Poole v. Monmouth College

603 A.2d 118, 254 N.J. Super. 154
CourtNew Jersey Superior Court Appellate Division
DecidedJuly 17, 1991
StatusPublished
Cited by3 cases

This text of 603 A.2d 118 (Poole v. Monmouth College) is published on Counsel Stack Legal Research, covering New Jersey Superior Court Appellate Division primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Poole v. Monmouth College, 603 A.2d 118, 254 N.J. Super. 154 (N.J. Ct. App. 1991).

Opinion

254 N.J. Super. 154 (1991)
603 A.2d 118

GERTRUDE M. POOLE, PLAINTIFF,
v.
MONMOUTH COLLEGE, A NON-PROFIT ORGANIZATION, DEFENDANT.

Superior Court of New Jersey, Chancery Division Monmouth County.

Decided July 17, 1991.

*157 Robert J. Haney (Carchman, Annich & Sochor, attorneys), for plaintiff.

Howard I. Masia (Chamlin, Rosen, Cavanagh, Uliano & Manna, attorneys), for defendant.

CUFF, J.S.C.

Plaintiff, Gertrude Poole, a former employee of Monmouth College, brings this action pursuant to 29 U.S.C.A. § 1132(a)(1)(B) to recover health benefits due to her under the terms of her employee health benefit plan, to enforce her rights under the terms of the plan and to clarify her rights to future benefits under the terms of the plan. Jurisdiction in this court is predicated on 29 U.S.C.A. § 1132(e). The following constitutes the undisputed facts in this case:

Gertrude M. Poole had been employed by Monmouth College, a private employer, since 1982. She had health problems before her employment and was evaluated for open heart surgery during her employment. In 1987, she applied for and was considered for medical leave of absence. By November 1989, it was clear that she would be terminated on or about January 2, *158 1990 due to failure to achieve tenure and the expiration of her last contract period. At that time, she was provided with a COBRA benefit letter, describing her entitlement to 18 months of eligibility for group health coverage following termination, so called "COBRA continuation coverage." Poole acknowledged receipt of the notice on November 13, 1989 and elected to continue coverage thereunder on or about February 27, 1990.

On December 19, 1989, certain amendments became effective which allowed a person eligible for COBRA continuation benefits to obtain an additional 11 months of eligibility, i.e. a total of 29 months, if the participant is determined eligible for disability benefits under the Social Security Act after termination of employment. Poole was not notified of this amendment and the possibility of extended benefits prior to her termination on January 2, 1990 or prior to her election of benefits on February 27, 1990, or at any time prior to her inquiry in August 1990. Shortly after January 2, 1990, Poole applied for Social Security disability insurance. On March 5, 1990, Poole was determined by the Social Security Administration to be entitled to Social Security disability insurance payments, and it was also determined that she had been disabled as of December 29, 1989, prior to her termination.

Poole learned of the amendment and the extended benefits on her own in August 1990, which was within the existing 18-month COBRA coverage, and promptly notified Monmouth College of her right to an extension. Monmouth College replied in November 1990, denying Poole was entitled to coverage for 29 months, stating that the college did not have a record of her disability at the time of her termination.

Two issues are before this court: 1) whether this court has jurisdiction to grant the requested relief; and 2) whether, assuming jurisdiction, Gertrude Poole is entitled to 29 months of COBRA continuation benefits.

The threshold issue is jurisdiction. Defendant argues that, having filed a complaint with the United States Department *159 of Labor, plaintiff is precluded from initiating this action. Defendant does not dispute that, but for the administrative claim, this court has jurisdiction pursuant to 29 U.S.C.A. § 1132(e) for civil actions brought pursuant to 29 U.S.C.A. § 1132(a)(1)(B).[1]

The sole relief a state court may grant is recovery of benefits, enforcement or clarification of rights under the plan. The injunctive relief authorized by 29 U.S.C.A. § 1132(a)(3) is not within the concurrent jurisdiction of a state court. Thus, a state court may not exercise its full equitable jurisdiction, although the practical effect of enforcement of rights under the plan may yield the same results. Gresham v. Mass. Mut. Life Ins. Co., 248 N.J. Super. 64, 69-70, 590 A.2d 241 (App.Div. 1991).

Defendant argues that, having filed the complaint with the Department of Labor, plaintiff must exhaust her administrative remedies. It is undisputed that no action has been taken on the complaint initiated by plaintiff. It is also undisputed that, unless extended, plaintiff's COBRA continuation benefits will expire on August 1, 1991.

Defendant initially did not cite any authority in support of its position other than the general maxim that one must exhaust one's administrative remedies. Our research reveals *160 that a participant or beneficiary may be required to exhaust administrative remedies prior to suing an employer. However, the administrative remedies which must be exhausted are those remedies established by the plan rather than any claim procedure established by the secretary of labor. See Amato v. Bernard, 618 F.2d 559 (9 Cir.1980); Scheider v. United States Steel Corp., 486 F. Supp. 211 (W.D.Pa. 1980). The case cited by defendant in a supplemental submission, Wolf v. National Shopmen Pension Fund, 728 F.2d 182 (3 Cir.1984) does not address the precise issue before the court and further is consistent with the general rule that the only exhaustion which is required is the internal plan remedies. Defendant has not raised any claim that plaintiff has failed to exhaust any remedies established under the Monmouth College plan. Accordingly, I conclude that this argument raised belatedly at oral argument must fail.[2] Thus, the next issue to be addressed is whether Gertrude Poole is entitled to the additional 11 months of coverage.

The Comprehensive Omnibus Budget Reconciliation Act of 1985 (COBRA), imposed continuation of health benefits provisions on private employer group health plans. Continuation of coverage is implemented through three statutes, (the Employee Retirement Income Security Act, Internal Revenue Code and Public Health Code) which are parallel and are amended together, as they were, in sections 6701(b) and 6801 of P.L. 101-239, the amendments in issue here. The Employee Retirement Income Security Act (ERISA), 29 U.S.C.A. § 1161 et seq., imposes continuation coverage requirements under ERISA. Enforcement mechanisms under ERISA are available under these provisions. 29 U.S.C.A. § 1132.

It is undisputed on or about January 2, 1990, Poole became entitled to COBRA continuation coverage due to termination of *161 employment, a qualifying event under 29 U.S.C.A. § 1163(2).[3] There are six qualifying events according to the statute. Poole was a "qualified beneficiary," a term usually defined as the spouse or dependent child of an employee covered under a group health plan as of the day prior to a qualifying event, 29 U.S.C.A. § 1167(3)(A),[4] except that the term also includes the employee when termination is the qualifying event, 29 U.S.C.A. § 1167(3)(B),[5] and thus, for this litigation, the term "qualified beneficiary" includes the employee herself. The required maximum period of coverage for such a qualifying event is 18 months, under 29 U.S.C.A. § 1162(2)(A)(i).[6]

There is a recently enacted provision relating to maximum period of COBRA continuation coverage for Social Security disability.

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603 A.2d 118, 254 N.J. Super. 154, Counsel Stack Legal Research, https://law.counselstack.com/opinion/poole-v-monmouth-college-njsuperctappdiv-1991.