Gleason v. SSM Health Care St. Louis, 4:11-cv-01182

Background

Plaintiff Connie Gleason filed a pro se state-law claim for negligent misrepresentation, later removed to federal court under ERISA preemption.
Court has previously held the state-law claim preempted by ERISA; plaintiff does not allege an ERISA claim.
Plan terms require written applications for benefits with specific disclosures, deadlines, and documentation.
Plaintiff submitted an incomplete claim on April 6, 2011, after the March 31 deadline, with non-eligible items.
SSM Health Care St. Louis (SSMHC-SL) denied the claim as untimely; plaintiff appealed internally and was denied again.
Court grants summary judgment for defendant, holding plaintiff failed to comply with the Plan’s express terms.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
ERISA preemption of state-law claim	Gleason argues no ERISA claim; disputes viability of preemption.	Court previously held preemption; no state-law claim viable.	Preemption upheld; no viable state-law claim.
Fiduciary status and liability	Plaintiff alleges fiduciary misrepresentation by plan administrator.	SSMHC-SL not a fiduciary; Plan administrator is SSM Health Care Corporation.	SSMHC-SL not a fiduciary; no fiduciary breach.
Remedy under ERISA	If not preempted, claim for benefits should be reviewed for denial.	Plan grants discretion to administrator; review under abuse-of-discretion standard.	Denial upheld under abuse-of-discretion; not entitled to benefits.

Key Cases Cited

Harris v. SWAN, Inc., 459 F. Supp. 2d 857 (E.D. Mo. 2005) (elements of ERISA breach claim (fiduciary, misrepresentation))
Daniels v. Thomas and Betts Corp., 263 F.3d 66 (3d Cir. 2001) (ERISA fiduciary duties standards; misrepresentation burden)
Blankenship v. Chamberlain, 695 F. Supp. 2d 966 (E.D. Mo. 2010) (ERISA breach standards; fiduciary duty requirements)
In re Pfizer Inc. ERISA Litig., 2009 WL 749545 (S.D.N.Y. 2009) (informal statements cannot alter ERISA plan terms)
Antolik v. Saks, Inc., 463 F.3d 796 (8th Cir. 2006) (ERISA plan amendments must be in writing)
Barker v. Ceridian Corp., 193 F.3d 976 (8th Cir. 1999) (informal statements do not legally modify ERISA plan)
Farley v. Benefit Trust Life Ins. Co., 979 F.2d 653 (8th Cir. 1994) (oral modifications of ERISA plans prohibited)
John Morrell & Co. v. United Food and Commercial Workers Intern. Union, AFL-CIO, 37 F.3d 1302 (8th Cir. 1994) (plan entitlement to benefits hinges on plan terms)
Jessup v. Alcoa, Inc., 481 F.3d 1004 (8th Cir. 2007) (deferential abuse-of-discretion review when administrator discretionary)
Collins v. Central States, 18 F.3d 556 (8th Cir. 1994) (arbitrary-and-capacious standard when fiduciary discretion)
Lakey v. Remington Arms, 874 F.2d 541 (8th Cir. 1989) (interpret plan language grants deference to fiduciary)
Hutchins v. Champion, 110 F.3d 1341 (8th Cir. 1997) (deference when plan grants sole discretion)
Jones v. ReliaStar Life Ins. Co., 615 F.3d 941 (8th Cir. 2010) (standard of review for discretionary plan decisions)