Peters v. Boulder Insurance Agency, Inc.

829 P.2d 429, 15 Brief Times Rptr. 1163, 1991 Colo. App. LEXIS 268, 1991 WL 166216
CourtColorado Court of Appeals
DecidedAugust 29, 1991
Docket89CA0182
StatusPublished
Cited by7 cases

This text of 829 P.2d 429 (Peters v. Boulder Insurance Agency, Inc.) is published on Counsel Stack Legal Research, covering Colorado Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Peters v. Boulder Insurance Agency, Inc., 829 P.2d 429, 15 Brief Times Rptr. 1163, 1991 Colo. App. LEXIS 268, 1991 WL 166216 (Colo. Ct. App. 1991).

Opinion

Opinion by

Judge JONES.

Defendants, Boulder Insurance Agency, Inc. (Boulder), and Durham Life Insurance Company, appeal from a judgment entered against them based upon their refusal to pay insurance claims asserted by plaintiff, Steven Peters. Defendants assert that plaintiffs common law claims are preempted under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001, et seq. (1974). Defendants further assert that the trial court improperly instructed the jury as to a “hybrid” theory of recovery which combined elements of es-toppel and reasonable expectations. Plaintiff cross-appeals the trial court’s decision to enter a directed verdict in favor of the defendants on the issue of punitive damages. We affirm.

Boulder administered a multiple employer trust (MET) health insurance program in which small unrelated employers could pool premiums in order to obtain more favorable coverage and rates. This program, entitled “Group Benefits Trust,” was underwritten by Durham Life Insurance Company. Paragon Standard Corporation (Paragon) was one of approximately 450 employers participating in the program.

In June 1985, plaintiff entered into a venture capital agreement with Robert Davis, a co-owner of Paragon and several other related small companies, in which Davis agreed to finance a new company, Aero Defense Recruiting Technologies, Inc., in return for a 51% interest in that company.

Davis informed plaintiff that he would receive health insurance and instructed him to fill out an insurance application and to list Paragon as his employer. Plaintiff did as he was instructed.

Soon thereafter, Paragon began winding down, and another of Davis’ companies, Guarantor, began issuing checks for premium payments to defendant in Paragon’s place. For this reason, plaintiff considered that Boulder was on notice that Paragon was not his technical employer as the MET required.

In August 1985, Boulder received a claim by plaintiff in which he listed his employer as AERO/Defense. Ignoring the issue of plaintiff’s rightful employer, Boulder denied the claim on the basis that plaintiff’s insurance coverage would not become effective until September 1, 1985. Several days later, Boulder issued a policy and certificate of insurance to plaintiff. Both of these actions led plaintiff to believe that he was insured, despite the technical error in listing his employer as Paragon.

On September 4, 1985, plaintiff sustained serious injuries in an automobile accident. Plaintiff once again submitted claims to Boulder listing his employer as AERO/De-fense.

*432 More than five months after the accident, Boulder denied coverage. It directed plaintiff to submit the claim to his automobile insurance carrier, in spite of plaintiffs verbal and written notification to Boulder that he had no automobile insurance coverage for this accident.

Finally, over eight months after the accident, Boulder denied the claim based upon plaintiffs lack of eligibility.

The trial court denied defendants’ pretrial motion to dismiss plaintiffs claim of breach of contract and bad faith breach of contract based upon ERISA preemption. At trial, plaintiff recovered under both theories.

I.

Defendants first contend that the trial court erred in failing to grant defendant’s motion to dismiss based upon ERISA, in denying their motion for directed verdict, and in refusing to submit to the jury the issue of whether an ERISA plan was involved here. We do not agree.

Conflicts involving insurance claims which arise out of insurance programs covered by ERISA are preempted by the Act and must be resolved in the federal courts. Furthermore, under such circumstances, state law, and common law claims relating to the same subject matter cannot be considered. See Taggert Corp. v. Life & Health Benefits Administration, 617 F.2d 1208 (5th Cir.1980).

Here, for ERISA to apply, and thereby preempt plaintiff’s state law claims, defendants were required to show affirmatively that Paragon “established or maintained” an “employee welfare benefit plan” as set forth in 29 U.S.C. § 1002 (1974).

The existence of an ERISA plan is a question of fact to be resolved in light of all the surrounding facts and circumstances from the point of view of a reasonable person. Kanne v. Connecticut General Life Insurance Co., 859 F.2d 96 (9th Cir.1988).

In determining whether an ERISA plan exists, courts have focused on the level of involvement by the employer in the program so as to warrant regulation of the administrative integrity of the program. See Fort Halifax Packing Co. v. Coyne, 482 U.S. 1, 107 S.Ct. 2211, 96 L.Ed.2d 1 (1987). This focus is proper because ERISA’s fiduciary standards were intended to prevent abuses of the special responsibilities borne by those dealing with such plans and to shield employees from self-dealing, imprudent investing, and misappropriation of plan funds. Fort Halifax Packing Co. v. Coyne, supra.

In support of its contention that Paragon “established or maintained” the group insurance plan at issue in this case, defendants do little more than assert that Paragon paid insurance premiums on behalf of the plaintiff. That is insufficient to meet the ERISA criteria.

Although the case law in this area is somewhat contradictory, nearly all courts facing this issue have concluded that the bare purchase of insurance does not conclusively establish an ERISA plan. See Tag-gert v. Life & Health Benefits Administration, supra (ERISA does not regulate the bare purchase of health insurance if the purchasing employer neither directly nor indirectly owns, controls, administers, or assumes responsibility for the policy or its benefits); Donovan v. Dillingham, 688 F.2d 1367 (11th Cir.1982) (the purchase of insurance does not conclusively establish a plan, fund, or program although it is evidence of such).

Here, defendants failed to present evidence showing that Paragon maintained any significant administrative role in the operation of the group insurance plan. Moreover, the record reflects that Paragon possessed no control, or right of control, over any of the decisions made regarding the handling of the trust and its administration.

Defendants rely on Donovan v. Dillingham, supra, for the proposition that an ERISA plan may be established where the employer merely contributes toward payment of premiums. This reliance is misplaced.

*433 The court in Dillingham

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829 P.2d 429, 15 Brief Times Rptr. 1163, 1991 Colo. App. LEXIS 268, 1991 WL 166216, Counsel Stack Legal Research, https://law.counselstack.com/opinion/peters-v-boulder-insurance-agency-inc-coloctapp-1991.