Pens. Plan Guide P 23909w

48 F.3d 1231
CourtCourt of Appeals for the Tenth Circuit
DecidedDecember 31, 1995
Docket1231
StatusPublished

This text of 48 F.3d 1231 (Pens. Plan Guide P 23909w) is published on Counsel Stack Legal Research, covering Court of Appeals for the Tenth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pens. Plan Guide P 23909w, 48 F.3d 1231 (10th Cir. 1995).

Opinion

48 F.3d 1231

Pens. Plan Guide P 23909W

NOTICE: Although citation of unpublished opinions remains unfavored, unpublished opinions may now be cited if the opinion has persuasive value on a material issue, and a copy is attached to the citing document or, if cited in oral argument, copies are furnished to the Court and all parties. See General Order of November 29, 1993, suspending 10th Cir. Rule 36.3 until December 31, 1995, or further order.

Margaret T. BIAVA, personal representative of the Estate of
William E. Biava, Plaintiff-Appellee, Cross-Appellant,
v.
INSURERS ADMINISTRATIVE CORPORATION, an Arizona Corporation;
NN INVESTORS LIFE INSURANCE COMPANY, INC., also known as
PFL Life Insurance Company, an Iowa Corporation,
Defendants-Appellants, Cross-Appellees.

Nos. 94-2013, 94-2014.

United States Court of Appeals, Tenth Circuit.

March 1, 1995.

Before MOORE and BARRETT, Circuit Judges, and DOWNES*, District Judge.

ORDER AND JUDGMENT1

Insurers Administrative Corporation (IAC), NN Investors Life Insurance Company, Inc., also known as PFL Life Insurance Company

(PFL), hereinafter collectively referred to as appellants, appeal from a judgment entered in favor of William E. Biava, appellee.2 Biava cross-appeals from an order of the court denying his motion for attorney fees. A summary of the relevant facts follows.

Biava was president, chief executive officer, and director of Assaigai Analytical Laboratories, Inc. (Assaigai), a small family-owned New Mexico company, from October, 1985, until April, 1987. From April, 1987, until July, 1989, Biava worked at least 30 hours per week for Assaigai on marketing, diversification, and the acquisition of new business. Although Assaigai did not pay Biava a salary, it did pay for his work-related expenses and health insurance premiums. In January, 1989, Biava also received 1,350 shares of Assaigai stock for work he had performed.

In August, 1988, Assaigai established a plan of group health insurance for its eleven employees. IAC was the administrator of the plan and PFL was the underwriter for the group insurance provider. Insurance coverage extended to Assaigai's employees, defined as "person[s] directly employed and actively at work on a full-time basis of at least thirty (30) hours per week, in the regular course of business of, and compensated for services by, the Participating Employer [Assaigai]." (Appellants' Appendix, Tab 6 at 5). Assaigai paid 50% of the insurance premiums for each of its employees except Biava, for whom it paid 100% of the insurance premiums.

Biava's "eligibility for coverage under the plan was based on [his] application which was forged and submitted to IAC and PFL by their agents, Pat Corcoran and Eric Lane, stating that Biava was an active, full time employee of Assaigai working at least 30 hours per week and compensated at the rate of $5,000 per month." Id. at 2. Biava did not review or sign the forged application; he became a beneficiary under the plan based on the forged application. Id.

During December, 1988, and January, 1989, Corcoran and Lane were investigated by the New Mexico Superintendent of Insurance. Although IAC and PFL became aware that Corcoran's and Lane's insurance agency licenses were revoked due to fraudulent activity, they did not request new applications from Assaigai or its employees and they continued to accept the insurance premiums paid by Assaigai on behalf of Biava and other employees. Id. Assaigai's president, Biava's son, Assaigai's administrative manager, Biava's daughter-in-law, and Biava all understood and believed that Biava was covered by the plan. Id. at 4-5.

In 1989, Biava developed severe medical problems which resulted in his hospitalization at the University of New Mexico Hospital (Hospital) on July 7, 1989, and on several subsequent occasions. Prior to treating Biava, Hospital contacted IAC to verify that he was insured and that his anticipated treatment was covered. IAC advised Hospital that Biava was insured and that the anticipated treatment was covered. Biava executed a written assignment of his benefits under the plan to Hospital prior to receiving treatment. (Appellants' Appendix, Tab 10 at 4).

In March, 1990, IAC became aware that: Biava's hospital records indicated that he was retired; Biava was not listed as an employee on the quarterly unemployment tax returns filed by Assaigai with the State of New Mexico; and Biava was not listed as an officer or director of Assaigai in the articles of incorporation filed with the New Mexico State Corporation Commission.

On May 2, 1990, IAC advised Biava by letter that his coverage under the plan was rescinded as of August 1, 1988, the date the group policy was issued, based on the belief that he was not an employee as defined in the policy. In May, 1990, IAC attempted to refund to Assaigai the premiums it had paid on Biava's behalf. Assaigai refused to accept the refund. Assaigai continued to send IAC $238 per month to cover Biava's premiums through July, 1990.

After IAC refused to pay Hospital for Biava's treatment, Biava filed an action in state court. Appellants removed the action to federal district court, where Biava filed an action pursuant to the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq.

Following a two-day trial to the court, the district court entered judgment on February 2, 1993, in favor of Biava and against appellants in the amount of $100,560.12. The court reserved ruling on Biava's motion for attorney's fees, costs and prejudgment interest. On April 13, 1993, the district court entered a memorandum opinion and order denying Biava attorney's fees and costs and awarding him prejudgment interest at a rate of 15% per year pursuant to NMSA 56-8-4 (1978).

On July 20, 1993, the court entered an amended partial judgment superceding its February 2, 1993, judgment, wherein the court stated that the $100,560.12 awarded Biava under the February 2, 1993, judgment "... may not comport with the actual benefits payable under the terms of the plan." (Appellants' Appendix, Tab 9 at 1). The court reserved ruling on the monetary amount due and whether the award should be paid to Biava or directly to his medical care providers.

The court entered an amended judgment on December 10, 1993, in which it: awarded Biava judgment against appellants for benefits under the plan of $80,899.56; ordered that the $80,899.56 was to be disbursed directly to the medical providers; and ordered defendants to pay Biava prejudgment interest at a rate of 15% per year from May 2, 1990 on $80,899.56.

On appeal, appellants contend that the district court erred in concluding that Biava was eligible for benefits under the plan and in awarding prejudgment interest. Biava cross-appeals, contending that the court erred in refusing to award him attorney's fees.

I.

Appellants contend that the district court's conclusion that Biava was eligible for benefits under the plan must be reversed.

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Bluebook (online)
48 F.3d 1231, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pens-plan-guide-p-23909w-ca10-1995.