Smith v. Continental Casualty Co.

303 F. Supp. 2d 560, 2002 U.S. Dist. LEXIS 18312, 2002 WL 32334275
CourtDistrict Court, E.D. Pennsylvania
DecidedSeptember 16, 2002
Docket2:02-cv-01915
StatusPublished

This text of 303 F. Supp. 2d 560 (Smith v. Continental Casualty Co.) is published on Counsel Stack Legal Research, covering District Court, E.D. Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Smith v. Continental Casualty Co., 303 F. Supp. 2d 560, 2002 U.S. Dist. LEXIS 18312, 2002 WL 32334275 (E.D. Pa. 2002).

Opinion

MEMORANDUM

WALDMAN, District Judge.

Plaintiff asserts a claim for benefits under the Employee Retirement Income Security Act (“ERISA”) and a state law bad faith claim under 42 Pa.C.S.A. § 8371 arising from the denial of long-term disability insurance benefits by defendant. 1 Defendant has moved to dismiss the state law bad faith claim as preempted by ERISA and concomitantly to strike plaintiffs demand for punitive damages and a jury trial.

Dismissal for failure to state a claim is appropriate when it clearly appears that plaintiff can prove no set of facts to support the claim that would entitle him to relief. See Conley v. Gibson, 355 U.S. 41, 45-46, 78 S.Ct. 99, 2 L.Ed.2d 80 (1957); Robb v. Philadelphia, 733 F.2d 286, 290 (3d Cir.1984). Such a motion tests the legal sufficiency of a claim accepting the veracity of the claimant’s allegations and all reasonable inferences drawn therefrom. See Markowitz v. Northeast Land Co., 906 F.2d 100, 103 (3d Cir.1990); Sturm v. Clark, 835 F.2d 1009, 1011 (3d Cir.1987). A claim may be dismissed when the facts alleged are legally insufficient to support the relief sought. See Pennsylvania ex rel. Zimmerman v. PepsiCo., Inc., 836 F.2d 173, 179 (3d Cir.1988).

Defendant provided long-term disability insurance to plaintiff under an employee benefit plan maintained by his employer, Murray Insurance Associates. Under the terms of the plan, defendant is obligated to pay long-term disability benefits if an insured becomes “continuously unable to engage in any occupation for which [insured is] or become[s] qualified by education, training or experience; and not working for wages in any occupation for which [insured is] or become[s] qualified by education, training or experience,” or if the insured becomes “unable to earn more than 80% of [insured’s] monthly earnings in any occupation for which [insured is] qualified by education, training or experience.”

Plaintiff was employed by Murray Insurance as Vice President of Finance and Administration until March 30, 2001. Plaintiff was diagnosed with Parkinson’s Disease in 1997, and continued to work until his disease progressed to the point where he could no longer perform his duties. On January 17, 2001, plaintiff made a claim for long-term disability benefits under the policy issued by defendant. On June 26, 2001, defendant informed plaintiff that his claim had been denied. Plaintiff appealed this denial. He provided defendant with information from his neurologist and from Murray Insurance supporting his claim that he was unable to perform the duties of his job. On October 4, 2001, defendant informed plaintiff that it had reaffirmed its decision to deny his claim.

*563 ERISA broadly preempts all state laws that “relate to any employee benefit plan.” 29 U.S.C. § 1144(a). This provision preempts both state common law and statutory causes of action. See Ingersoll-Rand Co. v. McClendon, 498 U.S. 133, 138, 111 S.Ct. 478, 112 L.Ed.2d 474 (1990); Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 47-48, 107 S.Ct. 1549, 95 L.Ed.2d 39 (1987). A law “relates to” an employee benefit plan if it has a connection with or reference to such a plan, even if it was not designed to affect such plans or does so only indirectly. See Ingersoll-Rand, 498 U.S. at 138, 111 S.Ct. 478; Shaw v. Delta Air Lines, Inc., 463 U.S. 85, 97, 103 S.Ct. 2890, 77 L.Ed.2d 490 (1983). The Supreme Court noted that “policy choices reflected in the inclusion of certain remedies and the exclusion of others under the federal scheme would be completely undermined if ERISA-plan participants and beneficiaries were free to obtain remedies under state law that Congress rejected in ERISA.” Pilot Life, 481 U.S. at 54, 107 S.Ct. 1549.

Plaintiff asserts that nevertheless his § 8371 claim is not preempted because it falls within ERISA’s “saving clause.” That clause provides in pertinent part that “nothing in this title 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. § 1144(b)(2)(A).

In Metropolitan Life Insurance Co. v. Massachusetts, 471 U.S. 724, 105 S.Ct. 2380, 85 L.Ed.2d 728 (1985), the Supreme Court set forth a framework for analyzing whether particular laws fall within ERISA’s saving clause. The first inquiry is whether, from a “common-sense view of the matter,” the law regulates insurance. Id. at 740,105 S.Ct. 2380. The second inquiry focuses on three factors derived from the case law interpreting the McCarran-Ferguson Act: “first, whether the practice has the effect of transferring or spreading a policyholder’s risk; second, whether the practice is an integral part of the policy relationship between the insurer and the insured; and third, whether the practice is limited to entities within the insurance industry.” Id. at 743, 105 S.Ct. 2380. The Supreme Court made clear in UNUM Life Insurance Co. of America v. Ward, 526 U.S. 358, 119 S.Ct. 1380, 143 L.Ed.2d 462 (1999), however, that a state law need not satisfy all three McCarran-Ferguson factors to “regulate insurance” within the meaning of the saving clause. Rather, the factors are “considerations to be weighed” in making a saving clause determination. Id. at 373, 119 S.Ct. 1380.

The Court held in UNUM Life that California’s notice-prejudice rule, which provides that an insurer cannot avoid liability because a claim was untimely without showing actual prejudice resulted from the delay, fell within the saving clause and was not preempted. The Supreme Court more recently held that an Illinois law requiring HMOs to provide independent medical review of disputes with primary care physicians was not preempted by ERISA. See Rush Prudential HMO, Inc. v. Moran, 536 U.S. 355, 122 S.Ct. 2151, 153 L.Ed.2d 375 (2002).

By its terms, § 8371 applies only to “actions on insurance policies” and, from a common-sense view, regulates insurance. The statute does not effect the transfer or spread of á policyholder’s risk.

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Related

Conley v. Gibson
355 U.S. 41 (Supreme Court, 1957)
Shaw v. Delta Air Lines, Inc.
463 U.S. 85 (Supreme Court, 1983)
Metropolitan Life Insurance v. Massachusetts
471 U.S. 724 (Supreme Court, 1985)
Pilot Life Insurance v. Dedeaux
481 U.S. 41 (Supreme Court, 1987)
Ingersoll-Rand Co. v. McClendon
498 U.S. 133 (Supreme Court, 1990)
Unum Life Insurance Co. of America v. Ward
526 U.S. 358 (Supreme Court, 1999)
Rush Prudential HMO, Inc. v. Moran
536 U.S. 355 (Supreme Court, 2002)
Sturm v. Clark
835 F.2d 1009 (Third Circuit, 1987)
Kaplan v. Cablevision of PA, Inc.
671 A.2d 716 (Superior Court of Pennsylvania, 1996)
Creeger Brick & Building Supply Inc. v. Mid-State Bank & Trust Co.
560 A.2d 151 (Supreme Court of Pennsylvania, 1989)
D'AMBROSIO v. Pa. Nat. Mut. Cas. Ins. Co.
431 A.2d 966 (Supreme Court of Pennsylvania, 1981)
Pennsylvania ex rel. Zimmerman v. Pepsico, Inc.
836 F.2d 173 (Third Circuit, 1988)
Pane v. RCA Corp.
868 F.2d 631 (Third Circuit, 1989)
Anthuis v. Colt Industries Operating Corp.
971 F.2d 999 (Third Circuit, 1992)

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Bluebook (online)
303 F. Supp. 2d 560, 2002 U.S. Dist. LEXIS 18312, 2002 WL 32334275, Counsel Stack Legal Research, https://law.counselstack.com/opinion/smith-v-continental-casualty-co-paed-2002.