Reese v. Brookdale Motors, Inc.

567 N.W.2d 83, 21 Employee Benefits Cas. (BNA) 1683, 1997 Minn. App. LEXIS 826, 1997 WL 422879
CourtCourt of Appeals of Minnesota
DecidedJuly 29, 1997
DocketC8-97-353
StatusPublished
Cited by2 cases

This text of 567 N.W.2d 83 (Reese v. Brookdale Motors, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals of Minnesota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Reese v. Brookdale Motors, Inc., 567 N.W.2d 83, 21 Employee Benefits Cas. (BNA) 1683, 1997 Minn. App. LEXIS 826, 1997 WL 422879 (Mich. Ct. App. 1997).

Opinion

OPINION

HARTEN, Judge.

Respondents 1 sued appellant Brookdale Motors, claiming that they were entitled to, and wrongfully denied, health care benefits *85 under Brookdale Motors’ group health insurance plan. Seeking to recover damages for unreimbursed medical expenses, Reese initiated suit pursuant to the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1132(a)(1)(B) (1994). See 29 U.S.C. § 1132(e) (1994) (giving state courts of competent jurisdiction and federal district courts concurrent jurisdiction over section 1132(a)(1)(B) actions). On cross-motions for summary judgment, the district court denied Brookdale Motors’ motion and granted summary judgment to Reese, awarding Reese $3,500 in attorney fees pursuant to 29 U.S.C. § 1132(g)(1) (1994). We affirm.

FACTS

On March 24, 1994, Brookdale Motors hired John Reese for a full-time maintenance position. That same day, Reese completed an enrollment form to participate in Brook-dale Motors’ group health insurance plan — a plan governed by ERISA. The ERISA plan, which Brookdale Motors provided to employees through a master group insurance contract between itself and Medica Choice, contained certain eligibility requirements. Under the plan, an employee “working a minimum of 30 hours per week” was considered a “subscriber” and eligible for coverage. The plan also provided that coverage for newly hired employees began “the first of the month following a 30-day waiting period.” Accordingly, if Reese met the plan’s eligibility requirements, his coverage became effective May 1, 1994.

Although hired as a full-time employee and expected to work 40 hours per week, Reese averaged less than 10 hours per week. Brookdale Motors’ time records indicate that he worked a total of 88.91 hours over a nine-week period. Nonetheless, Brookdale Motors did not notify Reese that his full-time employment status had changed; it was Reese’s continuing belief that he remained a full-time employee.

On receipt of his enrollment form, Medica Choice sent Reese a member packet, which included a certificate explaining his group insurance plan coverage. Additionally, Brookdale Motors began to deduct insurance premiums from Reese’s salary. On May 5, 1994, Reese’s wife, Laurie Reese, gave birth to the couple’s daughter, Anna Reese. The birth was premature; due to complications, Reese incurred medical expenses totaling $14,324 between May 5 and July 31, 1994. Under the plan’s terms, newborn children were automatically covered for 31 days from their date of birth.

By certified letter postmarked June 1, 1994, Brookdale Motors notified Reese that it was terminating his employment effective May 31, 1994, due to poor performance and absenteeism. The termination letter also informed Reese that his medical coverage benefits had been canceled as of May 1, 1994 (the earliest possible date of his coverage under the plan). Finally, the letter enclosed reimbursement to Reese for the medical premiums that Brookdale Motors had automatically withheld from his paycheck.

On May 31, 1994, Brookdale Motors submitted a change-of-application form to Medi-ca Choice, requesting that Reese be deleted from the plan effective May 1, 1994. Brook-dale Motors made the following notation on the form as the basis for the deletion:

Hired as full-time employee — obligation not met by employee. Employee worked 89 hours in nine weeks.

Reese later sought benefits under the plan for the medical expenses resulting from his daughter’s premature birth, but Brookdale Motors denied coverage. This lawsuit followed.

Both partiés moved for summary judgment. The district court granted summary judgment to Reese, concluding that he was entitled to health care benefits from May 1, 1994, through the date of his termination, May 31, 1994. Additionally, the district court concluded that Reese was entitled to continued COBRA 2 coverage through July 31, 1994, because Brookdale Motors did not notify Reese of his continuation rights during the 60-day election period as required by the *86 plan. Because payment of the COBRA premiums was Reese’s responsibility, the district court offset his $14,324 recovery by the cost of the 60-day coverage period.

ISSUES

1. Did the district court apply the correct standard of review in considering Brookdale Motors’ denial of health care benefits to Reese?

2. Did the district court err in construing the plan’s eligibility provisions?

3. Did the district court abuse its discretion in awarding attorney fees to Reese?

ANALYSIS

On appeal from summary judgment, we determine whether any genuine issues of material fact exist and whether the district court erred in its application of the law. Wartnick v. Moss & Barnett, 490 N.W.2d 108, 112 (Minn.1992). In doing so, we view the evidence in the light most favorable to the nonmoving party. State by Beaulieu v. City of Mounds View, 518 N.W.2d 567, 571 (Minn.1994).

1. Brookdale Motors on appeal asserts for the first time that its decision to deny health care benefits to Reese was entitled to deference. Although the parties presented the issue to the district court as one of contract interpretation and the district court made its decision on that basis, Brookdale Motors now argues that this court should apply the arbitrary and capricious standard to review the dealership’s decision to deny benefits. Applying this standard, Brookdale Motors contends that it properly exercised discretion vested in it by the plan in denying Reese health care benefits. See Finley v. Special Agents Mut. Benefit Ass’n, 957 F.2d 617, 621 (8th Cir.1992) (listing five factors courts consider when applying arbitrary and capricious standard).

A threshold issue in section 1132(a)(1)(B) actions challenging the denial of group health insurance benefits is determination of the appropriate standard of judicial review. See Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 108, 109 S.Ct. 948, 953, 103 L.Ed.2d 80 (1989) (granting certiorari to resolve conflict among circuits as to appropriate standard of review in actions under section 1132(a)(1)(B)). In Firestone, the Supreme Court held

that a denial of benefits challenged under § 1132(a)(1)(B) is to be reviewed under a de novo

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Bluebook (online)
567 N.W.2d 83, 21 Employee Benefits Cas. (BNA) 1683, 1997 Minn. App. LEXIS 826, 1997 WL 422879, Counsel Stack Legal Research, https://law.counselstack.com/opinion/reese-v-brookdale-motors-inc-minnctapp-1997.