Pitts v. American National Insurance

836 F. Supp. 1280, 1993 U.S. Dist. LEXIS 19673, 1993 WL 452521
CourtDistrict Court, S.D. Mississippi
DecidedNovember 1, 1993
DocketNo. 2:92-cv-227PS
StatusPublished
Cited by1 cases

This text of 836 F. Supp. 1280 (Pitts v. American National Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. Mississippi primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pitts v. American National Insurance, 836 F. Supp. 1280, 1993 U.S. Dist. LEXIS 19673, 1993 WL 452521 (S.D. Miss. 1993).

Opinion

[1282]*1282MEMORANDUM OPINION AND ORDER

PICKERING, District Judge.

This matter is before the Court on Motion for Partial Summary Judgment filed on behalf of the Plaintiff requesting a finding that this case is not governed by ERISA and on a separate Motion for Partial Summary Judgment filed on behalf of the plaintiff on the issue of whether defendant’s coverage is primary or secondary to Medicare. The Court, having reviewed the motions, the responses, the briefs of the parties, the authorities cited, and being fully advised in the premise, finds as follows, to-wit;

FACTUAL BACKGROUND

Gregory Pitts suffered permanent brain damage in an accident in January, 1986 while employed with United Plumbing, Inc. of Ellisville, Mississippi. Prior to that time, American Security Life Insurance Company, the predecessor company of the defendant herein, had issued a policy of health insurance to United covering its employees including Gregory Pitts. After paying more than $100,000 in benefits relating to Pitts’ injury, defendant elected to terminate the policy for alleged policy violations which occurred prior to Pitts’ accident. Thereafter, in October, 1986, Pitts filed suit in state court for an adjudication of the enforceability of the policy, as well as for certain specified damages under state law. That suit was removed to this court and tried in 1989 and affirmed by the Fifth Circuit on May 21, 1991. See Pitts By and Through Pitts v. American Sec. Life, 931 F.2d 351 (5th Cir.1991).

The Fifth Circuit affirmed the district court’s finding that Gregory Pitts was entitled “to coverage for all medical expenses resulting from the injury”, that “[t]his matter is governed by ... (ERISA)”, and that plaintiffs claims for bad faith breach of contract and punitive damages were preempted by ERISA. Id., at 354-58. Plaintiff filed the instant action in November, 1992 to enforce payment of certain medical expenses incurred by Gregory Pitts and not paid by defendant even after the Fifth Circuit decision. Plaintiff alleges that since defendant canceled the policy in question in April, 1987, his claims do not “relate to” an ERISA plan and thus cannot be preempted. Defendant alleges that it is responsible only for those medical expenses of Gregory Pitts that are in excess of those payable by Medicare and that plaintiff has not cooperated in coordinating with Medicare and thus defendant has not been in a position to pay claims due. Plaintiff asserts that this “forced coordination” of benefits by defendant with Medicare is a breach of State law, federal law and public policy and one ground to which he is entitled to collect damages for. He also claims entitlement to damages for defendant’s alleged bad faith failure to comply with the 1991 order of the Fifth Circuit.

STANDARD OF REVIEW

The Federal Rules of Civil Procedure, Rule 56(c) authorizes summary judgment where “the pleadings, depositions, answers to interrogatories and admissions on file, together with affidavits, if any, show that there is no genuine dispute as to any material fact and that the moving party is entitled to judgment as a matter of law.” Celotex Corporation v. Catrett, 477 U.S. 317, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). A Judge’s function at the summary judgment stage is not himself to weigh the evidence and determine the truth of the matter, but to determine whether there is a genuine issue for trial. There is no issue for trial unless there is sufficient evidence favoring the non-moving party for a jury to return a verdict for that party. If the evidence is merely colorable, or is not significantly probative, summary judgment may be granted. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986).

Although Rule 56 is peculiarly adapted to the disposition of legal questions, it is not limited to that role. Professional Managers, Inc. v. Fawer, Brian, Hardy & Zatzkis, 799 F.2d 218, 222 (5th Cir.1986). “The mere existence of a disputed factual issue, therefore, does not foreclose summary judgment. The dispute must be genuine, and the facts must be material.” Id. “With regal’d to ‘materiality’, only those disputes over facts that might affect the outcome of the lawsuit under the governing substantive law will preclude summary judgment.” Phillips Oil [1283]*1283Company v. OKC Corporation, 812 F.2d 265, 272 (5th Cir.1987).

In making its determinations of fact on a motion for summary judgment, the Court must view the evidence submitted by the parties in a light most favorable to the non-moving party. McPherson v. Rankin, 736 F.2d 175, 178 (5th Cir.1984).

The moving party has the duty to demonstrate the lack of a genuine issue of material fact and the appropriateness of judgment as a matter of law to prevail on his motion.Union Planters Nat. Leasing v. Woods, 687 F.2d 117 (5th Cir.1982). Once a properly supported motion for summary judgment is presented, the nonmoving party must rebut with “significant probative” evidence. Ferguson v. National Broadcasting Co., Inc., 584 F.2d 111, 114 (5th Cir.1978). In other words, “the nonmoving litigant is required to bring forward ‘significant probative evidence’ demonstrating the existence of a triable issue of fact.” In re Municipal Bond Reporting Antitrust Lit, 672 F.2d 436 (5th Cir.1982). To defend against a proper summary judgment motion, one may not rely on mere denial of material facts nor on unsworn allegations in the pleadings or arguments and assertions in briefs or legal memoranda. The nonmoving party’s response, by affidavit or otherwise, must set forth specific facts showing that there is a genuine issue for trial. Rule 56(e), Fed.R.Civ.P. See also, Union Planters Nat. Leasing v. Woods, 687 F.2d at 119.

PLAINTIFF’S THEORIES

Plaintiff advances two basic theories as to why his claims are not preempted by ERISA. First, he argues that the policy of insurance at issue here is not an employee benefit plan under ERISA because it was canceled in April, 1987. He next argues that defendant’s conduct since the ruling of the Fifth Circuit is so egregious that it has been stripped of its ERISA protection. In the opinion of this Court, the decision of the Fifth Circuit holding that “this matter is governed by the provisions of the Employee Retirement Income Security Act of 1974 (ERISA)”, Pitts By and Through Pitts v. American Sec. Life, 931 F.2d at 354, is dispositive of this matter.

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Bluebook (online)
836 F. Supp. 1280, 1993 U.S. Dist. LEXIS 19673, 1993 WL 452521, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pitts-v-american-national-insurance-mssd-1993.