United of Omaha v. Business Men's

CourtCourt of Appeals for the Eighth Circuit
DecidedJanuary 14, 1997
Docket95-3185
StatusPublished

This text of United of Omaha v. Business Men's (United of Omaha v. Business Men's) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eighth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
United of Omaha v. Business Men's, (8th Cir. 1997).

Opinion

_____________

No. 95-3185 _____________

United of Omaha, * * Plaintiff - Appellee, * Appeal from the United States * District Court for the v. * Western District of Missouri. * Business Men's Assurance * Company of America, * * Defendant - Appellant. *

Submitted: April 8, 1996

Filed: January 14, 1997 _____________

Before RICHARD S. ARNOLD, Chief Judge, WOLLMAN and HANSEN, Circuit Judges. _____________

HANSEN, Circuit Judge.

Business Men's Assurance Company of America (BMA) appeals from an order of the district court granting summary judgment to United of Omaha (United) in a dispute under Missouri state law over which company was responsible to pay health insurance benefits. BMA argues that the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. §§ 1001 et seq., preempts United's claim and, alternatively, that the district court erroneously interpreted and applied Missouri law, on issues of both liability and damages. We affirm in part and reverse in part. I. FACTS

The undisputed facts of this case are as follows. BMA issued a group health insurance policy to Western Water Management, Inc. (Western) for the benefit of Western's employees, effective January 1, 1989. Western's group policy was a welfare plan subject to ERISA. During the time of its coverage, one of Western's employees, Clyde Jones, became totally and permanently disabled, and as a result, Jones experienced a reduction in hours of employment. This was a "qualifying event" under the Consolidated Omnibus Budget Reconciliation Act (COBRA), 29 U.S.C. §§ 1161-68 (1988), a 1985 amendment to ERISA that requires plan sponsors like Western to provide an opportunity for individuals like Jones to obtain continuing coverage under such circumstances. Jones elected to obtain coverage, which BMA began providing to Jones as a COBRA continuee on October 1, 1989. The BMA policy expired on November 30, 1990.

Western replaced the BMA policy with an insurance policy issued by United, effective December 1, 1990. Jones began paying monthly premiums to United on that date and was thereafter covered as a COBRA continuee under the United policy.

During the period between December 1, 1990 and December 1, 1991, the 12-month period following BMA's policy's termination, a number of health care providers presented bills to United for Jones's medical expenses. United paid the bills but later sought reimbursement from BMA, contending that BMA was responsible for the expenses pursuant to Missouri law that governs the discontinuance and replacement of insurance for disabled individuals. See Mo. Rev. Stat. §§ 376.438, 376.441. BMA refused to reimburse United, pointing to a provision in BMA's group policy which provides that its obligation to provide extended benefits terminates when an individual becomes fully covered by another insurer.

2 United brought this action against BMA, seeking damages under Missouri law for the hospital and medical expenses United had paid on behalf of Jones during the 12-month period following the termination of BMA's policy. The parties filed a series of motions for summary judgment, making arguments on liability, certain affirmative defenses, and damages. The district court granted United's motions for summary judgment, holding that United's state-law claim was not preempted by ERISA and, according to Missouri law, BMA is liable for Jones's medical and hospital expenses incurred from December 1, 1990, through December 1, 1991. The court calculated the damages based upon the full amount of medical expenses United had paid, plus prejudgment interest.

BMA appeals, asserting a number of arguments. First, BMA contends that the district court erroneously interpreted sections 376.438 and 376.441 of the Missouri Revised Statutes. Second, BMA claims that ERISA preempts the Missouri statutes, as interpreted by the district court, because they are in conflict with the federal statute, as amended by COBRA. BMA also argues that ERISA preempts United's state-law subrogation claim. Next, BMA maintains that even if the district court correctly interpreted the statutes, and even if United's claim is not preempted, the court erroneously applied the Missouri state law of equitable subrogation. Finally, BMA contends that the district court erred in calculating damages.

II. Standard of Review

We review the district court's grant of summary judgment de novo, applying the same standards as did the district court. Kerns v. Benefit Trust Life Ins. Co., 992 F.2d 214, 217 (8th Cir. 1993). Summary judgment is appropriate when the evidence, viewed in the light most favorable to the nonmoving party, shows there is no genuine issue of material fact and the moving party is entitled to judgment as a matter of law. Fed. R. Civ. P. 56(c). In this case,

3 because the parties do not dispute the facts, our inquiry is limited to whether United was entitled to judgment as a matter of law. We review the district court's determination of Missouri state law de novo. Salva Regina College v. Russell, 499 U.S. 225, 231 (1991); United States v. Green Acres Enters., Inc., 86 F.3d 130, 133 (8th Cir. 1996).

III. Statutory Interpretation

To determine whether United has a cause of action that is preempted by ERISA, we must interpret the state statute on which the cause of action is based. The district court interpreted the state statute to require BMA, as a prior carrier of group health insurance, to provide Jones an extension-of-benefits for 12 months following the termination of the policy, regardless of whether Western had secured replacement coverage. The court then looked at BMA's policy, which provided an extension for medical expenses, without payment of a premium, "1) for up to 3 months after coverage terminates for any sickness or injury; and 2) for up to 9 more months for the sickness or injury causing the total disability," but which also stated that the extension of benefits would be terminated on "[t]he date the [c]overed [p]erson is covered under any other group policy or employer-funded plan." (J.A. at 76.) Finding this termination provision of the policy to be incompatible with Missouri law, the district court held that it was void. BMA argues that the extension-of-benefits coverage provided in its policy does not violate the state statute because it is reasonable, within the meaning of section 376.438.1, for BMA to refuse to extend benefits after the disabled person is covered by a replacement policy.

Our primary objective in interpreting the Missouri statute is to ascertain the legislative intent from the statutory language and, if possible, to give effect to that intent. Rothschild v. State Tax Comm'n of Mo., 762 S.W.2d 35, 37 (Mo. 1988) (en banc).

4 "[W]e consider the words employed in the statute in their plain and ordinary meaning, we presume the legislature did not intend an absurd law, and we favor a construction that avoids unjust or unreasonable results." Id. (internal citation omitted).

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