Salameh v. Provident Life & Accident Insurance

23 F. Supp. 2d 704, 1998 U.S. Dist. LEXIS 15162
CourtDistrict Court, S.D. Texas
DecidedSeptember 24, 1998
DocketCivil Action H-96-2874
StatusPublished
Cited by7 cases

This text of 23 F. Supp. 2d 704 (Salameh v. Provident Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Salameh v. Provident Life & Accident Insurance, 23 F. Supp. 2d 704, 1998 U.S. Dist. LEXIS 15162 (S.D. Tex. 1998).

Opinion

MEMORANDUM AND ORDER

CRONE, United States Magistrate Judge.

Pending before the court is Defendant Provident Life & Accident Insurance Company’s (“Provident”) Motion to Dismiss Plaintiffs State Law Claims and to Strike Plaintiffs Jury Demand due to ERISA Preemption (# 18) and Plaintiffs Demand for Jury Trial (#6). Having reviewed the motions, the submissions of the parties, the pleadings, and the applicable law, the court is of the opinion that the defendant’s motion should be granted and the plaintiffs motion should be denied.

I. Background

Plaintiff Dr. Raja N. Salameh (“Salameh”) is a board certified urologist practicing in Pasadena, Texas. Prior to 1990, Salameh and Dr. Raul Garcia (“Garcia”) were partners operating under the name Urology Associates, P.A. (“Urology Associates”). On July 1, 1990, Dr. Gary Hurwitz (“Hurwitz”) joined their practice and, on July 1, 1993, became a one-third owner of Urology Associates.

Effective April 8,1990, Salameh obtained a disability income insurance policy from Provident. On October 1, 1990, however, Sala-meh’s individual disability policy became part of Urology Associates’ risk group policy covering all three physicians — -Salameh, Garcia, and Hurwitz. The creation of a risk group *709 was precipitated by Urology Associates’ obtaining a Provident disability income policy for Hurwitz. The premium was reduced as a result, and the partnership began paying the premium for the entire group, rather than Salameh paying an individual premium.

On June 5, 1993, Salameh slipped and fell in the hallways of Southmore Medical Center Hospital. Salameh asserts that he “injured his neck, back, and body generally” in the fall, rendering him unable to perform the same “quantity and quality of surgeries” as he performed before the accident. He claims that, as a result of his injuries, he sustained a loss of earning capacity, which he contends will continue throughout the remainder of his life. Provident denied disability benefits to Salameh,' maintaining that his fall did not result in an immediate loss of income and further disputing his claim for future loss of income. Salameh instituted this action in state court on August 1, 1996, asserting claims for disability benefits under the policy as well for damages arising from Provident’s alleged violation of Articles 21.21 and 21.55 of the Texas Insurance Code. Provident timely removed the case to federal court on the basis of diversity of citizenship. Provident contends that Salameh’s disability income policy is part of an ERISA Plan, preempting his state law claims and foreclosing the availability of a jury trial.

II. Analysis

A. Existence of an ERISA Plan

The Employee Retirement Security Act (“ERISA”) applies to employee benefit plans “established by or maintained by an employer or employee organization” engaged in interstate commerce. See Meredith v. Time Ins. Co., 980 F.2d 352, 354 (5th Cir.1993) (citing 29 U.S.C. § 1003(a)). “In enacting ERISA, Congress designed a comprehensive system of regulating employee benefit plans in order ‘to provide the maximum degree of protection to working men and women’ whose employers provide benefits.” Madonia v. Blue Cross & Blue Shield of Va., 11 F.3d 444, 448 (4th Cir.1993), cert. denied, 511 U.S. 1019, 114 S.Ct. 1401, 128 L.Ed.2d 74 (1994) (quoting S.Rep. No. 127, 93rd Cong., 2d Sess. (1974), reprinted in 1974 U.S.C.C.A.N. 4639, 4838, 4854). Two types of employee benefit plans are governed by ERISA: “employee welfare benefit plans” and “employee pension benefit plans.” See Weaver v. Employers Underwriters, Inc., 13 F.3d 172, 175 (5th Cir.), cert. denied, 511 U.S. 1129, 114 S.Ct. 2137, 128 L.Ed.2d 866 (1994) (citing 29 U.S.C. § 1002(3)). An “employee welfare benefit plan” is defined as:

any plan, fund, or program which was heretofore or is hereafter established or maintained by an employer or by an employee organization, or by both, to the extent that such plan, fund, or program was established or is maintained for the purpose of providing for its participants or their beneficiaries, through the purchase of insurance or otherwise, (A) medical, surgical, or hospital care or benefits, or benefits in the event of sickness, accident, disability, death or unemployment, or vacation benefits ....

29 U.S.C. § 1002(1); see California Div. of Labor Standards Enforcement v. Dillingham Constr., N.A., Inc., 519 U.S. 316, 117 S.Ct. 832, 836 n. 2, 136 L.Ed.2d 791 (1997); Peterson v. American Life & Health Ins. Co., 48 F.3d 404, 408 (9th Cir.), cert. denied, 516 U.S. 942, 116 S.Ct. 377, 133 L.Ed.2d 301 (1995); Madonia, 11 F.3d at 446; Meredith, 980 F.2d at 354.

The Fifth Circuit has “devised a comprehensive test for determining whether a particular plan qualifies as an ‘employee welfare benefit plan.’ ” Id. Under this test, a court must ascertain “whether a plan (1) exists; (2) falls within the safe-harbor provision established by the Department of Labor; and (3) satisfies the primary elements of an ERISA ‘employee benefit plan’ — establishment or maintenance by an employer intending to benefit employees.” Id. “If any part of the inquiry is answered in the negative, the- submission is not an ERISA plan.” Id. “At the outset, any court confronted with the question “whether a particular arrangement constitutes an employee welfare benefit plan under ERISA “must first satisfy itself that there is in fact a plan at all.” ’ ” Id. (citing MDPhysicians & Assocs., Inc. v. State Bd. of Ins., 957 F.2d 178, 183 (5th Cir.), cert. de n ied, 506 U.S. 861, 113 S.Ct. 179, 121 L.Ed.2d 125 (1992)); Madonia, 11 F.3d at 446-47. “‘In determining whether a plan *710 ... [exists,] a court must determine whether from the surrounding circumstances a reasonable person could ascertain the intended benefits, beneficiaries, source of financing, and procedures for receiving benefits.’ ” Meredith, 980 F.2d at 355 (quoting Donovan v. Dillingham, 688 F.2d 1367, 1373 (11th Cir.1982)); accord Madonia, 11 F.3d at 447.

In this case, upon analyzing the first prong, a reasonable person could ascertain that a plan exists. , The evidence establishes that the provision of disability insurance to the physicians of Urology Associates was and is part of an overall design of employee benefits, which constitutes an ERISA plan. See Peterson, 48 F.3d at 407; Bellisario v. Lone Star Life Ins., 871 F.Supp. 374, 378-79 (C.D.Cal.1994). It is well recognized that a disability plan funded through the purchase of insurance may be categorized as an “employee benefit plan.”

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Waldmann v. Fulp
259 F. Supp. 3d 579 (S.D. Texas, 2016)
McSperitt v. Hartford Life Insurance
393 F. Supp. 2d 418 (N.D. Texas, 2005)
Burgos v. GROUP & PENSION ADMINISTRATORS, INC.
286 F. Supp. 2d 812 (S.D. Texas, 2003)
Armstrong v. Columbia/HCA Healthcare Corp.
122 F. Supp. 2d 739 (S.D. Texas, 2000)
Lain v. UNUM Life Insurance Co. of America
27 F. Supp. 2d 926 (S.D. Texas, 1998)

Cite This Page — Counsel Stack

Bluebook (online)
23 F. Supp. 2d 704, 1998 U.S. Dist. LEXIS 15162, Counsel Stack Legal Research, https://law.counselstack.com/opinion/salameh-v-provident-life-accident-insurance-txsd-1998.