hospitalization, coverage was later revoked and her claims for benefits were denied on the basis that her claim related to a preexisting condition, sickle-cell anemia. The Marshalls sued Bankers and Hall/MIA, alleging breach of the duty of good faith and fair dealing, fraud, intentional infliction of emotional distress, negligence, and violation of Insurance Code section 790.03. Defendants denied liability. Both sides moved unsuccessfully for summary judgment on the issue of whether ERISA preempted the Marshalls’ action. (29 U.S.C. § 1144(a).) That issue was bifurcated for trial on stipulated facts as set forth in the preceding three paragraphs.

The trial court ruled that Miller Import’s insurance program constituted an “employee welfare benefit plan” within the meaning of ERISA, so that the Marshalls’ claims were preempted. Accordingly, it entered judgment for defendants. The Court of Appeal reversed, holding that because there was no administrative activity potentially subject to employer abuse, ERISA was not implicated. For the reasons that follow, we conclude the Court of Appeal erred in focusing on the employer’s involvement in administration of policy benefits.

Analysis

ERISA is a comprehensive federal law designed to promote the interests of employees and their beneficiaries in employee pension and benefit plans. [1051]*1051(Shaw v. Delta Air Lines, Inc. (1983) 463 U.S. 85, 90 [77 L.Ed.2d 490, 496-497, 103 S.Ct. 2890].) As a part of this integrated regulatory system, Congress enacted various safeguards to preclude abuse and to secure the rights and expectations that ERISA brought into being. (29 U.S.C. § 1001; see also Sen. Rep. No. 93-127, 1st Sess., p. 36 (1973).) Prominent among these safeguards is an expansive preemption provision, found at section 514 of ERISA (29 U.S.C. § 1144; Ingersoll-Rand v. McClendon (1990) 498 U.S. 133, _ [112 L.Ed.2d 474, 482-483, 111 S.Ct. 478]; Carpenters So. Cal. Admin. Corp. v. El Capitan Development Co. (1991) 53 Cal.3d 1041, 1047 [282 Cal.Rptr. 277, 811 P.2d 296].)

ERISA’s preemption clause is conspicuous for its breadth, establishing as an area of exclusive federal concern the subject of every State law that “relates to” an employee benefit plan governed by ERISA. (FMC Corp. v. Holliday (1990) 498 U.S. 52, _ [112 L.Ed.2d 356, 364, 111 S.Ct. 403].) ERISA preempts “any and all State laws insofar as they . . . relate to any employee benefit plan,” except laws “which regulate insurance . . . .” (29 U.S.C. § 1144(a), (b)(2)(A).) An employee benefit plan is not deemed to be an insurance company or other insurer, or to be engaged in the business of insurance, for purposes of any state law purporting to regulate insurance companies or insurance contracts. (29 U.S.C. § 1144(b)(2)(B).)

In Pilot Life Ins. Co. v. Dedeaux, supra, 481 U.S. 41

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Bluebook (online)
832 P.2d 573, 2 Cal. 4th 1045, 10 Cal. Rptr. 2d 72, 92 Daily Journal DAR 9567, 15 Employee Benefits Cas. (BNA) 2018, 61 U.S.L.W. 2080, 92 Cal. Daily Op. Serv. 6101, 1992 Cal. LEXIS 3053, Counsel Stack Legal Research, https://law.counselstack.com/opinion/marshall-v-bankers-life-casualty-co-cal-1992.