Soniat v. Travelers Ins. Co.

538 So. 2d 210, 1989 WL 6024
CourtSupreme Court of Louisiana
DecidedJanuary 30, 1989
Docket87-C-2705
StatusPublished
Cited by27 cases

This text of 538 So. 2d 210 (Soniat v. Travelers Ins. Co.) is published on Counsel Stack Legal Research, covering Supreme Court of Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Soniat v. Travelers Ins. Co., 538 So. 2d 210, 1989 WL 6024 (La. 1989).

Opinion

538 So.2d 210 (1989)

Steven J. SONIAT and Debra Landry Soniat
v.
TRAVELERS INSURANCE COMPANY and Iberville Fabricators, Inc.

No. 87-C-2705.

Supreme Court of Louisiana.

January 30, 1989.

*211 Dana Larpenteur, Wilbert & Larpenteur, Plaquemine, for applicant.

Alton Pierce, Jr., Durant, Pierce & Malone, Baton Rouge, for respondent.

LEMMON, Justice.

The principal issue in this case is whether the medical expenses for the delivery of plaintiffs' child were covered under an employees group health insurance policy when the pregnancy occurred while the policy was in effect, but the child was not born until after the policy had been cancelled for non-payment of premiums by the employer and the employee's employment had been terminated by the employer's business failure. Under La.R.S. 22:213 B(7), as that statute read at the time of the events at issue here, cancellation of a policy by an insurer could not "prejudice any claim arising prior thereto".[1] For the reasons hereafter discussed we hold that the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001 et seq., does not pre-empt La.R.S. 22:213 B(7); that Section 213 B(7) applied to group health and accident insurance policies in 1984; and that the insurer's cancellation of the policy did not affect plaintiff's claim for expenses arising from the pregnancy which originated prior to the cancellation.

Facts

When his wife became pregnant in 1983, Steven Soniat had been employed by Iberville Fabricators for nine years. Soniat had medical and hospitalization insurance coverage for himself and his wife under a group health insurance policy which covered Iberville's employees through Iberville's membership in the Louisiana Association of Business and Industry (LABI). The group insurance plan was administered by LABI and underwritten by Travelers Insurance Company.[2]

Iberville deducted a portion of the premiums for the insurance from Soniat's wages and paid the balance as a fringe benefit. Deductions of premiums from Soniat's wages continued until April 18, 1984, but Iberville failed to remit the premiums to LABI for February and March.

On March 19, 1984, LABI notified Iberville that premiums had not been paid for the months of February and March and that the policy would be cancelled if payment was not received by March 31. On April 4, 1984, LABI notified Iberville by letter that "your group coverage has been cancelled for non-payment of premiums effective February 1, 1984". Thereafter LABI wrote Travelers requesting that payment of claims be made through the date for which Iberville had remitted premium payments. One of the pending claims was *212 that of Soniat for expenses of his wife's prenatal care, some of which had already been paid by Travelers.

Although the Soniats never received written notice of cancellation of the policy, Mrs. Soniat contacted Travelers directly in April, 1984 to inquire about her coverage. Travelers informed her that there would be coverage only until the end of April and then only if Iberville remitted the collected premiums. As to her paying the premiums individually, she was informed that the policy could be converted from a group policy to an individual policy, but the individual policy would not cover the expenses connected with her pregnancy which had originated before the effective date of the individual policy.

Iberville went out of business in early May of 1984, and Soniat's employment was terminated at that time.

On June 22, 1984, Mrs. Soniat gave birth to a son. When the Soniats filed a claim for expenses of the delivery and subsequent care of the baby in the amount of $7,703.39, Travelers declined payment on the basis that the expenses were incurred after termination of Soniat's coverage under the policy. The Soniats then filed the instant action.

After trial on the merits the district court rendered judgment in favor of the Soniats for double the medical expenses, plus interest, attorney's fees and costs. The court of appeal reversed, holding that May 31, 1984, the last day of the month in which Soniat's employment terminated, was the last possible date that Soniat could have had coverage under the policy.[3] 517 So.2d 325. Since the expenses were not incurred until the child's birth in June, the court reasoned that the policy did not provide coverage.[4]

We granted certiorari to consider the correctness of that holding. 518 So.2d 511.

Pre-emption of State Law by ERISA

Travelers filed exceptions of no cause of action and lack of subject matter jurisdiction in the court of appeal and in this court, contending that the relief sought by the Soniats under Louisiana law was pre-empted by ERISA. Citing Pilot Life Insurance Co. v. Dedeaux, 481 U.S. 41, 107 S.Ct. 1549, 95 L.Ed.2d 39 (1987), Travelers argues that the remedies specified in ERISA are exclusive and that all state common law and statutory remedies for benefits under an ERISA plan are pre-empted.

Through ERISA Congress established comprehensive regulation of, among other things, employee welfare benefit plans that "through the purchase of insurance or otherwise" provide medical, surgical, or hospital care or benefits, or benefits in the event of sickness, accident, disability or death. 29 U.S.C. § 1002(1). The group medical insurance purchased by Iberville for its employees through LABI was clearly an employee benefit plan subject to regulation by ERISA.

The petition in this case, which set forth a claim for benefits allegedly due under the insurance policy written by Travelers, clearly stated a cause of action for recovery of benefits under both ERISA and Louisiana law.[5] Furthermore, ERISA specifically *213 provides that state courts have concurrent jurisdiction with federal district courts over actions brought by an employee to recover benefits due him under an ERISA-regulated plan.[6] Thus, the district court properly overruled Travelers' exceptions. The crucial ERISA issue on the merits is whether the pre-emption provision of 29 U.S.C. § 1144 precludes application of La.R.S. 22:213 B(7), the state law upon which the Soniats rely for relief in this case.

The provisions of ERISA relating to pre-emption include the pre-emption clause in § 1144(a), the saving clause in § 1144(b)(2)(A), and the deemer clause in § 1144(b)(2)(B), as follows:

"Except as provided in subsection (b) of this section [the saving clause], the provisions of this subchapter and subchapter III of this chapter shall supercede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan...." 29 U.S.C. § 1144(a). (emphasis added)
"Except as provided in subparagraph (B) [the deemer clause], nothing in this 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. § 1144(b)(2)(A).

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Bluebook (online)
538 So. 2d 210, 1989 WL 6024, Counsel Stack Legal Research, https://law.counselstack.com/opinion/soniat-v-travelers-ins-co-la-1989.