Wayman v. Colonial Penn Life Insurance

805 F. Supp. 525, 1992 U.S. Dist. LEXIS 20716, 1992 WL 319636
CourtDistrict Court, E.D. Tennessee
DecidedApril 28, 1992
DocketNo. CIV 3-89-0484
StatusPublished
Cited by2 cases

This text of 805 F. Supp. 525 (Wayman v. Colonial Penn Life Insurance) is published on Counsel Stack Legal Research, covering District Court, E.D. Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Wayman v. Colonial Penn Life Insurance, 805 F. Supp. 525, 1992 U.S. Dist. LEXIS 20716, 1992 WL 319636 (E.D. Tenn. 1992).

Opinion

MEMORANDUM OPINION

JORDAN, District Judge.

This is a civil action governed by the Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. §§ 1001, et seq. (“ERISA”). The plaintiff says that on July 4, 1988, she was the spouse of Coy Wayman, who had group health insurance coverage through his employment. The underwriter of this policy was the defendant Colonial Penn Life Insurance Co. (“Colonial Penn”). It is unclear from the complaint what role the defendant InstaServ System, Inc. (“InstaServ”) played, but the plaintiff alleges that InstaServ was Colonial Penn’s “agent, servant and employee,” suggesting that InstaServ was an administrator with respect to this employee welfare benefit plan.

The plaintiff says that on July 4, 1988, she suffered permanent and disabling injury in an accident. She says that Colonial Penn, through InstaServ, paid some medical bills incurred as a result of this injury, but then terminated coverage of her.

It is stated in the plaintiff’s complaint that Colonial Penn increased the premium for the coverage provided by this policy after July 4, 1988, and that the plaintiff paid this increased premium when it became known to her. While it is not clear in the complaint, this suggests that some conversion feature of the policy had an impact upon this case. The plaintiff says in her complaint that she complied with all policy conditions regarding proofs of loss and submission of medical expenses.

In her amended complaint, the plaintiff added the defendants All American Life Insurance Company (“All American”) and Consultants and Administrators, Inc. (“C & A”).1 It appears that All American became the underwriter of Coy Wayman’s employee welfare benefit plan after the termination of the group insurance coverage underwritten by Colonial Penn, and that C & A was the administrator of this second plan. The plaintiff says that All American agreed to continue the coverage provided by the plan formerly underwritten by Colonial Penn, and agreed also to waive any limitation or exclusion of coverage by reason of her pre-existing condition, the condition caused by her accidental injury. The plaintiff says that All American’s “agent,” C & A, knew of her condition at the time All American became the group health insurance policy underwriter, and that C & A assured the plaintiff that she would continue to have coverage under the All American policy, but that All American then denied coverage.

Colonial Penn says in its answer that it terminated the group health insurance policy effective September 30,1988 for reasons which had nothing to do with the plaintiff, and that it continued to provide individual coverage for the plaintiff for 90 days after September 30, 1988. It denies that it charged any premium for this 90-day continuation coverage.

The copy of its policy which is attached to Colonial Penn’s answer shows that this policy was issued to a trustee of a trust for the benefit of multiple employers. See the definition of “multiple employer welfare [527]*527arrangement” in 29 U.S.C. § 1002(40)(A), part of ERISA as codified.

InstaServ says in its answer that it is a subsidiary of C & A. It denies that it was Colonial Penn’s agent, and says instead that it was “a servicing representative performing specified functions and duties for ... Colonial Penn” under an administrative agreement between Colonial Penn and Ins-taServ’s parent, C & A.

All American says in its answer that the plaintiff was excluded specifically from coverage under its policy, because she was totally disabled as a result of the injury which she received on July 4, 1988, which rendered her an ineligible dependent under the All American Policy. All American denies that it waived any pre-existing condition limitation or exclusion in its policy.

In its answer, C & A denies that it was All American’s agent, and denies that it had full knowledge of all of the plaintiff’s conditions, as alleged by her.

Colonial Penn takes the position in its cross-claim that All-American waived any pre-existing condition limitation or exclusion in the latter’s policy, and that All American therefore provided coverage for the plaintiff effective October 1, 1988. Colonial Penn says that it paid benefits for medical and hospitalization expenses incurred during the coverage period of All American’s policy, and that it is entitled to reimbursement by All American for these benefits paid. Colonial Penn says that All American should also be primarily liable for expenses incurred by or on behalf of the plaintiff on and after March 31, 1989, because InstaServ, as All American’s agent, offered the plaintiff’s husband a conversion policy of insurance, but All American then denied Mr. Wayman’s application for this conversion policy. On this basis, Colonial Penn seeks, in addition to reimbursement, indemnity against any liability which it might have to the plaintiff as a result of her loss of insurance coverage in 1989 and afterwards.

In response to Colonial Penn’s cross-claim, All American insists that it excluded the plaintiff from coverage specifically, that it did not waive any pre-existing condition limitation or exclusion in her case, and that InstaServ was not its agent. All American states also that Colonial Penn had a contractual duty to provide coverage for the plaintiff during the first 90 days after the termination of the Colonial Penn policy, which, All American says, defeats Colonial Penn’s claim for reimbursement.

Colonial Penn moved first for summary judgment [doc. 19, supplemented by doc. 22]. In support of its motion, Colonial Penn has submitted evidence to show that it decided before the plaintiff suffered injury to terminate all group health insurance policies underwritten by it for multiple employer trusts and administered by third-party administrators, which included the policy under which the plaintiff had coverage, and that it terminated this particular policy in accordance with all applicable policy provisions. The policy reserved to the underwriter the right of termination.

In a form letter dated August 23, 1988 and sent to the plaintiff’s husband’s employer, among others, Colonial Penn advised that employee group coverage under its policy would terminate effective October 1, 1988, and stated in part,

Your administrator, [C & A], has made arrangements to offer you coverage through another company.... They will provide information to you concerning their coverage.
Colonial Penn, of course, will honor all contractual obligations, and you and your insured employees may have the right to convert your insurance to a Colonial Penn conversion policy. For details see the section entitled “Conversion Privilege” in your Certificate of Insurance. Additionally, any insured totally disabled on October 1, 1988 may be eligible for extended benefits. Please see the section of your Certificate entitled “Extended Benefits in Event of Total Disability.”

As for the roles of C & A and InstaServ in this series of events, it is undisputed that the latter was a subsidiary of the former. C & A formed InstaServ as a servicing organization, solely for the purpose of processing and paying insurance claims. InstaServ acted as the administra[528]

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EFS National Bank v. Averitt Express, Inc.
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895 F. Supp. 961 (E.D. Tennessee, 1995)

Cite This Page — Counsel Stack

Bluebook (online)
805 F. Supp. 525, 1992 U.S. Dist. LEXIS 20716, 1992 WL 319636, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wayman-v-colonial-penn-life-insurance-tned-1992.