Selmon v. Metropolitan Life Insurance

277 S.W.3d 196, 372 Ark. 420, 2008 Ark. LEXIS 114, 2008 WL 451228
CourtSupreme Court of Arkansas
DecidedFebruary 21, 2008
Docket06-1340
StatusPublished
Cited by27 cases

This text of 277 S.W.3d 196 (Selmon v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering Supreme Court of Arkansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Selmon v. Metropolitan Life Insurance, 277 S.W.3d 196, 372 Ark. 420, 2008 Ark. LEXIS 114, 2008 WL 451228 (Ark. 2008).

Opinion

Annabelle Clinton Imber, Justice.

The instant appeal involves issues arising out of the Employee Retirement Income Security Act (ERISA), 29 U.S.C.A. § 1001 through 1461 (1999 & Supp. 2007). The appeal was originally filed in the Arkansas Court of Appeals. However, because Arkansas state courts rarely hear cases involving ERISA and because this case involves an area of the law in need of clarification, we assumed the instant case from the court of appeals pursuant to Arkansas Supreme Court Rule l-2(b)(5) (2007).

Appellant Larry D. Selmon was employed by Great Lakes Chemical Company for over twenty years, performing maintenance and other manual labor. Great Lakes maintained a self-funded, long-term disability plan for its employees that was administered by Appellee Metropolitan Life Insurance Company (MetLife). The plan provided that an employee could receive long-term disability benefits after disclosing all other income sources and completing a Qualifying Disability period. In what was called the Rehabilitation Program, disability benefits could continue for up to twenty-four months after completion of the Qualifying Period if the employee was qualified to receive benefits for Total Disability. An employee was considered to have a Total Disability in two circumstances:

1. During the Qualifying Period plus the next 24 months of disability, you must be unable to perform all the normal duties of your regular position with Great Lakes Chemical Corporation or its covered subsidiary and you must at no time engage in any occupation or employment for pay or profit. . . .
2. After the Qualifying Disability period plus the next 24 months, you must be completely unable to engage in any occupation or employment for which you are or become qualified because of your education, training, or experience.

Injuries or sickness that were “not treated by a physician” were excluded from the plan, and the plan also specified that benefits would only continue during total disability and would not be continued upon recovery.

In 1997, Selmon suffered a heart attack, but he attempted to return to work. Then, in February 1998, he suffered a second heart attack and underwent angioplasty and a cardiac catheterization. His last day of work at Great Lakes was on February 18, 1998, and he began receiving disability benefits from MetLife in April 1998. Selmon continued to draw disability benefits for almost three years. In April 2001, MetLife discovered that Selmon had not seen a doctor since March 2000. Then, in June 2001, MetLife notified Selmon that his disability benefits had been terminated due to his failure to comply with the plan requirements and remain under the regular care of a physician.

Selmon hired an attorney in September 2002 and obtained permission to supplement his case file with new medical records. MetLife began its review of Selmon’s case on May 19, 2003, and on September 19, 2003, MetLife sent Selmon a letter stating that it had decided to uphold its earlier decision. MetLife’s decision on review was based upon MetLife’s original conclusion that Selmon had failed to comply with the plan’s policies, and upon information regarding Selmon’s medical condition at the time when his benefits were terminated.

On October 8, 2003, Selmon filed a complaint against MetLife in the Pulaski County Circuit Court. He asserted a claim for wrongful termination of his benefits, as well as common-law bad-faith claims and a deceptive-trade-practices claim. In its answer to Selmon’s complaint, MetLife contended that his state-law claims were preempted by ERISA. Selmon then filed a motion for a jury trial, alleging that his claims were saved from federal preemption. After a hearing, the circuit court entered an order denying Selmon’s motion for jury trial and finding that his state-law claims were preempted by ERISA. Upon reviewing the merits of Selmon’s claim for benefits, the circuit court affirmed MetLife’s decision to terminate Selmon’s benefits.

Selmon appealed the circuit court’s decision. He raises three points of error: (1) the circuit court erred in ruling that his bad-faith claim was preempted by ERISA and in denying his motion for a jury trial, (2) the circuit court erred in applying an abuse-of-discretion standard of review to MetLife’s decision, and (3) MetLife wrongfully terminated his benefits.

I. Preemption

Selmon first argues that the circuit court erred in denying his motion for a jury trial based upon ERISA preemption. Selmon asserts that the United States Supreme Court’s recent holding in Kentucky Ass’n of Health Plans, Inc. v. Miller, 538 U.S. 329 (2003) (KAHP), overrules the Court’s past precedent regarding ERISA preemption and establishes that Selmon’s bad-faith claim falls under the ERISA savings clause. MetLife disputes that assertion, arguing instead that the Supreme Court’s decision in Pilot Life Insurance Co. v. Dedeaux, 481 U.S. 41 (1987), which addressed federal preemption of state bad-faith claims, was not overruled by KAHP, and, therefore remains the controlling precedent here.

The issue of preemption is a question of law, and this court reviews questions of law de novo on appeal. Nucor Corp. v. Kilman, 358 Ark. 107, 186 S.W.3d 720 (2004). The ERISA preemption clause at 29 U.S.C.A. § 1144(a) states that the provisions ofERISA 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 and not exempt under section 1003(b).” 29 U.S.C.A. § 1144(a) (1999). The savings clause in section 1144(b)(2)(A) states that nothing in the subchapter “shall be construed to exempt or relieve any person from any law of any state which regulates insurance, banking, or securities.” 29 U.S.C.A. § 1144(b)(2)(A) (1999) (emphasis added). A “State law” is defined as “all laws, decisions, rules, regulations, or other State action having the effect of law, of any State.” 29 U.S.C. § 1144(c)(1) (1999).

In Pilot Life Insurance Co. v. Dedeaux, supra, the Supreme Court addressed the issue of whether a Mississippi common-law bad-faith claim was preempted by ERISA. Id. Mississippi law defined bad faith by an insurance company as when “an insurance carrier refuses to pay a claim when there is no reasonably arguable basis to deny it.” Id. at 50. The Court used the three factors from the McCarran-Ferguson Act, 15 U.S.C.A. § 1011 through 1015 (1997 & Supp. 2007), to determine whether a practice falls within the “business of insurance.” Those factors are:

[F| irst whether the practice has the effect of transferring or spreading a policyholder’s risk; second, whether the practice is an integral part of the pohcy relationship between the insurer and the insured; and third, whether the practice is hmited to entities within the insurance industry.

Id. at 48-49 (emphasis in original).

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277 S.W.3d 196, 372 Ark. 420, 2008 Ark. LEXIS 114, 2008 WL 451228, Counsel Stack Legal Research, https://law.counselstack.com/opinion/selmon-v-metropolitan-life-insurance-ark-2008.