Pipefitters Local 636 Insurance Fund v. Blue Cross Blue Shield of Michigan

654 F.3d 618, 52 Employee Benefits Cas. (BNA) 1590, 2011 U.S. App. LEXIS 16624, 2011 WL 3524325
CourtCourt of Appeals for the Sixth Circuit
DecidedAugust 12, 2011
Docket09-2607
StatusPublished
Cited by79 cases

This text of 654 F.3d 618 (Pipefitters Local 636 Insurance Fund v. Blue Cross Blue Shield of Michigan) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pipefitters Local 636 Insurance Fund v. Blue Cross Blue Shield of Michigan, 654 F.3d 618, 52 Employee Benefits Cas. (BNA) 1590, 2011 U.S. App. LEXIS 16624, 2011 WL 3524325 (6th Cir. 2011).

Opinions

OPINION

SUHRHEINRICH, Circuit Judge.

Defendant-Appellant, Blue Cross Blue Shield of Michigan (“BCBSM”), brings this interlocutory appeal following the district court’s certification of a class action on behalf of Plaintiffs-Appellees, Pipefitters Local 636 Insurance Fund and its Trustees (“Fund”), and the proposed class, in this action brought under the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. §§ 1001 et seq. Because this class action is not the superior method of adjudication required under Federal Rule of Civil Procedure 23(b)(3), and prosecuting separate actions does not present the risk of inconsistent adjudications required under Federal Rule of Civil Procedure 23(b)(1)(A), we REVERSE.

I. BACKGROUND

This case is the subject of a prior appeal, Pipefitters Local 636 v. Blue Cross & [622]*622Blue Shield of Mich. (Pipefitters I), 213 Fed.Appx. 473 (6th Cir.2007), as well as a companion appeal, decided on April 6, 2011, Pipefitters Local 636 Ins. Fund v. Blue Cross & Blue Shield of Mich. (Pipefitters II), 418 Fed.Appx. 430 (6th Cir. 2011) (unpublished).1 We adopt the background as set forth in our Pipefitters I opinion:

The [Fund] is a multiemployer trust fund administered pursuant to ERISA and the Labor Management Relations Act, 29 U.S.C. § 186, for the purpose of providing health and welfare benefits to its participants and beneficiaries. For several years, the Fund was an insured group customer of BCBSM, purchasing insurance coverage by paying premiums. The Fund converted in June 2002 to a self-funded plan, providing benefits by using fund assets. At that time, the Fund entered into an Administrative Services Contract (“ASC”) with BCBSM for services including: claims processing; financial' management and reporting; negotiation of participating provider agreements; cost containment initiatives; maintenance of all necessary records; and provision of information through established audit procedures.
Under the terms of the ASC, the Fund agreed to pay claims and administrative charges, including amounts billed during the year, hospital prepayments, actual administrative charges and group conversion fee, any late payment charges, statutory and/or contractual interest, and “[a]ny other amounts which are the Fund’s responsibility pursuant to this Contract.” The ASC also states that “[t]he Provider Network Fee, contingency, and any cost transfer subsidies or surcharges ordered by the State Insurance Commissioner as authorized pursuant to [Michigan law] will be reflected in the hospital claims cost contained in Amounts Billed.”
From June 2002 to January 2004, BCBSM collected from the Fund [a cost transfer subsidy fee, known as the Other-Than-Group (“OTG”) subsidy,] to subsidize coverage for non-group clients. The OTG subsidy was regularly collected from BCBSM’s group clients. Self-insured clients, however, were not always required to pay the fee, and the parties dispute whether Michigan law authorized the imposition of OTG subsidy fees on such clients. In January 2004, BCBSM unilaterally eliminated the OTG subsidy charge to the Fund.

Id. at 474-475 (some alterations in original) (footnotes omitted) (citations omitted).

In September 2004, the Fund sued BCBSM, alleging that BCBSM breached its fiduciary duty under ERISA by imposing and failing to disclose the OTG subsidy from June 2002 to January 2004. Specifically, the Fund claimed that the OTG assessment violated Mich. Comp. Laws § 550.1211(2), which precludes some cost transfers between self-funded subscribers and BCBSM.

BCBSM moved for dismissal under Federal Rule of Civil Procedure 12(b)(6), asserting that it was not acting as an ERISA fiduciary when it assessed the OTG fee. The district court dismissed the claim and [623]*623the Fund appealed. On appeal, we decided that the Fund had sufficiently stated a claim for a breach of fiduciary duty under ERISA and reversed and remanded for further proceedings. Pipefitters I, 213 Fed.Appx. at 480. Specifically, we set forth rules for defining what constituted an ERISA fiduciary:

Under ERISA, a third-party administrator such as BCBSM is deemed a fiduciary to the extent that it exercises “discretionary authority or discretionary control respecting management of [a] plan or ... any authority or control respecting management or disposition of its assets.” 29 U.S.C. § 1002(21)(A)(i)....
ERISA defines “fiduciary” in functional terms with regard to each action in question. See Hamilton v. Carell, 243 F.3d 992, 998 (6th Cir.2001).... ERISA “does not describe fiduciaries simply as administrators of the plan,” but evaluates the fiduciary role “to the extent that [an administrator] acts in such a capacity in relation to the plan.” [Pegram v. Herdrich, 530 U.S. 211, 225, 120 S.Ct. 2143, 147 L.Ed.2d 164 (2000) ] (quotation marks and citation omitted).
Under ERISA, fiduciary duties arise where an administrator exerts “any authority or control respecting management or disposition of [a fund’s] assets.” [29 U.S.C.] § 1002(21)(A). An administrator is deemed a fiduciary when it exercises “ ‘practical control^, gver an ERISA plan’s money.’ ” [Briscoe v. Fine, 444 F.3d 478, 494 (6th Cir.2006) ] (quoting IT Corp. v. Gen. Am. Life Ins. Co., 107 F.3d 1415, 1421 (9th Cir.1997)). The administrator’s “disposition of funds held in an account over which it exerted control makes it a fiduciary to the extent that it exercised such control.” Id. at 490. Discretion in the disposition of plan assets is not required; it is “irrelevant whether [the administrator] exercised ‘discretion’.... ‘[A]ny authority or control’ is enough.” Chao v. Day, 436 F.3d 234, 236 (D.C.Cir.2006).
A fiduciary relationship does not exist, however, where an administrator “performs purely ministerial functions such as processing claims, applying plan eligibility rules, communicating with employees, and calculating benefits.” Baxter v. C.A. Muer Corp., 941 F.2d 451, 455 (6th Cir.1991). Fiduciary authority must amount to more than “mere possession, or custody over the plant’s] assets.” Briscoe, 444 F.3d at 494 (quotations omitted). In addition, fiduciary status under ERISA does not apply where “parties enter into a contract term at arm’s length and where the term confers on one party the ...

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654 F.3d 618, 52 Employee Benefits Cas. (BNA) 1590, 2011 U.S. App. LEXIS 16624, 2011 WL 3524325, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pipefitters-local-636-insurance-fund-v-blue-cross-blue-shield-of-michigan-ca6-2011.