Stetson v. PFL Insurance

16 F. Supp. 2d 28, 1998 U.S. Dist. LEXIS 12276, 1998 WL 461888
CourtDistrict Court, D. Maine
DecidedJuly 8, 1998
DocketCivil 97-392-P-C
StatusPublished
Cited by7 cases

This text of 16 F. Supp. 2d 28 (Stetson v. PFL Insurance) 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
Stetson v. PFL Insurance, 16 F. Supp. 2d 28, 1998 U.S. Dist. LEXIS 12276, 1998 WL 461888 (D. Me. 1998).

Opinion

MEMORANDUM OF DECISION AND ORDER

GENE CARTER, District Judge.

Plaintiffs John and Bonnie Stetson brought this suit in Cumberland County Superior Court, alleging breach of contract, intentional and negligent misrepresentation, intentional and negligent infliction of emotional distress, and violations of the Maine Deceptive Trade Practices Act, 10 M.R.S.A. §§ 1211-16, and the Maine Unfair Trade Practices Act, 5 M.R.S.A. §§ 205-A — 214. 1 Defendants PFL Life Insurance Company (“PFL”), United Group Association, Inc. (“UGA”), and Linda Housel (“Housel”) removed the action to this Court pursuant to 28 U.S.C. §§ 1441(a) and (b) and 1446 (Docket No. 1). 2 Now before the Court is Defendants’ Motion for Summary Judgment (Docket No. 18), in which Defendants seek summary judgment on the ground that Plaintiffs’ state law claims are preempted by the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 et seq. For the reasons set forth below, the Court will deny Defendants’ Motion for Summary Judgment.

I. BACKGROUND

This case arises from misrepresentations allegedly made by Housel to Mr. Stetson during her efforts to sell a PFL health insurance policy to Mr. Stetson’s employer, Hebert’s Auto Service. At the time of the alleged misrepresentations, the employees of Hebert’s Auto Service were covered by a group health insurance policy issued by Travelers Insurance Company. Plaintiffs’ Statement of Material Facts (“Plaintiffs’ Statement”) (Docket No. 26) ¶5; Defendants’ Statement of Material Facts (“Defendants’ Statement”) (Docket No. 19) ¶ 1. The employer paid the premiums for its employees; Mr. Stetson paid for coverage for his wife and children. Defendants’ Statement ¶3. In August 1996, Housel made a sales presentation to the employees of Hebert’s Auto Service and encouraged them to abandon their Travelers group health insurance policy in favor of a PFL policy. Plaintiffs’ Statement ¶ 6; Defendants’ Statement ¶ 5. At the time Housel solicited Hebert Auto Service’s employees, she was acting as an agent of PFL. Plaintiffs’ Statement ¶ 7; Defendants’ Statement ¶ 8. UGA had a contractual relationship with PFL to sell its policies, and Housel had a contractual relationship with UGA to sell PFL health insurance policies in Maine. Plaintiffs’ Statement ¶¶2-3.

Plaintiffs allege that Housel made three primary misrepresentations during her sales presentation. First, they assert that she represented to the Hebert’s Auto Service employees that the PFL health insurance *30 policy would be as good as, if not better than, their current Travelers policy. Plaintiffs’ Statement ¶ 8. Second, they claim Housel represented that if the employees purchased PFL’s “Accident Benefit Expense Rider,” they would be covered 100% in the event of an accident. Id. Finally, they assert that Housel, after checking with her supervisor, assured Mr. Stetson that Mrs. Stetson’s weekly psychotherapy treatment would be covered by the PFL policy. Id. ¶ 9. Housel denies that she made any of the alleged misrepresentations. Id. ¶ 17.

The employees of Hebert’s Auto Service decided almost unanimously to surrender their Travelers policy in favor of the PFL policy, which took effect on October 1, 1996. Plaintiffs’ Statement ¶¶ 11-12; Defendants’ Statement ¶ 6. When Mrs. Stetson’s treating physician submitted a claim for Mrs. Stetson’s psychotherapy in November 1996, PFL denied the claim, indicating that the policy did not provide coverage for the treatment. Plaintiffs’ Statement ¶ 13. On January 11, 1997, Mr. Stetson was seriously injured in a snowmobile accident and was hospitalized for a week and a half. Id. ¶ 14. Upon discharge, he required a back brace and physical therapy. Id. His medical costs relating to the accident totaled in excess of $65,000. Id. Mr. Stetson submitted a claim to PFL for all of the medical expenses arising from his accident. Id. ¶ 15. The PFL policy covered only $14,000 of Mr. Stetson’s $27,000 hospital bill and did not cover his back brace or physical therapy at all. 3 Id. The Stetsons now owe over $40,000 in medical bills relating to Mrs. Stetson’s psychotherapy and Mr. Stetson’s snowmobiling accident. Id. ¶ 16. The employees of Hebert’s Auto Service dropped PFL as their health insurer in the summer of 1997. Id. ¶ 18. In November 1997, the Stetsons brought this suit seeking damages for the results of Housel’s allegedly tortious conduct. Defendants argue that Plaintiffs’ state law claims are preempted by ERISA.

II. STANDARD

In determining a motion for summary judgment, the Court views

“the entire record in the light most hospitable to the party opposing summary judgment, indulging all reasonable inferences in that party’s favor.” Griggs-Ryan v. Smith, 904 F.2d 112, 115 (1st Cir.1990) (citations omitted). Summary judgment is appropriate only if “the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(c).

Euromotion, Inc. v. BMW of North America, Inc., 136 F.3d 866, 869 (1st Cir.1998).

III. DISCUSSION

“ERISA is a comprehensive statute designed to promote the interests of employees and their beneficiaries in employee benefit plans.” Shaw v. Delta Air Lines, Inc., 463 U.S. 85, 90, 103 S.Ct. 2890, 77 L.Ed.2d 490 (1983). Section 514(a) of ERISA provides that “the provisions of [ERISA] shall supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan described in section 1003(a) of this title and not exempt under section 1003(b) of this title.” 4 29 U.S.C. § 1144(a). For purposes of section 514, “[t]he term ‘State law 5 includes all laws, decisions, rules, regulations, or other State action having the effect of law, of any State.” 29 U.S.C. § 1144(e)(1). The purpose of section 514(a) is “to ensure uniformity in [employee benefit] plans by preventing states from imposing divergent obligations upon them.” Boston Children’s Heart Foundation, Inc. v. Nadal-Ginard,

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Bluebook (online)
16 F. Supp. 2d 28, 1998 U.S. Dist. LEXIS 12276, 1998 WL 461888, Counsel Stack Legal Research, https://law.counselstack.com/opinion/stetson-v-pfl-insurance-med-1998.