Shelton v. Annuity Board of the Southern Baptist Convention

915 F. Supp. 124, 1996 U.S. Dist. LEXIS 1945, 1996 WL 74174
CourtDistrict Court, E.D. Missouri
DecidedFebruary 20, 1996
DocketNo. 1:95CV5SNL
StatusPublished

This text of 915 F. Supp. 124 (Shelton v. Annuity Board of the Southern Baptist Convention) is published on Counsel Stack Legal Research, covering District Court, E.D. Missouri primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Shelton v. Annuity Board of the Southern Baptist Convention, 915 F. Supp. 124, 1996 U.S. Dist. LEXIS 1945, 1996 WL 74174 (E.D. Mo. 1996).

Opinion

MEMORANDUM

LIMBAUGH, District Judge.

Plaintiff has filed this action seeking payment of benefits allegedly due under a group health insurance plan. In May 1995 defendants filed a motion for summary judgment (# 8). On June 23, 1995 this case was reassigned to the undersigned. In August 1995, this Court entered a show cause order directing the plaintiff to respond to the defendants’ summary judgment motion. In September 1995 responsive pleadings regarding the pending summary judgment motion were filed by the parties. On October 25, 1995 plaintiff filed a supplemental memorandum raising for the first time the issue of whether Missouri or Texas law was controlling. On December 29,1995 this Court entered a show cause order directing the defendants to file a responsive pleading addressing the “choice of law” issue raised by the plaintiff. On January 11, 1996 defendants filed their pleading in response to the Court’s December 29,1995 show cause order. This matter is now ripe for disposition by the Court.

Courts have repeatedly recognized that summary judgment is a harsh remedy that should be granted only when the moving party has established his right to judgment with such clarity as not to give rise to controversy. New England Mut. Life Ins. Co. v. Null, 554 F.2d 896, 901 (8th Cir.1977). Summary judgment motions, however, “can be a tool of great utility in removing factually insubstantial cases from crowded dockets, freeing courts’ trial time for those that really do raise genuine issues of material fact.” Mt. Pleasant v. Associated Elec. Coop. Inc., 838 F.2d 268, 273 (8th Cir.1988).

Pursuant to Fed.R.Civ.P. 56(c), a district court may grant a motion for summary judgment if all of the information before the court demonstrates that “there is no genuine issue as to material fact and the moving party is entitled to judgment as a matter of law.” Poller v. Columbia Broadcasting System, Inc., 368 U.S. 464, 467, 82 S.Ct. 486, 488, 7 L.Ed.2d 458 (1962). The burden is on the moving party. Mt. Pleasant, 838 F.2d at 273. After the moving party discharges this burden, the nonmoving party must do more than show that there is some doubt as to the facts. Matsushita Elec. Industrial Co. v. Zenith Radio Corp., 475 U.S. 574, 586, 106 S.Ct. 1348, 1355-56, 89 L.Ed.2d 538 (1986). Instead, the nonmoving party bears the burden of setting forth specific facts showing that there is sufficient evidence in its favor to allow a jury to return a verdict for it. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249, 106 S.Ct. 2505, 2510-11, 91 L.Ed.2d 202 (1986); Celotex Corp. v. Catrett, 477 U.S. 317, 324, 106 S.Ct. 2548, 2553, 91 L.Ed.2d 265 (1986).

In passing on a motion for summary judgment, the court must review the facts in a light most favorable to the party opposing the motion and give that party the benefit of any inferences that logically can be drawn from those facts. Butter v. Buechler, 706 F.2d 844, 846 (8th Cir.1983). The court is required to resolve all conflicts of evidence in favor of the nonmoving party. Robert Johnson Grain Co. v. Chem. Interchange Co., 541 F.2d 207, 210 (8th Cir.1976). With these principles in mind, the Court turns to an examination of the facts.

Plaintiff was an employee of the Immanuel Baptist Church in Cobden, Illinois from October 1985 through September 1986. This church, during the relevant time-period, was associated with the Southern Baptist Convention. During his employment tenure with the Immanuel Baptist Church, plaintiff applied for and became a participant in a health insurance program, known as the Church Comprehensive Medical Program (the “Plan”) sponsored by defendant Annuity Board of the Southern Baptist Convention [127]*127(hereinafter referred to as simply the Annuity Board) and administered by the Aetna Life Insurance Company. In September 1986, plaintiff became totally disabled and no longer employed by the Immanuel Baptist Church. Plaintiff has not been employed by any church affiliated with the Southern Baptist Convention since September 1986.

Beginning in January 1991, the Plan became self-insured and administered by defendant Prudential. Up until January 1, 1994, the Plan’s premiums were collected directly from individuals whom the Plan believed to be eligible participants in the Plan. However, starting January 1, 1994 the Plan would begin collecting premiums, not directly from Plan participants, but instead from the Southern Baptist churches for their employee-participants. Affidavit of Joel H. Mathis. When the Plan notified Immanuel Baptist Church of the change in the way premiums would be collected, i.e. it would be charged a premium for its employees participating in the Plan, including the plaintiff, Immanuel Baptist Church advised the Plan that the plaintiff had not been employed by it since September 1986. Mathis Affidavit; Defendants’ Exhibit 2. The Plan, as administered by Prudential, requires an eligible participant to have been employed full-time on January 1,1991 by a church or related organization affiliated with the Southern Baptist Convention.

On or about October 1990 plaintiff was diagnosed with Lyme disease and has incurred medical costs associated with the treatment of the disease. Plaintiff seeks to recover under the- Plan for these medical costs.

Defendants contend that plaintiff is not entitled to recover pursuant to the Plan because he was never an eligible participant in the Plan, as administered by defendant Prudential. Defendants contend that on January 1, 1991 plaintiff was not “actively at work” full-time at an affiliated church, thus, he is not an eligible participant in the Plan. Plaintiff argues that he was an eligible participant in the Plan, as administered by Aet-na, in 1985 and that this has never changed. He further argues that his wife informed both Aetna and Prudential of his “disability” and that his premium payments were accepted by both Aetna and Prudential up until 1993; consequently, defendants are estopped from denying coverage.

The first issue to be addressed is whether Missouri or Texas law applies in this case. Courts sitting in diversity jurisdiction must apply the substantive law of the forum state; this includes using the choice of law rules of the forum state. As a federal court sitting in Missouri and deciding issues controlled by state law, this Court must use the choice of law rules used in Missouri.

After reviewing the relevant easelaw, it appears that both the state courts and the Eighth Circuit (interpreting Missouri state law) are in a state of confusion as to the applicable rule for insurance cases. It is well-established that under Missouri law, insurance policies are regarded as contracts. See, Sargent Construction Co. v. State Automobile Insurance Co., 23 F.3d. 1324, 1326 (8th Cir.1994); Peters v. Employers’ Mutual Casualty Co., 853 S.W.2d.

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Related

Poller v. Columbia Broadcasting System, Inc.
368 U.S. 464 (Supreme Court, 1962)
Anderson v. Liberty Lobby, Inc.
477 U.S. 242 (Supreme Court, 1986)
New England Mutual Life Insurance Company v. Null
554 F.2d 896 (Eighth Circuit, 1977)
En Serch Corporation v. Shand Morahan & Co., Inc.
952 F.2d 1485 (Fifth Circuit, 1992)
Continental Casualty Co. v. Allen
710 F. Supp. 1088 (N.D. Texas, 1989)
Miller v. Home Insurance Co.
605 S.W.2d 778 (Supreme Court of Missouri, 1980)
Buck v. American States Life Ins. Co.
723 F. Supp. 155 (E.D. Missouri, 1989)
Minnesota Mutual Life Insurance Company v. Morse
487 S.W.2d 317 (Texas Supreme Court, 1972)
Nutmeg Insurance v. Pro-Line Corp.
836 F. Supp. 385 (N.D. Texas, 1993)
State Farm Mutual Automobile Insurance Co. v. MFA Mutual Insurance Co.
671 S.W.2d 276 (Supreme Court of Missouri, 1984)

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Bluebook (online)
915 F. Supp. 124, 1996 U.S. Dist. LEXIS 1945, 1996 WL 74174, Counsel Stack Legal Research, https://law.counselstack.com/opinion/shelton-v-annuity-board-of-the-southern-baptist-convention-moed-1996.