Spellman v. United Parcel Service, Inc.

540 F. Supp. 2d 237, 43 Employee Benefits Cas. (BNA) 1560, 2008 U.S. Dist. LEXIS 22031, 2008 WL 740598
CourtDistrict Court, D. Maine
DecidedMarch 19, 2008
DocketCivil 07-67-P-H
StatusPublished
Cited by6 cases

This text of 540 F. Supp. 2d 237 (Spellman v. United Parcel Service, Inc.) is published on Counsel Stack Legal Research, covering District Court, D. Maine primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Spellman v. United Parcel Service, Inc., 540 F. Supp. 2d 237, 43 Employee Benefits Cas. (BNA) 1560, 2008 U.S. Dist. LEXIS 22031, 2008 WL 740598 (D. Me. 2008).

Opinion

MEMORANDUM DECISION AND ORDER ON CROSS-MOTIONS FOR SUMMARY JUDGMENT

D. BROCK HORNBY, District Judge.

The issue in this case is whether the Employee Retirement Income Security Act of 1974 (“ERISA”) preempts an employee’s state law claim that derives from a Maine insurance statute, Bureau of Insurance rule, and enforcement penalty. The Maine provisions require a disability insurer to award an employee disability benefits “without regard to any policy exclusion for work-related injury or disease,” whenever the employee’s workers’ compensation claim has been resisted on the ground that the underlying condition is not work-related, and the Workers’ Compensation Board has not yet decided the claim. For violation of this provisional payment requirement, the employee can seek imposition of a penalty of up to $10,000. I conclude that ERISA preempts the employee’s request for a penalty, but not the substance of the rule and statute. I Grant summary judgment to the defendants and Deny it to the plaintiff.

Factual and Procedural Background

The plaintiff, Timothy Spellman, is an employee of the defendant United Parcel Service (“UPS”). 1 Spellman filed a claim for workers’ compensation benefits under the Maine Workers’ Compensation Act. 2 UPS and its workers’ compensation insurer, Liberty Mutual Group, denied liability. They filed a Notice of Controversy with the Maine Workers’ Compensation Board *241 (“the Board”) on the ground that Spell-man’s injury was not work-related. 3

Next, Spellman filed a claim for benefits under the UPS National LTD Plan. 4 The UPS National LTD Plan is a long-term disability benefits plan that UPS provides under an insurance contract with the defendant Metropolitan Life Insurance Company (“MetLife”). 5 MetLife is the claims fiduciary for the plan. 6 MetLife denied Spellman’s claim for disability benefits on the ground that his injury was work-related. The UPS National LTD Plan states that benefits are not payable “for any disability that results from ... any on-the-job injury or illness, as determined by Met-Life.” 7

In response, Spellman filed a Petition for Assessment of Civil Penalty against UPS and MetLife under Maine’s Workers’ Compensation Act. 8 The Act provides: “Payment of benefits due a person under an insured disability plan or insured medical payments plan may not be delayed or refused because that person has filed a workers’ compensation claim based on the same personal injury or disease.” 39-A M.R.S.A. § 222(1). This is known as the “provisional payment” section. A Bureau of Insurance rule adopted to implement the statutory requirement states:

If a workers’ compensation claimant is awaiting a Board determination on a claim in which the employer or workers’ compensation carrier has filed a notice of controversy contesting the work-relatedness of the claimant’s condition, and the claimant is covered under an insured health plan, then the health carrier must determine eligibility and provide benefits to the claimant, according to the terms of the health plan but without regard to any policy exclusion for work-related injury or disease.

02-031 CMR ch. 530, § 4(A) (emphasis added). Spellman’s Petition asked the Board to assess a civil penalty of $10,000 against UPS and MetLife for their failure to comply with 39-A M.R.S.A. § 222 and Bureau of Insurance Rules ch. 530, § 4. 9

MetLife removed the proceeding to this court under 28 U.S.C. § 1441. 10 MetLife and UPS each moved for sum *242 mary judgment arguing that ERISA preempts Spellman’s state-law claims. UPS also argues that it is exempt because the Maine statute and rule apply only to insurers or self-insured employers, of which it is neither. 11 Spellman opposed the motions for summary judgment and filed a cross-motion for summary judgment. 12 I invited the Attorney General of the State of Maine to defend the state law. 13 As a result, the Attorney General submitted an amicus brief opposing the defendants’ preemption arguments.

After hearing oral argument, I conclude that § 222 and the Bureau of Insurance rule do not apply to UPS. As to MetLife, I conclude that the Maine insurance provisions requiring a disability insurance carrier to pay benefits until a workers’ compensation claim is resolved survive preemption. 14 However, I conclude that ERISA does preempt the state law penalty provision that Spellman’s petition invokes. As a result, I grant summary judgment to UPS and MetLife and deny it to Spellman.

*243 Analysis

(a) UPS

Section 222 prohibits delaying or denying disability benefits to an employee who has petitioned for workers’ compensation benefits. 39-A M.R.S.A. § 222(1). It instructs the Superintendent of Insurance to “adopt rules to implement this section.” 39-A M.R.S.A. § 222(3). The Bureau of Insurance rule implementing § 222 and requiring provisional payment of disability benefits applies to a “health carrier.” 02-031 CMR ch. 530, § 4(A). A health carrier is “the insurance company, nonprofit health service corporation, or other entity responsible for payment of benefits or provision of services under an insured health plan.” 02-031 CMR ch. 530, § 3(B). Nothing in the record suggests that UPS is any of these. Spellman’s only argument on this point is that, under the Workers’ Compensation Act, “UPS and MetLife are, in effect and by definition, the same entity.” 15 Whatever the merit of this interpretation of the Workers’ Compensation Act, 16 it does not support the argument that UPS is a “health carrier” under the Bureau of Insurance rule. UPS does not fit the definition of “health carrier” provided in the rule. Spellman’s long term disability benefits are provided through an insurance contract with MetLife. 17 Met-Life is the claims fiduciary and plan administrator for the UPS National LTD Plan. 18 Under the Plan terms, UPS “does not have discretionary authority with respect to benefit claims that are insured.” 19

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Cite This Page — Counsel Stack

Bluebook (online)
540 F. Supp. 2d 237, 43 Employee Benefits Cas. (BNA) 1560, 2008 U.S. Dist. LEXIS 22031, 2008 WL 740598, Counsel Stack Legal Research, https://law.counselstack.com/opinion/spellman-v-united-parcel-service-inc-med-2008.