Jane Tomczyk v. Blue Cross & Blue Shield United of WisconsinJane Tomczyk v. Blue Cross & Blue Shield United of Wisconsin
Jаne Tomczyk brought this action against Blue Cross and Blue Shield United of Wisconsin (Blue Cross), a Wisconsin nonprofit corporation, alleging ERISA, state common-law, and constitutional violations. The District Court granted summary judgment to Blue Cross on the ERISA count, and dismissed the others. Tomczyk appeals the disposition of her ERISA and state common-law claims. We affirm. Moreover, because of the largely frivolous nature of this appeal, as well as the misleading manner in which it was presented to this Court, we impose Rule 38 sanctions on Tomczyk's attorneys, Marjan Kmiec and Christopher McConville of Kmiec Law Offices.
I.
Jane Tomczyk is a member of an ERISA-regulated group health insurance plan issued by Blue Cross and sponsored by her employer. After undergoing oral surgery on October 3, 1987, she filed a claim with Blue Cross for reimbursement of approximately $8,250 in surgical and hospital fees.
The District Court dismissed the state common-law claims as preempted by ERISA, and the § 1983 claim owing to a lack of state action.
See Tomczyk v. Blue Cross & Blue Shield United of Wisconsin,
A.
We review
de novo
the District Court’s grant of summary judgment to Blue Cross.
See Doe v. Allied-Signal, Inc.,
The District Court concluded that the oral surgery performed on Tomczyk was not a covered procedure under her insurance plan. Tomczyk has not appealed the court’s
de novo
interpretation of the insurance contract.
See Firestone Tire & Rubber Co. v. Bruch,
Tomczyk receives her insurance coverage through the Blue Cross “Advantage Program.” Under this program, certain requirements must be met before a plan member may receive full benefits for covered serviсes for nonemergency inpatient hospital care. Blue Cross must determine that the hospitalization is medically necessary and authorize the care. Additionally, the member must notify Blue Cross prior to admission that hospitalization is anticipated, and a length of stay must be authorized. The contract provides that, “[i]f the admission was not preauthorized, benefits will be limited to 80% of the amount otherwise allowed according to the contract provisions for covered benefits.” Exhibit A, Section MC, at 74. Moreover, the contract states that even where the hospital stay is preauthorized, “[ojther limitations, exclusions and conditions of the contract are not affected by this section and still apply.” Id.
Tomczyk first consulted with John Goeckerman, D.D.S., who subsequently performed the surgery on her jaw, on September 21, 1987. Dr. Goeckerman determined that Tomczyk required corrective treatment consisting of two variations of a surgical procedure known as “osteotomy of the temporo mandibular joint.” On September 30, аn employee with Dr. Goecker-man’s office called Blue Cross’s Advantage
In her brief, Tomczyk claims that McKinch told Dr. Goeckerman’s office that her “insurance was in ‘perfect standing’ ” and that Blue Cross “would cover all medical costs regarding Jane Tomczyk’s medicаlly necessary surgery, thereby approving said surgical treatments.” Appellant’s Br. at 5-6. Nowhere does the record support such an assertion. The sole piece of evidence Tomczyk cites in this regard is Dr. Goeckerman’s affidavit. That affidavit, however, states only that McKinch had told his office that Blue Cross “had authorized the hospital stay for the intended surgery,” Goeckerman Affidavit at 1, an assertion Blue Cross does not dispute. According to McKinch’s affidavit, she informed Dr. Goeckerman’s office that she “would authorize a three day inpatient hospital stay.” McKinch Affidavit at 2. Significantly, however, her affidavit also states that she informed Dr. Goeckerman’s office “that the authorization related to the patient’s need to have the procedures done as an inpatient and was not an authorization of coverage,” id., and “that it would be advisable to get verification of coverage from Blue Cross’ Medical Review department.” Id. Additionally, because she had determined, and informed Dr. Goeckermаn’s office, that the procedure might not be covered, she did not send the customary letter confirming admission preauthorization. Id. Tomczyk presents no evidence disputing McKinch’s statements or showing that Blue Cross authorized the surgery or otherwise agreed to pay for the hospital stay.
Tomczyk’s brief argues that since Blue Cross authorized the hospital stay, one can draw a reasonable inference that it also preauthorized the surgery. Appellant’s Br. at 9. At oral argument before this Court, Tomczyk’s counsеl, Christopher McCon-ville, contended that it is also reasonable to conclude that once Dr. Goeckerman obtained the preauthorization for the hospital stay, “he thought he had authority not only for the hospital stay, but for the surgery.” McConville’s contention is belied by an October 7 letter Dr. Goeckerman sent to Blue Cross. The first sentence reads, “This letter is sent as a request for prior determination of benefits.” Plaintiff’s Exhibit A. The letter goes on to outline his diagnosis, suggested treatment, and surgical fees. The plаin language of the letter shows that, contrary to McConville’s assertion, Dr. Goeckerman was indeed aware that Blue Cross had not preauthorized the surgery, which had been performed on October 3.
We are disturbed by the manner in which counsel for Tomczyk manipulated relevant facts. Her brief reads into Dr. Goecker-man’s affidavit statements that simply aren’t there. The affidavit states only that the hospital stay was preauthorized; it does not state, as Tomczyk’s brief claims, that “Blue Cross would cover all medical costs regarding Jane Tomczyk’s medically necessary surgery, thereby approving said surgical treatments.” Tomczyk’s brief also misrepresents the contents of Dr. Goecker-man’s letter of October 7, asserting, for example, that Dr. Goeckerman included the cost breakdowns “as a common curtesy” [sic], Appellant’s Br. at 6, when the letter clearly is a request for determination of benefits. That Tomczyk’s attorney further perpetuated these patently inaccurate characterizations at oral argument only serves to highlight his generally distressing approach in this appeal. We affirm the District Court, and find that no material fact exists regarding whether the surgical treatment was authorized.
Tomczyk’s brief asserts further that, at the very least, Tomczyk should be able to recover the costs of her hospital stay. That the hospital stay was preauthorized is not in dispute; Blue Cross has admitted as much.
See
Appellee’s Br. at 4; McKinch Affidavit at 2. Admission preauthorization, however, does not necessarily result in reimbursement. As we have nоted, McKinch’s affidavit states that she told Dr. Goeckerman’s office that this preauthorization related only to the need to have that type of procedure performed as an
B.
Tomczyk also appeals the District Court’s dismissal of her state common-law claims of bad faith, breach of contract, and tortious interference with contract. As to her bad faith claim, she attempts to circumvent ERISA’s broad preemptive provisions by claiming that the Wisconsin law of bad faith is a law which “regulates insurance” and, as such, avoids preemption through ERISA’s “saving clause.” She attempts to salvage her claims of breach of contract and tortious interference with contract by recharacterizing them as “federal law claims” and urging this Court to therefore consider them as claims for breach of fiduciary duty under ERISA. Appellant’s Br. at 19. We reject her arguments.
1.
Tomczyk contends that the Wisconsin law of bad faith escapes ERISA’s broad preemptive scope because it is a law regulating insurance and thus falls within the ambit of ERISA’s “saving clause.”
See
29 U.S.C. § 1144(b)(2)(A). ERISA generally preempts any state law which “relates to” employee benefit plans.
Id.
§ 1144(a).
1
The saving clause, however, provides that a state law which specifically “regulates insurance” escapes this preemption,
id.
§ 1144(b)(2)(A);
see Pilot Life Ins. Co. v. Dedeaux,
In
Pilot Life
— which involved, as here, an insurеd employee benefit plan — the Supreme Court held that Mississippi bad faith law was not a law regulating insurance within the meaning of § 1144(b). The Court relied primarily on three rationales: the law was not “specifically directed to
Tomczyk attempts to distinguish
Pilot Life
by asserting that, unlike the Mississippi law of bad faith, Wisconsin bad faith law “is directly meant to regulate unfair trade practices within the insurance industry.” Appellant’s Br. at 15. She cites two cases as authority,
Brockmeyer v. Dun & Bradstreet,
Attempts such as this to mislead this Court were, unfortunately, commonplace in this appeal. Tomczyk continually ignored relevant precedent from this jurisdiction. Her brief failed to cite a case from the Eastern District of Wisconsin which specifically held that ERISA preempted the Wisconsin tort of bad faith.
See Rust v. Blue Cross & Blue Shield United of Wisconsin,
No. 87-C-0751,
Finally, Tomczyk’s brief gave short shrift to
Maciosek v. Blue Cross & Blue Shield United of Wisconsin,
2.
In appealing her claims for breach of contract and tortious interference with her contractual relationship with her doctor, Tomczyk attempts to escape the inescapable (i.e., preemption) by adding a twist, arguing that this Court should consider these state common-law claims as claims for breach of fiduciary duty under ERISA. Appellant’s Br. at 19. This Court in
Maciosek
rejected essentially the same argument,
II.
In bringing this appeal, Tomczyk’s counsel, Christopher McConville and Marjan Kmiec (both of Kmiec Law Offices), continue a disturbing pattern of litigating claims that repeatedly advance the same frivolous arguments. This case, the most recent in a litany of nonmeritorious ERISArelated cases brought by these attorneys, unfortunately is just one strand in a tangled web of claims manifesting a disregard for the duty of candor that undergirds the judicial system.
In
Smith, supra,
the plaintiff, through Kmiec, alleged breach of contract, bad faith breach of contract, breach of fiduciary duty, and intentional infliction of emotional distress, and sought punitive damages. As here, the plaintiff in
Smith
argued that the state law claims should not be preempted by ERISA because of the saving clause. Citing
Pilot Life and Metropolitan Life Ins. Co. v. Taylor,
Despite the strong language and clear holding of Smith, McConville and Kmiec briefed the Tomczyk appeal with only a single reference to it — a comment that “some of these issues herein are currently pending before the Seventh Circuit” and a reservation of the right to amend the brief should Smith be decided during the pend-ency of the Tomczyk appeal. Appellant’s Br. at 4-5. The brief failed to substantively address the District Court opinion in Smith, state its holding, dispute its reasoning, or attempt in any way to distinguish it from the case at hand.
Similarly, Tomczyk’s brief failed to adequately address this Court’s decision in
Ma-ciosek.
As with
Smith,
the sole reference to
Maciosek
was the comment reserving the right to amend if
Maciosek
were decided during the pendency of Tomczyk’s appeal. Unlike
Smith, Maciosek
was issued during the pendency.
Maciosek
specifically held that the plaintiffs’ claims for breach of contract, tortious interference with a contractual relationship, and intentional infliction of emotional distress were preempted by ERISA,
[t]he Maciosek case was not a bad faith case, but instead was treated by the court and parties as a violation of Wisconsin Common Law which prohibited an insurer from recovering mistaken payments unless the payment was caused by a mistake of fact.
Appellant’s Reply Br. at 2. This assertion is patently incorrect. The
Maciosek
opinion specifically states that “[t]he state law causes of action ... obviously are preempted under the Supreme Court’s construction of ERISA.”
In sanctioning the plaintiff’s attorneys in
Smith,
the court admonished that “[counsel cannot ignore settled precedent and bring repeated suits that have no basis in the law.”
Kmiec argues that the ERISA claims in Tomczyk were still pending at the time the Macioseks’ claims were filed, so the decision was not a final judgment and no appeal was possible. While that is true, it does not explain why Kmiec failed to distinguish a case from the Eastern District of Wisconsin that directly resolved two of the Macioseks’ claims. Ignoring precedent from the same jurisdiction is not making a “good faith argument for the extension, modification, or reversal of existing law_” Fed.R.Civ.P. 11. And like it or not, Tomczyk was the “existing law” of the district court when these claims were filed, and when Kmiec filed his brief in opposition to the motion to dismiss.
Maciosek,
The lessons of Maciosek and Smith apparently did not take. Tomczyk’s brief to this Court failed to adequately discuss or distinguish Smith or Maciosek, the very cases in which Kmiec and McConville were cited for ignoring existing precedent. Even more egregious, at oral argument, Tomczyk’s counsel attempted to explain away the brief’s failure to adequately address this Court’s decision in Maciosek by asserting that it was rendered during the pendenсy of the Tomczyk appeal — the very same argument used (and rejected) before this Court in Maciosek as a rationale for failing to address Tomczyk!
Moreover, just as the Maciosek brief failed to cite the District Court’s decision in Tomczyk, Tomczyk’s brief failed to cite yet another Eastern District of Wisconsin decision, Meyer v. Employers Health Ins. Co., supra, despite Meyer’s holding that ERISA preempts state-law breach of contract and tortious interference with contract claims and, therefore, its obvious relevance to the present case. When confronted at oral argument with this omission, McConville again mislead this Court, asserting that Meyer was inapplicable because it involved a sеlf-insured plan (itself a specious distinction) when in truth, Meyer, as here, involved an insured plan.
This tactic of ignoring existing, and potentially dispositive, precedent, as well as the numerous attempts to mislead this Court through bold misrepresentations of fact and law, disserve the parties, opposing counsel, and this Court.
See Hill,
Before turning to the specifics of this case, we wish to make clear that it is not our intent to “chill” discussion or to dissuade counsel from bringing credible appeals. Rather, it is our objеctive to protect the integrity of this system by enforcing attorneys’ ethical responsibilities, and to preserve the availability of the federal courts for worthy claims by deterring groundless appeals.
See Hill,
“An appeal is frivolous when the result is obvious or when the appellant’s argument is wholly without merit.”
Mays,
We previously have held that misrepresentations of controlling law and disingenuous arguments, “because they postpone resolution of the real issues and cause delay, can be evidence of bad faith under the second part of the Rule 38 analysis.”
Williams,
Because of the aforementioned conduct before this Court, we have determined that a significant penalty is warranted. Accordingly, we impose sanctions in the amount of $2,000 against Tomczyk’s attorneys.
4
Further, Tomczyk’s attorneys shall be assessed the costs of this appeal. Blue Cross shall submit to the clerk of this Court within fifteen days of thе date of this opinion proper documentation of its expenses in defending this appeal. Counsel for Tomczyk will have an opportunity to
Affirmed With Sanctions.
Notes
. The "preemption clause” states:
Except as provided in subsection (b) of this section [the "saving clause”], the provisions of this subchapter and subchapter III of this chapter shall supercede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan.
29 U.S.C. § 1144(a).
. The “saving clause" provides:
Except as provided in subparagraph (B) [the "deemer clause”], nothing in this title shall be construed to exempt or relieve any person from any law of any State which regulates insurance, banking or securities.
29 U.S.C. § 1144(b)(2)(A). The "deemer clause” states:
Neither an employee benefit plan described in section 1003(a) of this title, which is not exempt under section 1003(b) of this title (other than a plan established primarily for the purpose of providing death benefits), nor any trust established under such a plan, shall be deemed to be an insurance company or other insurer, ... or to be engaged in the business of insurance ... for the purposes of any law of any State purporting to regulate insurance companies, insurance contracts, banks, trust companies, or investment companies.
Id. § 1144(b)(2)(B).
. Because we affirm the dismissal of both her ERISA and state common-law claims, we need not address Tomczyk’s claims for extra-contractual compensatory and punitive damages. Suffice it to note that, although this Circuit had not yet determined the availability of extra-contractual compensatory damages when Tomczyk brought this appeal, we had definitively held that punitive damages are not available under ERISA.
See Kleinhans v. Lisle Savings Profit Sharing Trust,
. This Circuit has on several occasions imposed a flat sum award as "damages” under Rule 38 without having evidence of attorneys’ fees and other expenses before it.
See, e.g., Cheek v. Doe,
Additionally, as this Court noted in
Hill,