James Barber v. Unum Life Insurance Company of AmericaJames Barber v. Unum Life Insurance Company of America
OPINION OF THE COURT
At issue is whether ERISA preempts Pennsylvania’s bad faith statute for insurance claims,
I.
Facts
This matter involves a dispute over disability benefits provided to plaintiff James Barber by his employer under an employee benefit plan governed by the Employee Retirement Income Security Act of 1974, as amended
After Barber became disabled, he applied for and received long-term disability benefits. But UNUM subsequently terminated the benefits after determining Barber was no longer disabled under the policy’s terms. Barber brought suit for breach of contract and for bad faith, requesting punitive damages under
UNUM moved under
Procedural Background
In
Rosenbaum v. UNUM Life Insurance Co. of America,
No. 01-6758,
II.
A. Conflict Preemption
Under the doctrine of conflict preemption, a state law may be preempted “to the extent that it actually conflicts with federal law,”
English v. Gen. Elec. Co.,
Until the Supreme Court’s recent decision in
Aetna Health Inc. v. Davila,
— U.S. -,
[The provisions of ERISA] set forth a comprehensive civil enforcement scheme that represents a careful balancing of the need for prompt and fair claims settlement procedures against the public interest in encouraging the formation of employee benefit plans. The policy choices reflected in the inclusion of certain remedies and the exclusion of others under the federal scheme would be completely undermined if ERISA-plan participants and beneficiaries were free to obtain remedies under state law that Congress rejected in ERISA.
Id.
at 54,
The Supreme Court revisited conflict preemption in
Rush Prudential,
Although we have yet to encounter a forced choice .between the congressional policies of exclusively federal remedies and the reservation of the business of insurance to the States, we have anticipated such a conflict, with the state insurance regulation losing out if it allows plan participants “to obtain remedies ... that Congress rejected in ERISA.”
Id.
at 378,
The parties here have focused on whether the Supreme Court treatment of
In
Aetna Health,
the Court held the plaintiffs’ claims under the Texas Healthcare Liability Act, which imposed a duty of ordinary care in the handling of coverage decisions, were completely preempted by ERISA and therefore removable to federal court.
Id.
at 2492-93, 2498. Noting that ERISA’s “integrated enforcement mechanism, ERISA § 502(a),” is “essential to accomplish Congress’ purpose of creating a comprehensive statute for the regulation of employee benefit plans,” the Court held “any state-law cause of action that duplicates, supplements, or supplants the ERISA civil enforcement remedy conflicts with the clear congressional intent to make the ERISA remedy exclusive and is therefore pre-empted.”
Id.
at 2495 (citing
Pilot Life,
Reading
Pilot Life, Rush Prudential,
and
Aetna Health
together, a state statute is preempted by ERISA if it provides “a form of ultimate relief in a judicial forum that added to the judicial remedies provided by ERISA,”
Rush Prudential,
B. Express Preemption and the Saving Clause
1. The Saving Clause’s Effect on Conflict Preemption
Barber contends
In
Aetna Health,
— U.S. -,
ERISA § 514(b)(2)(A) must be interpreted in light of the congressional intent to create an exclusive federal remedy in ERISA § 502(a). Under ordinary principles of conflict pre-emption, then, even a state law that can arguably be characterized as ‘regulating insurance’ will be pre-empted if it provides a separate vehicle to assert a claim for benefits outside of, or in addition to, ERISA’s remedial scheme.
Id.
at 2500.
9
Citing
Pilot Life,
2. Express Preemption
In the alternative, we believe the District Court erred in finding
UNUM responds that
Suppose a state law required all licensed attorneys to participate in 10 hours of continuing legal education (CLE) each year. This statute “regulates” the practice of law-even though sitting through 10 hours of CLE classes does not constitute the practice of law-because the state has conditioned the right to practice law on certain requirements, which substantially affect the product delivered by lawyers to their clients.
Id.
at 337-38,
Under the second prong, however,
Moreover, claims for bad faith insurance breaches bear no relation to the risk pooled-the risk of loss the insurer agrees to bear on behalf of the insured. Within the insurance industry, “risk” means the risk of occurrence of injury or loss for which the insurer contractually agrees to compensate the insured. With risk pooling, “a number of risks are accepted, some of which involve losses,” and the “losses are spread over all the risks so as to enable the insurer to accept each risk at a slight fraction of the possible liability upon it.”
Union Labor Life Ins. Co. v. Pireno,
Our conclusion is buttressed by
Pireno,
[Plaintiffs] argument contains the unspoken premise that the transfer of risk from an insured to his insurer actually takes place not when the contract between those parties is completed, but rather only when the insured’s claim is settled. This premise is contrary to the fundamental principle of insurance that the insurance policy defines the scope of risk assumed by the insurer from the insured.
Id.
at 131,
Moreover, the threat that punitive awards may result in increased costs that could be passed on to the insured is too attenuated to be deemed to “substantially affect” the risk pooling arrangement. Accordingly, under the Miller test, Pennsylvania’s bad faith statute does not “regulate insurance” within the meaning of ERISA’s saving clause and is expressly preempted by ERISA.
III.
For the foregoing reasons, we will reverse the judgment of the District Court and remand with instructions to dismiss Barber’s bad faith claim.
Notes
.
In an action arising under an insurance policy, if the court finds that the insurer has acted in bad faith toward the insured, the court may take all of the following actions:
(1) Award interest on the amount of the claim from the date the claim was made by the insured in an amount equal to the prime rate of interest plus 3%.
(2) Award punitive damages against the insurer.
(3) Assess court costs and attorney fees against the insurer.
Id.
. Subparagraph (B) (“the deemer clause”) provides:
Neither an employee benefit plan ... nor any trust established under such a plan, shall be deemed to be an insurance company or other insurer, bank, trust company, or investment company or to be engaged in the business of insurance or banking for purposes of any law of any State purporting to regulate insurance companies, insurance contracts, banks, trust companies, or investment companies.
If a state law "relate[s] to ... employee benefit plants],” it is pre-empted. § 514(a). The saving clause excepts from the preemption clause laws that “regulat[e] insurance.” § 514(b)(2)(A). The deemer clause makes clear that a state law that "purport[s] to regulate insurance” cannot deem an employee benefit plan to be an insurance company. § 514(b)(2)(B).
Pilot Life Ins. Co. v. Dedeaux,
. In
Rosenbaum v. UNUM Life Insurance Co. of America,
No. 01-6758,
.Several other federal district courts in Pennsylvania held ERISA preempts
One district court agreed with
Rosenbaum II,
. We have subject matter jurisdiction under
The issues presented are legal issues over which we exercise plenary review.
Concepcion v. Morton,
. In addition to
Pilot Life
and
Rush Prudential,
the Supreme Court has asserted on other occasions Congress did not intend to authorize remedies other than those provided under ERISA § 502(a), emphasizing the "overpowering” federal policy in ERISA’s exclusive civil enforcement provisions.
See Metropolitan Life Ins. Co. v. Taylor,
. Even if the Supreme Court's discussion of conflict preemption were dicta, we do not view their dicta lightly:
[W]e should not idly ignore considered statements the Supreme Court makes in dicta. The Supreme Court uses dicta to help control and influence the many issues it cannot decide because of its limited docket. "Appellate courts that dismiss these expressions [in dicta] and strike off on their own increase the disparity among tribunals (for other judges are likely to follow the Supreme Court's marching orders) and frustrate the evenhanded administration of justice by giving litigants an outcome other than the one the Supreme Court would be likely to reach were the case heard there.”
Official Comm. of Unsecured Creditors of Cybergenics Corp. ex rel. Cybergenics Corp. v. Chinery,
. The District Court decided this case before the decision in
Aetna Health,
- U.S. -,
. Amicus supporting Barber's position contend that because
. Prior to
Miller,
the seminal case interpreting ERISA's insurance regulation preemption exception was
Metropolitan Life Insurance Co.
v.
Massachusetts,
Applying the McCarran-Ferguson factors, the Supreme Court has saved from preemption: an Illinois law requiring HMOs to provide independent review of whether services are medically necessary,
Rush Prudential,
. Barber attempts to cast the saving clause in a broad light by claiming
Miller’s
reference to "the risk pooling” arrangement between insurer and insured refers simply to the "insurance” arrangement between them. But the
Miller
test is intended to clarify ERISA's opaque statutory language which saves statutes that "regulate insurance.”
. We recognize
Pilot Life
was decided under the
pre-Miller
McCarran-Ferguson standard which asked whether the law at issue "has the effect of transferring or spreading a policy holder's risk."
. As with Pilot Life, we find the Court's analysis of insurance risk in the pre-Miller Pireno to still offer guidance.