Kriwox v. Empire State Regional Council of Carpenters
7:10-cv-01070
N.D.N.Y.May 26, 2011Background
- Plaintiffs Patrick and Laurie Kriwox sue Empire State Carpenters Welfare Fund and EBS-RMSCO, Inc. for breach of the health insurance plan's benefits for their daughter O.K.
- The plan was established by Empire State and administered by EBS, under which O.K. claimed medical expenses totaling about $171,000 after a 2009 ATV accident.
- EBS paid roughly $3,353 of the claims and denied the remainder, citing a rider excluding coverage for injuries from certain hazardous activities.
- Plaintiffs appealed the denial in December 2009 and February 2010; the appeals were denied, reinforcing the initial denial.
- Plaintiffs filed suit in state court in July 2010, which was removed to federal court, and amended the complaint to add Empire State as a defendant.
- Plaintiffs moved to amend again to recharacterize the claim as ERISA-based or to add a second ERISA-related and statutory-penalties claim; defendants did not oppose the cross-motion.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the amendment to add ERISA and penalties claims is permissible | Kriwoxs seek ERISA claim and penalties without prejudice | EBS/Empire State would be prejudiced; preemption issues unresolved | Amendment granted; prejudice not shown; ERISA claim and penalties allowed |
| Whether the preemption doctrine bars the amended complaint | Complaint should be recharacterized under ERISA § 502 | ERISA preemption would bar state-law contract claim | Preemption analysis rendered moot by granting amendment; amendment proceeds |
| Whether leave to amend should be denied as futile | Amendment raises valid ERISA claim and penalties | Proposed amendments would be futile | Amendment not futile; merits proceed |
Key Cases Cited
- Arthurs v. Metropolitan Life Insurance Co., 760 F. Supp. 1095 (S.D.N.Y. 1991) (recharacterization of state-law claims as ERISA claims is appropriate)
- Harrison v. Metropolitan Life Ins. Co., 417 F. Supp. 2d 424 (S.D.N.Y. 2006) (pleading sufficiency allows ERISA framing when appropriate)
- Fanney v. Trigon Insurance Co., 11 F. Supp. 2d 829 (E.D. Va. 1998) (disagreement among courts on preemption treatment)