Wadsworth v. Whaland

562 F.2d 70, 1 Employee Benefits Cas. (BNA) 1464
CourtCourt of Appeals for the First Circuit
DecidedSeptember 1, 1977
DocketNos. 77-1135 and 77-1136
StatusPublished
Cited by90 cases

This text of 562 F.2d 70 (Wadsworth v. Whaland) is published on Counsel Stack Legal Research, covering Court of Appeals for the First Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Wadsworth v. Whaland, 562 F.2d 70, 1 Employee Benefits Cas. (BNA) 1464 (1st Cir. 1977).

Opinion

LAY, Circuit Judge.

This case presents an important and fundamental question of federal preemption because of an alleged conflict between the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C § 1001 et seq., and the New Hampshire state law regulating the content of group insurance policies, Chapter 57 of the Laws of 1976, N.H.Rev. Stat.Ann. §§ 415:18-a, 419:5-a and 420:5-a (1976). Chapter 57 requires the “issuers” of group health insurance policies to provide coverage for the treatment of mental illnesses and emotional disorders.1 ERISA does not require this. Administrators of various health and welfare funds which provide benefits chiefly through the purchase of group health insurance,2 brought this action against Francis E. Whaland, Commissioner of Insurance for the State of New Hampshire, seeking a declaration that Chapter 57 is unconstitutional and an in[73]*73junction restraining its enforcement. The fund administrators’ principal contention is that ERISA preempts the provisions of Chapter 57, to the extent that that chapter applies to employee benefit plans.3 Alternatively, they assert that the New Hampshire statutory scheme is an undue burden on interstate commerce and violates the due process and equal protection clauses of the United States Constitution. Both parties filed motions for summary judgment. After an evidentiary hearing relating primarily to the issue of irreparable harm, the district court, the Honorable Hugh H. Bownes presiding, held that ERISA did not preempt state regulation of group insurance policies, and that Chapter 57 did not contravene any provision of the Constitution. We affirm.

I.

ERISA.

As the preamble to the Act indicates,4 ERISA is the result of a congressional en[74]*74deavor to curb the funding and disclosure abuses of employee pension and welfare benefit plans by establishing minimum federal standards. Title I of ERISA, composed of five main subparts, provides the substantive regulatory provisions governing two basic types of employee benefit plans. Those two types are pension plans, which provide for retirement or deferred income,5 and welfare benefit plans, which provide medical, health, sickness, accident, and other non-pension benefits.6

Part one of Title 17 deals with the reporting and disclosure requirements for both types of plans. The basic purposes of these requirements are to inform employees of their rights, and to assist the Secretary of Labor in determining the financial soundness of the plan. See Brummond, Federal Preemption of State Insurance Regulation Under ERISA, 62 Iowa L.Rev. 57, 61-62 (1976). Thus, the fund administrators are required to provide each participant and each beneficiary with a summary description of their plan drafted in language understandable by the average plan participant 8 and to make available a copy of the plan’s annual report.9 A copy of the information provided to participants and beneficiaries, as well as other data, must be furnished to the Secretary of Labor.10

Parts two11 and three12 of Title I are limited in that they apply only to pension benefit plans. Part two creates minimum vesting standards and participation requirements, while part three provides funding requirements.

Part four13 of the Title sets forth the fiduciary standards for the management of employee pension and welfare benefit plans. These standards provide in part that the plan be in writing,14 the assets be held in trust15 exclusively for the benefit of employees,16 and that the plan investments be diversified.17 A “prudent man” standard is established for fund administrators, and prohibited financial transactions are listed.18

Finally, part five19 contains the administrative and enforcement provisions which apply to both employee pension plans and welfare benefit plans. It creates broad criminal and civil penalties20 and sets forth general guidelines governing claims procedures.21 Part five also gives the Secretary of Labor broad investigative powers22 and authority to promulgate regulations.23

II.

The “Funds”.

The funds administered by plaintiffs are employee welfare benefit plans within the [75]*75meaning of § 3 of ERISA.24 All of the funds, with the exception of New Hampshire Employer’s Benefit Trust, are “TaftHartley Trusts” in that they are also regulated by § 302 of the Labor Management Relations Act.25 Also with the exception of New Hampshire Employer’s Benefit Trust, which is voluntarily operated by employees, the funds are the products of collective bargaining agreements that require employers to contribute at a specified level. While the level of contributions is specified by the collective bargaining agreements, benefits are not.

Each year the fund administrators meet with local unions to determine the types of coverage desired by the members. The fund administrators must obtain, at the least possible cost, the coverage chosen. To fulfill this obligation the fund administrators, with the aid of insurance consultants, put together packages upon which they request sealed bids from insurance companies. Although the funds are self-insurers on a few benefits, approximately 90 per cent of the benefits are provided through group insurance policies. However, for all practical purposes, under the group insurance policies the funds are self-insurers who retain the insurance companies to provide the administrative service of processing claims.26 Because the premiums are experience rated the amount of claims for the year is projected; if the actual amount of claims is higher than the projection, the premium is adjusted upward; if the actual amount of claims is lower than the projection, the premium is adjusted downward. So in the long run, the funds reimburse the insurance company for all claims.

III.

A. The Preemption Issue.

The preemption issue is raised by § 514 of ERISA27 which provides that all state laws that “relate to” employee benefit plans are superseded.28 This sweeping language is modified by a saving clause which reaffirms the authority of the states to regulate insurance.29 However, the saving clause is further limited in that no plan will be “deemed” to be an insurance company, insurer or engaged in the business of insurance for the purpose of any state insurance law.30

Plaintiffs contend that § 514 preempts any direct or indirect regulation of employ[76]*76ee benefit plans by the state.31 They urge that Chapter 57

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Bluebook (online)
562 F.2d 70, 1 Employee Benefits Cas. (BNA) 1464, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wadsworth-v-whaland-ca1-1977.