Smith v. Blue Cross & Blue Shield United of Wis.

724 F. Supp. 618, 1989 WL 129384
CourtDistrict Court, E.D. Wisconsin
DecidedOctober 31, 1989
Docket89-C-473
StatusPublished
Cited by6 cases

This text of 724 F. Supp. 618 (Smith v. Blue Cross & Blue Shield United of Wis.) is published on Counsel Stack Legal Research, covering District Court, E.D. Wisconsin primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Smith v. Blue Cross & Blue Shield United of Wis., 724 F. Supp. 618, 1989 WL 129384 (E.D. Wis. 1989).

Opinion

724 F.Supp. 618 (1989)

Jackson B. SMITH and Vivian E. Smith, husband and wife, Plaintiffs,
v.
BLUE CROSS & BLUE SHIELD UNITED OF WISCONSIN, and Delco Electronics, a General Motors corporation, Defendants.

No. 89-C-473.

United States District Court, E.D. Wisconsin.

October 31, 1989.

*619 Marjan R. Kmiec and Christopher A. McConville, Kmiec Law Offices, Milwaukee, Wis., for plaintiffs.

Kim M. Cafaro, Blue Cross & Blue Shield United of Wisconsin, Milwaukee, Wis., for Blue Cross.

George D. Cunningham and Susan R. Maisa, Foley & Lardner, Milwaukee, Wis., for Delco.

DECISION AND ORDER

WARREN, Chief Judge.

Before the Court are defendants' motions to dismiss or, in the alternative, motions for summary judgment and for sanctions.

I. BACKGROUND

On March 30, 1989, plaintiffs Jackson B. and Vivian E. Smith commenced this action in Milwaukee County Circuit Court against Delco Electronics Corporation and Blue Cross and Blue Shield United of Wisconsin. The defendants removed the action to this Court on April 25, 1989. The complaint alleges five state tort and contract law claims and one federal claim based on the U.S. Constitution. The five state claims are: (1) breach of contract; (2) bad faith breach of contract; (3) breach of fiduciary duty; (4) intentional infliction of emotional distress; and (5) a claim for punitive damages. The constitutional claim is based on the fifth and fourteenth amendments.

The claims are based on the same alleged set of facts. Plaintiffs assert that Delco and Blue Cross improperly denied the Smiths' claims for health care benefits under the group health care plan that covered the Smiths through Mr. Smiths' employment with Delco. The Smiths submitted bills for treatment to Blue Cross received for a weight loss program. According to the complaint, Blue Cross insured Delco's health care plan, and Blue Cross "denied said claims based upon their statement that no benefit for weight reduction by diet control were covered care under the employee contract." See Complaint ¶¶ 4-10.

*620 II. MOTION TO DISMISS STANDARD

In analyzing a motion to dismiss, the Court will not dismiss the complaint unless it is clear that no set of facts that plaintiff could prove consistent with the pleadings would entitle plaintiff to relief. Hishon v. King & Spalding, 467 U.S. 69, 73, 104 S.Ct. 2229, 2232-33, 81 L.Ed.2d 59 (1984); Conley v. Gibson, 355 U.S. 41, 45-46, 78 S.Ct. 99, 101-02, 2 L.Ed.2d 80 (1957); Murphy v. Lane, 833 F.2d 106, 107 (7th Cir.1987); Vaden v. Village of Maywood, 809 F.2d 361, 363 (7th Cir.), cert. denied, 482 U.S. 908, 107 S.Ct. 2489, 96 L.Ed.2d 381 (1987). The Court will accept all well-pleaded factual allegations in the complaint as true. Vaden, 809 F.2d at 363; Doe v. St. Joseph's Hospital of Fort Wayne, 788 F.2d 411, 414 (7th Cir.1986). In addition, the Court will view the allegations in the complaint in a light most favorable to the nonmoving parties, in this case the plaintiffs. Car Carriers, Inc. v. Ford Motor Co., 745 F.2d 1101, 1104 (7th Cir.1984); Wolfolk v. Rivera, 729 F.2d 1114, 1116 (7th Cir.1984).

III. CONSTITUTIONAL CLAIMS

The Smiths allege a claim against Delco and Blue Cross for the denial of health care benefits based on the fifth and fourteenth amendments to the Constitution. Complaint ¶ 21. The fifth and fourteenth amendments apply, however, only to actions by state or federal governments, and not acts of private persons or private entities. See, e.g., Tulsa Professional Collection Services v. Pope, 485 U.S. 478, 108 S.Ct. 1340, 99 L.Ed.2d 565 (1988) (fourteenth amendment); San Francisco Arts & Athletics v. Olympic Comm., 483 U.S. 522, 107 S.Ct. 2971, 97 L.Ed.2d 427 (1988) (fifth and fourteenth amendments); Rendell-Baker v. Kohn, 457 U.S. 830, 838-39, 102 S.Ct. 2764, 2769-70, 73 L.Ed.2d 418 (1982) (fourteenth amendment); Public Utilities Commission v. Pollak, 343 U.S. 451, 461, 72 S.Ct. 813, 820, 96 L.Ed. 1068 (1952) (fifth amendment); Civil Rights Cases, 109 U.S. 3, 11, 3 S.Ct. 18, 21, 27 L.Ed. 835 (1883) (fourteenth amendment). Because the plaintiffs have failed to allege facts that would support the allegations that Blue Cross and Delco acted in violation of the fifth and fourteenth amendments, these claims must be dismissed.

Plaintiffs' assertions that state action is present in this case because the State of Wisconsin licenses and regulates the insurance industry, and that Delco is licensed to and does sell insurance in Wisconsin and that it is regulated by the Wisconsin Insurance Commissioner, are manifestly incorrect. Delco, a manufacturing division of General Motors Corporation, is not an insurer, and plaintiffs have not pleaded such facts in their complaint. That the insurance industry is regulated does not make a benefit claims decision state action. This Court rejected a similar argument by the same counsel in Tomczyk v. Blue Cross and Blue Shield of Wisconsin, 715 F.Supp. 914, 918 (E.D.Wis.1989), for § 1983: "The [insurer's] decision to deny benefits is a `purely private one', notwithstanding that it is licensed and regulated by the state." The plaintiffs' complaint does not allege any facts from which the conclusion can be drawn that Delco's or Blue Cross' decisions to deny plaintiffs benefits are state action.

IV. PLAINTIFFS' STATE LAW CLAIMS

The Supreme Court of the United States in Pilot Life Insurance Co. v. Dedeaux, 481 U.S. 41, 107 S.Ct. 1549, 95 L.Ed.2d 39 (1987), and Metropolitan Life Insurance Co. v. Taylor, 481 U.S. 58, 107 S.Ct. 1542, 95 L.Ed.2d 55 (1987), held that state tort and contract actions alleging improper processing of a claim for benefits under an ERISA covered employee benefit plan are preempted under ERISA. ERISA covers, among other things, welfare benefit plans such as the one alleged in the plaintiffs' complaint which provide health care benefits to employees. 29 U.S.C. § 1002(1). The Pilot Life decision directly precludes plaintiffs' state tort and contract claims for benefits under an ERISA covered plan:

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