Verdon v. AIG Life Insurance

76 P.3d 283, 118 Wash. App. 449
CourtCourt of Appeals of Washington
DecidedSeptember 16, 2003
DocketNo. 28945-8-II
StatusPublished
Cited by2 cases

This text of 76 P.3d 283 (Verdon v. AIG Life Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals of Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Verdon v. AIG Life Insurance, 76 P.3d 283, 118 Wash. App. 449 (Wash. Ct. App. 2003).

Opinion

Armstrong, J.

AIG Life Insurance Company appeals a summary judgment ruling that Washington State law controls whether Sheila Verdón, its insured, is covered for a serious injury to her right arm. Verdón purchased an accidental death and dismemberment insurance policy from AIG that her employer administered. The question on appeal is whether the plan is part of Verdon’s Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001-1461 (ERISA) employment benefits and, thus, interpreted according to federal law, or whether ERISA’s “safe harbor provision” exempts it from ERISA, in which case Washington law applies. The answer depends on whether Verdon’s employer endorsed the insurance policy. We hold that issues of material fact exist as to whether Verdon’s employer endorsed the policy. Accordingly, we vacate the summary judgment and remand for trial.

FACTS

Sheila Verdón suffered injuries in an auto accident that left her completely unable to use her right arm and hand. At the time of the accident, she had an accidental death and dismemberment insurance policy with AIG Life Insurance Company, which her employer, MultiCare Health System, administered. The policy provided compensation for the loss of a hand, specifying that “ ‘[Ross’ of a hand or foot means complete severance through or above the wrist or ankle joint.” Clerk’s Papers (CP) at 49.

[452]*452If the policy is excluded from ERISA by its “safe harbor” provisions, ERISA does not apply and Washington law controls. According to Verdón, Washington law would allow her claim because she has a complete loss of functional use of her hand. Morgan v. Prudential Ins. Co. of Am., 86 Wn.2d 432, 437, 545 P.2d 1193 (1976). If, on the other hand, ERISA applies, AIG contends that only a total physical severance of the hand is compensable. The trial court ruled that the AIG plan was exempt from ERISA, that ERISA therefore did not preempt Verdon’s state law claims, that AIG’s policy provided coverage for Verdon’s injury, that Verdon was entitled to $250,000 plus interest, and that Verdon was entitled to attorney fees. AIG appeals.

ANALYSIS

We review summary judgment decisions de novo. Int’l Bhd. of Elec. Workers, Local Union No. 46 v. Trig Elec. Constr. Co., 142 Wn.2d 431, 434-35,13 P.3d 622 (2000), cert. denied, 532 U.S. 1002 (2001). In doing so, we view the facts in the light most favorable to the nonmoving party, AIG. Folsom v. Burger King, 135 Wn.2d 658, 663, 958 P.2d 301 (1998). Summary judgment is proper where there is no genuine issue of material fact and the moving party is entitled to judgment as a matter of law. CR 56(c).

I. ERISA and the Safe Harbor Provision

Congress enacted ERISA to protect people who participate in employee benefit plans by applying a uniform federal regulatory scheme to all claims covered by employee benefit plans. Johnson v. Watts Regulator Co., 63 F.3d 1129, 1132 (1st Cir. 1995). ERISA covers an employee welfare benefit plan or program that is “established or maintained” by the employer. Johnson, 63 F.3d at 1132. A Department of Labor regulation explains that an employer “may be involved with an employee welfare benefit program without being deemed to have ‘established or maintained’ it.” Johnson, 63 F.3d at 1133.

[453]*453This “safe harbor” regulation specifically states that:
[T]he terms “employee welfare benefit plan” and “welfare plan” shall not include a group or group-type insurance program offered by an insurer to employees or members of an employee organization, under which
(1) No contributions are made by an employer or employee organization;
(2) Participation the [sic] program is completely voluntary for employees or members;
(3) The sole functions of the employer or employee organization with respect to the program are, without endorsing the program, to permit the insurer to publicize the program to employees or members, to collect premiums through payroll deductions or dues checkoffs and to remit them to the insurer; and
(4) The employer or employee organization receives no consideration in the form of cash or otherwise in connection with the program, other than reasonable compensation, excluding any profit, for administrative services actually rendered in connection with payroll deductions or dues checkoffs.

29 C.F.R. § 2510.3-l(j). The parties agree that AIG’s plan satisfies the first, second, and fourth requirements. But they dispute the third requirement, whether MultiCare endorsed the plan to its employees.

An employer endorses a plan or program if “an objectively reasonable employee would conclude on the basis of the employer’s actions that the employer [has] not merely facilitated the program’s availability but [has] exercised control over it or made it appear to be part and parcel of the company’s own benefit package.” Johnson, 63 F.3d at 1135. The employee’s viewpoint is the “principal frame of reference in determining whether endorsement occurred.” Johnson, 63 F.3d at 1134.

In Johnson, the insurer drafted the policy, set the premium rates, and prepared and printed the sales brochure and enrollment cards. The employer distributed the brochures and enrollment cards and recommended enrollment in a cover letter. This letter Was on the employer’s letter[454]*454head and signed by its vice-president, but it explicitly told employees that the decision whether to enroll was up to them. Johnson, 63 F.3d at 1136. The employer collected premiums through payroll deductions, sent the insurer the premiums, kept a list of insureds, filled out the employer portion of the claim form, provided claim forms to employees, and kept track of employee eligibility. Johnson, 63 F.3d at 1136. The court upheld the trial court’s determination that the plan fell within the safe harbor provisions and was exempt from ERISA.

The Fifth Circuit considered the endorsement issue in Hansen v. Continental Insurance Co., 940 F.2d 971 (5th Cir. 1991). There, the employer gave its employees a booklet called “Group Accident Insurance Plan for the employees of Fairfield Industries,” on which the employer’s logo was printed. Hansen, 940 F.2d at 974. The booklet said it “explained] our plan of Group Accident Insurance,” and it asked employees to give the program “careful consideration.” Hansen, 940 F.2d at 974 (emphasis omitted). A full-time benefits administrator accepted claim forms and submitted them to the insurer. Hansen, 940 F.2d at 974.

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Cite This Page — Counsel Stack

Bluebook (online)
76 P.3d 283, 118 Wash. App. 449, Counsel Stack Legal Research, https://law.counselstack.com/opinion/verdon-v-aig-life-insurance-washctapp-2003.