Soniat v. Travelers Ins. Co.

517 So. 2d 325, 1987 WL 1514
CourtLouisiana Court of Appeal
DecidedJanuary 15, 1988
DocketCA 86 1199
StatusPublished
Cited by4 cases

This text of 517 So. 2d 325 (Soniat v. Travelers Ins. Co.) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal 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., 517 So. 2d 325, 1987 WL 1514 (La. Ct. App. 1988).

Opinion

517 So.2d 325 (1987)

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

No. CA 86 1199.

Court of Appeal of Louisiana, First Circuit.

November 10, 1987.
Writ Granted January 15, 1988.

*326 Dana K. Larpenteur, Plaquemine, for plaintiff (appellee).

A. Clay Pierce, Jr., Baton Rouge, for defendant (appellant).

*327 Before LANIER, CRAIN and LeBLANC, JJ.

LeBLANC, Judge.

This is a suit to collect medical and hospitalization benefits under an employee group insurance policy.

FACTS:

Prior to May of 1984, Steven Soniat was employed by Iberville Fabricators, Inc. Since Iberville was a member of the Louisiana Association of Business and Industry (LABI), Iberville's employees were entitled to join the group health insurance plan administered by LABI. This plan was underwritten by Travelers Insurance Company.

During 1983 and part of 1984, Soniat had family coverage under this plan. A portion of the premiums for this coverage was deducted from Soniat's paycheck, with the remainder being paid by Iberville. Although premiums were deducted from Soniat's checks until sometime in April of 1984, Iberville failed to pay the premiums for March of 1984 or any month thereafter.

When the Soniats became aware that there was a potential problem with coverage they were particularly concerned because Mrs. Soniat was pregnant at the time. Mrs. Soniat contacted Travelers and was told that there would be coverage under the policy only until the end of April. Mrs. Soniat was also informed that her family coverage could be converted from the group policy to an individual policy, but that the latter would not cover a pregnancy originating before its effective date.

Iberville went out of business in late April or early May and Soniat's employment was terminated at that time. By letter dated May 21, 1984, Iberville received notice that its coverage under the group policy was cancelled for non-payment of premiums, effective March 1, 1984. The Soniats were not given any written notice of cancellation.

On June 22, 1984, Mrs. Soniat gave birth to a son. The Soniats filed a claim with Travelers for the expenses incurred in the delivery and the subsequent medical care of the baby, a total of $7,703.39. Travelers refused the claim, denying the existence of any coverage. Mr. and Mrs. Soniat thereafter filed suit against Iberville and Travelers claiming $15,406.78 (double the amount of their medical expenses), attorney fees and interest. They alleged they were entitled to double the medical benefits incurred as a penalty against defendants. Iberville did not answer the suit and a default judgment was taken against it for $15,406.78 (double the medical benefits incurred, minus the applicable deductible amount), plus interest, 25 percent attorney fees and costs. Iberville did not appeal this judgment and it is now final.

Plaintiffs proceeded to trial against Travelers on December 9, 1985. Following trial, the court denied an exception of res judicata which had been filed by Travelers and rendered judgment in favor of the Soniats and against Travelers for $15,406.78 (double the medical benefits due minus the applicable deductible amount) plus interest, attorney fees in the amount of $3,100.00 and costs. Travelers has perfected a suspensive appeal from this judgment. Subsequent to the lodging of this appeal, Travelers filed written exceptions in this Court raising the objections of no cause of action and lack of subject matter jurisdiction. The Soniats have responded with a brief in opposition to these exceptions.

ISSUES:

1. Does plaintiffs' petition state a cause of action?

2. Does the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001, et seq., preempt the subject matter jurisdiction of the state court in this matter?

3. Does ERISA preempt the application of Louisiana state law to this matter?

4. Did the trial court err in denying Travelers' exception of res judicata?

5. Did plaintiffs' coverage under the Travelers policy terminate when Mr. Soniat was discharged by Iberville Fabricators?

6. Were all parties entitled to receive notice of cancellation given proper notice?

*328 ISSUES ONE, TWO AND THREE:

The basis of Travelers' exceptions of no cause of action and lack of subject matter jurisdiction is their claim that the remedy sought by plaintiffs under Louisiana law is preempted by ERISA, which provides regulations and enforcement provisions concerning employee benefit plans. See, 29 U.S.C. § 1001, et seq. Initially, we note that both a peremptory exception of no cause of action and a declinatory exception of lack of subject matter jurisdiction may be considered when raised for the first time on appeal if a written exception is filed with this court.[1] However, after full consideration of these exceptions, we conclude neither has merit. Plaintiffs' petition sets forth a claim for benefits allegedly due under the terms of the Travelers policy which is sufficient to establish a cause of action for breach of contract under both ERISA and state law. See, 29 U.S.C. § 1132(a)(1)(B).[2] Further, the provisions of ERISA specifically provide that state courts shall have concurrent jurisdiction with federal district courts regarding actions under 29 U.S.C. § 1132(e)(1).[3] Thus, it is clear both that plaintiffs' petition states a cause of action and that the trial court had subject matter jurisdiction over this matter.

Nevertheless, although neither of these exceptions have merit, an additional issue raised herein by a consideration of ERISA is whether it preempts the application of Louisiana law, requiring that federal common law be applied to the merits of this case. The Louisiana law which we conclude would normally be dispositive of this case is the case law that says it is not in contravention of the insurance code for a policy to provide that when an employee group insurance policy terminates by its express terms upon the termination of employment there is no coverage under the policy for pregnancy expenses incurred after the employee's discharge, even when the pregnancy commenced prior to the discharge. Trevino v. Prudential Ins. Co., 504 So.2d 1179 (La.App. 3d Cir.), writ denied, 506 So.2d 1230 (1987); Harrington v. Prudential Ins. Co., 477 So.2d 1272 (La. App. 3d Cir.1985); also see, LeBlanc v. Travelers Insurance Company, 486 So.2d 828 (La.App. 1st Cir.1986); Levine v. National Life & Accident Insurance Company, 389 So.2d 864 (La.App. 4th Cir.1980).[4] The determination of whether this case law *329 is preempted by ERISA requires analysis of the following ERISA provisions:

Except as provided in subsection (b) of this section [the saving clause], the provisions of this subchapter and subchapter III of this chapter shall supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan ... 29 U.S.C. § 1144

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Perkins v. Shelter Ins. Co.
540 So. 2d 488 (Louisiana Court of Appeal, 1989)
Soniat v. Travelers Ins. Co.
538 So. 2d 210 (Supreme Court of Louisiana, 1989)
Guidry v. Shelter Ins. Co.
535 So. 2d 393 (Louisiana Court of Appeal, 1988)
Soniat v. Travelers Insurance Co.
518 So. 2d 511 (Supreme Court of Louisiana, 1988)

Cite This Page — Counsel Stack

Bluebook (online)
517 So. 2d 325, 1987 WL 1514, Counsel Stack Legal Research, https://law.counselstack.com/opinion/soniat-v-travelers-ins-co-lactapp-1988.