Roberson v. Equitable Life Assurance Society of the United States

661 F. Supp. 416, 1987 U.S. Dist. LEXIS 4357
CourtDistrict Court, C.D. California
DecidedMay 27, 1987
DocketCV 86-2105 PAR (JRX)
StatusPublished
Cited by23 cases

This text of 661 F. Supp. 416 (Roberson v. Equitable Life Assurance Society of the United States) is published on Counsel Stack Legal Research, covering District Court, C.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Roberson v. Equitable Life Assurance Society of the United States, 661 F. Supp. 416, 1987 U.S. Dist. LEXIS 4357 (C.D. Cal. 1987).

Opinion

MEMORANDUM OF DECISION AND ORDER

RYMER, District Judge.

This is an action for damages brought by plaintiff Donald R. Roberson, Jr. against The Equitable Life Assurance Society of the United States (“The Equitable”) and Alpha Micro Systems. The matter concerns plaintiff’s claims for benefits under a group health insurance policy issued by defendant The Equitable. Plaintiff seeks to recover benefits, insurance coverage and extra-contractual damages for the alleged mishandling of his claims by The Equitable. Plaintiff filed his complaint in the Superior Court of the State of California on October 8, 1985, naming both his employer, Alpha Micro Systems, and The Equitable as defendants. Alpha Micro Systems removed the action to this Court on April 2, 1986. On September 2,1986, plaintiff filed a First Amended Complaint. No demand was made for a jury trial. The parties filed a Joint Status Conference Brief on August 18,1986. Again, no request for a jury trial was made in this pleading. Plaintiff, recognizing that he failed timely to demand a jury trial and thereby waived his right of trial by jury under Fed.R.Civ.P. 38(d), now requests relief from the waiver pursuant to Rule 39(b). Defendants oppose plaintiff’s motion and bring the instant motion for summary judgment. 1

Uncontroverted Facts

The parties have already stipulated in the Pre-Trial Order to a set of admitted facts *418 which cover all issues material to this motion. Defendants have filed the following statement of uncontroverted facts which substantially duplicates the contents of the Pre-Trial Order:

(1) In August, 1988, plaintiff began employment with defendant Alpha Micro Systems and, as a result, obtained health insurance coverage through group policy number 56601, D,H, issued to Alpha Micro Systems by defendant The Equitable.

(2) The employee group health insurance program made available to Alpha Micro Systems employees by Alpha Micro Systems, and maintained through the purchase of insurance from The Equitable, is an employee benefit plan, subject to and governed by the Employee Retirement Income Security Act of 1974 (“ERISA”).

(3) In May, 1984, plaintiff became ill and was diagnosed as suffering from severe ulcerative colitis.

(4) Plaintiff submitted to The Equitable for payment all medical bills incurred for treatment of his colitis condition which were provided on or before December 15, 1984. The Equitable paid plaintiff all benefits due for claims submitted for covered charges incurred on or before December 15,1984. Plaintiff contends additional benefits are due for services rendered after December 15, 1984.

(5) Plaintiffs claims in this action against The Equitable are: that he is entitled to additional benefits under The Equitable’s group policy; he is entitled to extra contractual damages for emotional distress as well as punitive damages for The Equitable’s mishandling of his claim for benefits under the group policy issued to Alpha Microsystems by The Equitable; and plaintiff is entitled to convert his group coverage under the group policy to individual coverage.

Plaintiff has not filed a statement of genuine issues because he agrees with the facts as submitted by defendants. (Plf’s Memo in Opp. to Summary Judgment, p. 2.) Thus, the only issue remaining is whether defendants are entitled to judgment as a matter of law.

Pre-emption of state law claims by ERISA

Plaintiff’s First Amended Complaint alleges eight claims against The Equitable: (1) breach of contract; (2) common law bad faith; (3) breach of statutory duty under California Insurance Code Section 790.03; (4) breach of fiduciary duty; (5) intentional infliction of emotional distress; (6) negligence; (7) intentional misrepresentation; and (8) negligent misrepresentation. Plaintiff alleges a ninth claim against defendant Alpha Microsystems for recovery of benefits under the Employee Retirement Income Security Act of 1974 (“ERISA”).

Defendants bring this motion for summary judgment in light of the Supreme Court’s recent decision in Pilot Life Insurance Company v. Dedeaux, — U.S. -, 107 S.Ct. 1549, 95 L.Ed.2d 39 (1987) which held that an employee’s common law claims against an insurer under an employee benefits plan were pre-empted by ERISA. The pre-emption provisions of ERISA are contained in 29 U.S.C. § 1144:

Except as provided in subsection (b) of this section, the provisions of this sub-chapter and subchapter III of this chapter shall supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan described in section 1003(a) of this title

Under this section, Congress intended to pre-empt all state laws that relate to employee benefit plans and not just state laws which purport to regulate an area expressly covered by this chapter. Wadsworth v. Whaland, 562 F.2d 70 (1st Cir.1977); see also Ellenburg v. Brockway, Inc., 763 F.2d 1091 (9th Cir.1985) (employee’s state claim for breach of implied covenant of good faith and fair dealing following denial of early retirement benefits under employer’s pension plan originated from handling and disposition of employee’s claim for early retirement benefits and was therefore directly connected with benefit plan and preempted by ERISA).

Plaintiff concedes that all his claims “relate to” an employee benefit plan covered by ERISA and are therefore subject to the *419 pre-emption provision of section 1144. (Pltf’s Memo, in Opp. at 5-6); see also Pilot Life Ins. Co. v. Dedeaux, — U.S. -, 107 S.Ct. 1549, 95 L.Ed.2d 39 (1987); Shaw v. Delta Airlines, Inc., 463 U.S. 85, 96-97, 103 S.Ct. 2890, 2899-3000, 77 L.Ed.2d 490 (1983). Plaintiff also concedes that all his claims based upon state common law are pre-empted. (Pltf s Memo, at 6); see also Pilot Life, — U.S. at -, 107 S.Ct. at 1553 (“Unless these common law causes of action fall under an exception to § 514(a), therefore, they are expressly preempted.”). However, plaintiff argues that his claim against The Equitable for breach of statutory duty under California Insurance Code Section 790.03(h) “regulates insurance” within the meaning of 29 U.S.C. § 1144(b)(2)(A), and therefore is saved from pre-emption by ERISA.

Subsection (b)(2)(A) of Section 1144, the so-called “saving clause,” provides that “nothing in this subchapter shall be construed to exempt or relieve any person from any law of any State which regulates insurance, banking, or securities.” As the Supreme Court said in Pilot Life: “The saving clause excepts from the pre-emption clause laws that ‘regulate insurance.’ ” Pilot Life, — U.S. at -, 107 S.Ct. at 1552. For example, in

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Bluebook (online)
661 F. Supp. 416, 1987 U.S. Dist. LEXIS 4357, Counsel Stack Legal Research, https://law.counselstack.com/opinion/roberson-v-equitable-life-assurance-society-of-the-united-states-cacd-1987.