Santana v. Deluxe Corp.

920 F. Supp. 249, 1996 U.S. Dist. LEXIS 4871, 1996 WL 166534
CourtDistrict Court, D. Massachusetts
DecidedMarch 12, 1996
DocketCivil Action 94-30111-FHF
StatusPublished
Cited by18 cases

This text of 920 F. Supp. 249 (Santana v. Deluxe Corp.) is published on Counsel Stack Legal Research, covering District Court, D. Massachusetts primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Santana v. Deluxe Corp., 920 F. Supp. 249, 1996 U.S. Dist. LEXIS 4871, 1996 WL 166534 (D. Mass. 1996).

Opinion

MEMORANDUM AND ORDER

FREEDMAN, Senior District Judge.

I. INTRODUCTION

On his own behalf, and on the behalf of all others similarly situated, plaintiff Mariano Santana (“Santana”) has brought a nine-count complaint against defendants Deluxe Corporation (“Deluxe”) and John Hancock Mutual Life Insurance Company (“John Hancock”) claiming that Deluxe and John Hancock have denied certain health care benefits to participants of a Deluxe employee benefit plan. Solely before the Court is John Hancock’s motion for summary judgment on all counts of Santana’s complaint.

II. SUMMARY JUDGMENT STANDARD

Federal Rule of Civil Procedure 56(c) declares that summary judgment is appropriate “if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(c). Where the party moving for summary judgment does not have the burden of proof at trial, that party must make a showing that the evidence is insufficient to support the nonmoving party’s case. Hayes v. Douglas Dynamics, Inc., 8 F.3d 88, 90 (1st Cir.1993), cert. denied, — U.S. -, 114 S.Ct. 2133, 128 L.Ed.2d 863 (1994). Once this showing is made, the nonmoving party must establish the existence of a genu *252 ine dispute as to some material fact, or the moving party will be entitled to judgment as a matter of law. Id. The nonmoving party has created a genuine issue of material fact if the evidence is such that a reasonable jury could return a verdict for the nonmoving party. Id.

III. FACTUAL AND PROCEDURAL HISTORY

The Court views the record in a light most favorable to Santana, the party opposing summary judgment, and will draw all reasonable inferences in his favor. See Mesnick v. General Elec. Co., 950 F.2d 816, 825 (1st Cir.1991), cert. denied, 504 U.S. 985, 112 S.Ct. 2965, 119 L.Ed.2d 586 (1992). The undisputed facts reveal that in 1982 John Hancock entered into a contract with the Benefits Administration Committee of the Deluxe Employees Health Care Plan (“BAC”) whereby John Hancock agreed to provide day-to-day administrative services with respect to certain Deluxe employee benefit plans. On or around January 1, 1989, Santana, who had been employed at Deluxe since 1977, was physically unable to work and began receiving disability benefits under an employee benefit plan (“Plan”) funded by Deluxe and serviced by John Hancock. In conjunction with his receipt of disability benefits, Santana was eligible for health insurance under the Plan.

In addition to benefits under the Plan, Santana’s disability also qualified him for Social Security benefits. As a function of his receipt of Social Security disability benefits, Santana qualified for Medicare on or around October 1, 1990. Under “Part A” Medicare, Santana was provided insurance for hospital treatment at no cost. Under “Part B” Medicare, Santana could elect to receive insurance for physician treatment, but would be assessed a monthly premium. Santana declined to enroll in Medicare “Part B” at that time.

On December 17,1991, December 26,1991, and February 2,1992, Santana incurred physician charges after visiting his dentist. Santana submitted the dental bills to John Hancock for payment under the Plan. John Hancock refused to pay the charges, informing Santana that Medicare was his primary insurance carrier and that his dental charges were subject to “coordination of benefits” under the Plan. As a result, Santana enrolled in Medicare “Part B” and began remitting the monthly premium.

Alleging that Deluxe and John Hancock coordinate health care benefits under the Plan secondary to Medicare in violation of the Social Security Act (“SSA”), Santana filed the instant action on May 10,1994 seeking class certification and requesting relief under the SSA, the Employee Retirement Income Security Act of 1974 (“ERISA”), and state law. John Hancock moved for summary judgment on all counts of Santana’s complaint on September 15, 1994. Santana opposed the motion, and John Hancock replied. After further discovery in this matter, Santana submitted further opposition to John Hancock’s motion for summary judgment, and John Hancock again replied. The Court heard oral argument on John Hancock’s motion for summary judgment on February 1, 1996, and the Court is now poised to rule on the motion.

IV. DISCUSSION

John Hancock advances three main contentions in support of its motion for summary judgment. First, John Hancock maintains that it is neither the Plan’s “administrator” nor a “fiduciary” of the Plan as those terms are defined in ERISA and, therefore, it is not subject to suit under ERISA. Second, John Hancock states that Santana’s state contract law claim is preempted by ERISA. Third, John Hancock argues that it is not the party responsible to make benefit payments to Santana under the Plan and, therefore, it is not subject to suit under SSA for allegedly failing to pay Plan benefits primary to Medicare. The Court will analyze the evidence of record and apply it to each of John Hancock’s arguments in turn to determine whether a genuine issue of material fact remains for trial.

A. ERISA

Four counts of Santana’s nine-count complaint seek relief under ERISA. John Han *253 cock contends that as a third-party administrator of the Plan, it is not subject to suit under ERISA. The Court agrees.

ERISA is codified at 29 U.S.C. §§ 1001 et seq., and its civil enforcement provisions are enumerated in section 1132(a). Counts II and III of Santana’s complaint are brought pursuant to section 1132(a)(1), which provides:

A civil action may be brought by a participant or beneficiary ... to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan____

29 U.S.C. § 1132(a)(1)(B). Count II of Santana’s complaint avers that John Hancock wrongfully denied Santana medical benefits under the Plan in violation of ERISA Count III alleges that John Hancock failed to provide Santana with an adequate summary plan description as required by ERISA

Count VII of Santana’s complaint is brought pursuant to section 1132(a)(3), which provides:

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Bluebook (online)
920 F. Supp. 249, 1996 U.S. Dist. LEXIS 4871, 1996 WL 166534, Counsel Stack Legal Research, https://law.counselstack.com/opinion/santana-v-deluxe-corp-mad-1996.