Washington National Insurance v. Hendricks

855 F. Supp. 1542, 1994 U.S. Dist. LEXIS 8828, 1994 WL 289306
CourtDistrict Court, W.D. Wisconsin
DecidedJune 23, 1994
Docket93-C-0108-C
StatusPublished
Cited by9 cases

This text of 855 F. Supp. 1542 (Washington National Insurance v. Hendricks) is published on Counsel Stack Legal Research, covering District Court, W.D. Wisconsin primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Washington National Insurance v. Hendricks, 855 F. Supp. 1542, 1994 U.S. Dist. LEXIS 8828, 1994 WL 289306 (W.D. Wis. 1994).

Opinion

OPINION and ORDER

CRABB, Chief Judge.

This is a civil action for monetary relief for breach of contract and in the alternative for a violation of the Employee Retirement Income Security Act of 1974, §§ 241402, as amended, 29 U.S.C. §§ 1001-1461. Plaintiff contends that defendants failed to pay the premiums required under the insurance policy and financing agreement entered into by the parties. Defendants assert several affirmative defenses and counterclaims pursuant to both Wisconsin law and ERISA. They contend that plaintiff terminated the agreements improperly, that they are entitled to rescission of the contracts and that their liability for any outstanding premiums should be offset by the excessive payments they made to plaintiff.

Now before the court are the parties’ .cross-motions for summary judgment and plaintiffs motion for a default judgment. Plaintiff seeks summary judgment on its claims and on defendants’ counterclaims; defendants seek summary judgment on plaintiffs claims and on their own counterclaim for wrongful termination.

Plaintiff contends that defendants’ first nine counterclaims are preempted by ERISA, but asserts that its own claims are not preempted. Conversely, defendants assert that plaintiffs claims are preempted, but not their own first nine counterclaims. I *1546 agree with both assertions of preemption and conclude that plaintiff’s claims and defendants’ first nine counterclaims are preempted by ERISA. Additionally, I conclude that plaintiff has no cause of action under the civil enforcement provisions of ERISA, but that it does have a cause of action for breach of contract under ERISA common law. Finally, I conclude that all of defendants’ affirmative defenses and counterclaims are without merit except that the record is insufficient to reach a decision at this time on the merits of defendants’ claim that they are entitled to an offset for improperly paid premiums.

For the purpose only of deciding this motion, I find that the following facts are undisputed.

UNDISPUTED FACTS

Plaintiff Washington National Insurance Company is an Illinois corporation engaged in the insurance business. Defendants Kenneth and Diane Hendricks are both adult residents of Wisconsin. Kenneth Hendricks is the sole owner or 50% owner with Diane Hendricks of a number of businesses throughout the United States. Diane Hendricks is president of one of those businesses, American Patriot Insurance Agency, Inc., and holds an insurance broker’s license.

For the purpose of providing the more than 1,000 employees of the Hendrickses’ businesses with health and life insurance and disability benefits, Kenneth Hendricks created an unincorporated entity called Hendricks Group, which maintained a bank account through which payments were collected for and dispersed from the various insurance policies that provided benefits to the Hendrickses’ employees. Jerome Mancuso served as defendants’ broker and consultant on insurance matters.

Before June 1988, Hendricks Group was insured by General American Insurance Company. In 1988, Mancuso recommended that defendants buy insurance from plaintiff Washington National instead. Plaintiff prepared a sales proposal and presented it to Syncor Administrative Services, which acted as a third party administrator of defendants’ insurance policies and was the “Broker of Record” for defendants from 1988 to 1990. During the course of discussions about insurance, plaintiffs sales representative, Robert Schmitke, was told that all the businesses that would be covered by the policies obtained by Hendricks Group were owned by Kenneth Hendricks and that Diane Hendricks was an officer of one of the businesses that would be covered by Hendricks Group’s policy. In May 1988, Diane Hendricks signed a Master Insurance Application and Minimum Premium Agreement with plaintiff as the “authorized representative” of “Kenneth A. Hendricks d/b/a Hendricks Group” and identified herself as an officer of one of the companies to be insured.

The insurance policy purchased by defendants defined the health care benefits and the procedures to be used to claim the benefits. The agreement became effective on June 1, 1988. Diane Hendricks signed renewals of the policy in 1989, 1990 and 1991. Schmitke was identified on the policy as plaintiffs Licensed Resident Agent.

Under the policy, plaintiff was obligated to administer the defendants’ claims and was responsible for determining benefits payable. Plaintiff had final authority and discretion to determine the benefits payable under the plan. Additionally, plaintiff retained the right to delegate responsibility for the administration of the plan. Kenneth Hendricks was responsible for remitting payments of insurance premiums and for collecting employee contributions. Kenneth Hendricks delegated these responsibilities to Diane Hendricks.

The policy was funded through the Minimum Premium Agreement. As part of the Minimum Premium Agreement, the parties entered into a Post-Termination Liability Agreement and a Deficit Recovery Limit Agreement. The Post-Termination Liability Agreement limited the Hendricks Group’s liability after the termination of the Master Agreement to claims incurred before termination but paid within a limited time after termination. Also, this agreement provided plaintiff with the ability to recoup certain accrued deficits in defendants’ account. The Deficit Recovery Limit Agreement limited the amount of deficit that plaintiff could re *1547 cover from defendants to 10% of the yearly-deficit. This agreement applied to all but the last year of the contract.

On April 30, 1990, Diana Hendricks informed plaintiff that Mancuso was the new “Broker of Record” for defendants and that “it is expressly understood that notice to Mr. Mancuso’s office will be considered notice to Hendricks.” On June 22, 1990, Schmitke sent Mancuso a letter authorized by one of plaintiffs vice presidents regarding plaintiffs delinquency and reinstatement procedures. (The procedures are not set forth in the insurance agreement or the Minimum Premium Agreement.) After outlining plaintiffs payment procedures for the policy, Schmitke stated:

Washington National delinquency procedures are:

First and second time delinquency within a twelve month period results in an offer of reinstatement which is subject to the payment of a reinstatement fee of 1.5% of the delinquent premium.
Third time delinquency within twelve month period results in termination with no offer of reinstatement.

In 1991, plaintiffs reinstatement procedures changed to include the requirement that reinstatements be approved by the premium and underwriting departments. However, defendants never received notice of such a change.

On July 1, 1990, Third Party Administrators, Inc., replaced Syncor as the “Broker of Record” for Hendricks Group. Subsequently, plaintiff executed a contract with Third Party Administrators, Inc., for administrative services.

On June 1, 1991, Hendricks Group renewed the Minimum Premium Agreement by signing an appendix to the agreement.

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Cite This Page — Counsel Stack

Bluebook (online)
855 F. Supp. 1542, 1994 U.S. Dist. LEXIS 8828, 1994 WL 289306, Counsel Stack Legal Research, https://law.counselstack.com/opinion/washington-national-insurance-v-hendricks-wiwd-1994.