McInnis v. Provident Life & Accident Insurance

21 F.3d 586
CourtCourt of Appeals for the Fourth Circuit
DecidedApril 12, 1994
DocketNo. 93-2003
StatusPublished
Cited by10 cases

This text of 21 F.3d 586 (McInnis v. Provident Life & Accident Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fourth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
McInnis v. Provident Life & Accident Insurance, 21 F.3d 586 (4th Cir. 1994).

Opinion

Affirmed by published opinion. Judge NIEMEYER wrote the opinion, in which Senior Judge BUTZNER and Judge ELLIS joined.

OPINION

NIEMEYER, Circuit Judge:

The employee benefit plan sponsored by Fruit of the Loom, Inc., provides medical [587]*587benefits to employees for injuries caused by third parties, provided that any employee making a claim agrees to reimburse the plan if the employee recovers payment from the third party. North Carolina’s wrongful death statute, N.C.Gen.Stat. § 28A-18-2, however, places a limit on such reimbursement from the estate of a deceased. The question presented here is whether the employee benefit plan must pay medical benefits to the estate of a deceased plan participant and be denied reimbursement under the North Carolina statute or, in the alternative, whether the North Carolina statute is preempted by ERISA. For the reasons that follow, we hold that in the circumstances of this case ERISA preempts the operation of the North Carolina statute.

I

On February 26, 1990, in Moore County, North Carolina, an automobile driven by Jeffrey C. Mclnnis was struck head-on by an automobile operated by Leon Hinson, who was intoxicated at the time. Jeffrey Mcln-nis’ wife, Lori McInnis, who was riding in the passenger’s seat, was seriously injured and hospitalized. Two weeks later, she died from her injuries. She was survived by her husband, who was appointed the administrator of her estate, and by a three-year-old child.

The insurance company covering Hinson offered to settle any claims against Hinson for the policy limit of $25,000, and the insurance company covering the Mclnnis vehicle offered to settle a claim under that company’s underinsurance coverage for $175,000. On the petition of Jeffrey Mclnnis as the administrator, the Superior Court in Richmond County, North Carolina, approved the settlement, as required by the North Carolina’s wrongful death statute, N.C.Gen.Stat. § 28A-13-3(a)(23), finding the settlement total of $200,000 to be “in the best interest of the Estate of Lori Smith Mclnnis, and the beneficiaries of said Estate, to wit: Jeffrey Charles Mclnnis and the minor, Joshua H. Mclnnis.” (Emphasis added).

Following the settlement, Jeffrey Mclnnis submitted a claim in the amount of $58,121 to the welfare benefit plan provided by Lori Mclnnis’ employer, Martin Mills, Inc., a subsidiary of Fruit of the Loom, Inc., for reimbursement of hospital expenses incurred by Lori Mclnnis before her death. The welfare benefit plan, which provided group life insurance and medical benefits for employees of Fruit of the Loom and its subsidiaries, was sponsored by Fruit of the Loom and issued by Provident Life and Accident Insurance Company (“Provident Life”). Lori Mclnnis concededly was covered by the plan as an employee of a subsidiary. Fruit of the Loom indicated that it would advance the medical benefits to Jeffrey Mclnnis, but only if he executed an “Acts of the Third Party” agreement as specified in the plan.1 Fruit of the Loom explained its position further in a letter to Mclnnis:

Fruit of the Loom Group Medical Plan does not provide coverage for injuries caused by a third party. Benefits, however, may be advanced only if the injured party executes an “Acts of Third Party” Agreement. This agreement státes that the injured party will reimburse the plan for the funds advanced upon recovery of a judgment or settlement from the third party-

McInnis refused to execute the agreement because, he claimed, such an agreement would force the estate to pay out medical expenses beyond an amount permitted by the state’s wrongful death statute. The applicable state act provided, in pertinent part:

The amount recovered in such action [by reason of the death of a person] is not [588]*588liable to be applied as assets, in the payment of debts or legacies, except as to burial expenses of -the deceased, and rear sonable hospital and medical expenses not exceeding one thousand five hundred dollars ($1,500) incident to the injury resulting in death.

N.C.Gen.Stat. § 28A-18-2(a) (emphasis added).2 Because Melnnis refused to execute the “Acts of Third Parties” agreement, Fruit of the Loom refused to advance medical payments under the terms of the plan.

Melnnis filed suit against Provident Life, Fruit of the Loom, and its subsidiary, Martin Mills. On the defendants’ motion for summary judgment, the district court entered judgment for the defendants, concluding that the “Acts of Third Parties” clause in Lori Melnnis’ plan was enforceable because the plan was covered by ERISA and because ERISA preempted any conflicting state provision. This appeal followed.

II.

Melnnis contends that, as administrator and successor in interest to Lori Melnnis’ rights under the plan, he is entitled to medical benefits for Lori Melnnis’ hospital expenses in the amount of $58,121. While he recognizes that the terms of the plan also require him to repay those benefits to the plan if he recovered for Lori Melnnis’ injuries from third parties, he contends that the North Carolina statute prohibits him from expending more than $1,500 in estate assets for such repayment. He thus claims that under state law, he cannot sign the payback agreement required by the plan.

Fruit of the Loom argues that to the extent the North Carolina statute alters the terms of a plan covered by ERISA, it is preempted by ERISA. It argues, in addition, that under principles of contract law, since Melnnis failed to satisfy the plan’s condition precedent to payment of medical benefits by not executing the payback agreement, Melnnis is not entitled to benefits. Fruit of the Loom asserts that advancing benefits •without a payback obligation would alter the terms of the plan in favor of Melnnis and to the possible detriment of others not implicated by the North Carolina statute.

Melnnis argues that the resolution of the issue is governed by our decision in Liberty Corp. v. NCNB, 984 F.2d 1383 (4th Cir.1993), where we held that, in the circumstances presented there, ERISA did not preempt the North Carolina wrongful death statute’s limitation on recovery of medical expenses. N.C.Gen.Stat. § 28A-18-2. Although Fruit of the Loom seeks to distinguish Liberty on the basis that the plan there did not impose a condition precedent to the payment of benefits, the critical issue is whether ERISA preempts application of the North Carolina statute under the circumstances of this case.

The broad scope of ERISA’s preemption has been frequently articulated. The Act provides:

Except as provided in subsection (b) of this section, the provisions of [ERISA] shall supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan.

29 U.S.C. § 1144(a) (emphasis added). The first step in the preemption analysis is to determine whether the purported claim “relates” to an employee benefit plan. See Custer v. Pan American Life Ins. Co., 12 F.3d 410, 418 (4th Cir.1993). The phrase “relates to” is given a broad, common sense meaning — “[a] law ‘relates to’ an employee benefit plan, in the normal sense of the phrase, if it has a connection with or reference to such a plan.”

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Kameron M. v. SSA Commissioner
N.D. California, 2025
Barrett v. Kijakazi
E.D. Washington, 2023
Dold v. Snohomish County
W.D. Washington, 2022
Rainwater v. Kijakazi
E.D. Washington, 2022
Simpson v. Saul
N.D. California, 2021
Byrne v. Kijakazi
E.D. Washington, 2021

Cite This Page — Counsel Stack

Bluebook (online)
21 F.3d 586, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mcinnis-v-provident-life-accident-insurance-ca4-1994.