Lead Opinion
This сase presents the following question: Does the Employment Retirement Income Security Act of 1974, commonly known as ERISA, preempt a common-law claim for breach of an employer-sponsored group medical insurance contract? In particular, the issue is whether ERISA preempts plaintiff, Liberty Northwest Insurance Corporation (Liberty), from enforcing a “Reimbursement and Subrogation” clause requiring defendant, a Liberty policyholder, to repay Liberty for any injury-related medical expenses paid to him by Liberty if he also recovers those expenses from the party that caused the injury. The trial court concluded that ERISA did nоt preempt the insurer’s breach of contract claim against defendant. We reverse.
I. FACTUAL, PROCEDURAL, AND LEGAL BACKGROUND
The following facts and conclusions are undisputed. Defendant held an employer-sponsored group health insurance policy issued by Liberty. The plan is an “employee benefit plan” under ERISA. 29 USC § 1002(1). One term of the policy provided,
“5.8 Reimbursement and Subrogation. When a Covered Person’s Injury appears to be the fault of another, benefits otherwise payable under the Plan for Covered Medical Expense incurred as a result of that Injury will not be paid unless the Covered Person or his/her legal representative agrees:
“(1) to repay Libеrty for such benefits to the extent they are for losses for which compensation is paid to the Covered Person by or on behalf of the person at fault;
“(2) to allow Liberty a lien on such compensation and to hold such compensation in trust for Liberty!.]”
On February 3,1997, defendant was injured in a bicycle accident and received extensive medical treatment. He subsequently authorized his representative to sign an agreement on his behalf to reimburse Liberty according to the terms of the policy if he recovered from the party that injured him.
In 1992, Justice Stevens noted that the scope of ERISA’s preemption clause, ERISA section 514(a), 29 USC section 1144 (Section 514(a)), had come before state and federal courts in more than 2,800 reported cases since Congress enacted the statute in 1974. District of Columbia v. Greater Washington Board of Trade,
Further, the Supreme Court has developed a method for analyzing preemption under ERISA that appears to vary in at least its terminology from traditional preemption analysis. For decades, Supreme Court opinions on preemption have followed a template like the one described in Pacific Gas & Elec. v. Energy Resources Comm’n,
*185 “It is well established that within constitutional limits Congress may pre-empt state authority by so stating in express terms. Absent explicit pre-emptive language, Congress’ intent to supersede state law altogether may be found from a schemе of federal regulation so pervasive as to make reasonable the inference that Congress left no room for the states to supplement it, because the Act of Congress may touch a field in which the federal interest is so dominant that the federal system will be assumed to preclude enforcement of state laws on the same subject, or because the object sought to be obtained by the federal law and the character of obligations imposed by it may reveal the same purpose. Even where Congress has not entirely displaced state regulation in a specific area, state law is pre-empted to the extent that it actually conflicts with federal law. Such a conflict arises when compliance with both federal and state regulations is a physical impossibility, or where state law stands as an obstacle to the accomplishment and execution of the full purposes and objectives of Congress.”
(Internal quotation marks and citations omitted.) Thus, traditionally, preemption is either express or implicit. Implicit preemption, in turn, is either “occupying the field” preemption or “conflict” preemption. “Conflict” preemption occurs, under this analysis, when simultaneous compliance with federal and state law is physically impossible or when compliance with state law impedes implementation of federal law.
To the displeasure of at least one Supreme Court justice,
Thus, instead of using traditional preemption terms and templates, the Court determines whether the state law in question “has a connection with or reference to” an ERISA plan. Shaw v. Delta Air Lines, Inc.,
Following the Supreme Court’s lead, then, we do not apply standard рreemption analysis with its distinctive typology and consequent distinctions between various classes of cases. Instead, we focus our inquiry on whether Liberty’s breach of contract action “has reference to” ERISA, whether permitting that action would interfere with the objectives of ERISA, and whether permitting it would have a significant impact on the administration of ERISA plans— acknowledging that these inquiries, to some extent, blend into each other. We also acknowledge and take guidance from two precepts that the Court affirms in both traditional and ERISA preemption cases: first, preemption is always a matter of Congressional intentiоn; and second, in the absence of a clear indication to the contrary, Congress does not intend to
Because resolving this case requires interpretation of ERISA, we must initially confront the issue of interpretive method. The parties correctly assert that in interpreting ERISA, we must
“follow the methodology generally used in ERISA preemption cases by the Supreme Court of the United States. That is, ‘we begin * * * with the text of the provision in question, and move on, as need be, to the structure and purpose of the Act in which it occurs.’ New York Blue Cross, [514 US at 665 ].”
Shaw v. PACC Health Plan, Inc.,
That approach, in fact, accurately reflects the Supreme Court’s approach in many early ERISA preemption cases. The Court held, for example, that ERISA preempts state laws requiring pension plans not to discriminate on the basis of pregnancy, observing that the “breadth of [ERISA’s] pre-emptive reach is apparent from [its] language,” Shaw,
All of those pronouncements, however, occurred before New York Blue Cross. In that 1995 case, the Court explained that, “[i]f‘relate to’ were taken to extend to the furthest stretch of its indeterminancy, then for all practical purposes pre-emption would never run its cоurse[.]”
For example, defendant calls to our attention, and urges us to adopt, thé magistrate judge’s reasoning in a
II. ANALYSIS
A. Does Liberty’s claim “have reference” to ERISA?
As noted above, a law “has reference to” ERISA if it explicitly names that statute. Mackey,
“Funds or benefits of a pension, retirement, or employee benefit plan or program subject to the provisions of the federal Employee Retirement Income Security Act of 1974, as amended, shall not be subject to the process of garnishment * * * ”
Ga Code Ann § 18-4-22.1 (1982) (quoted in Mackey,
Closer reading of Mackey, however, reveals that the suggested analogy does not apply. The Court held that the garnishment action survived a preemption challenge not because it was an application of an ERISA-neutral statute but because it conflicted with other provisions of ERISA that “indicatе that Congress did not intend to forbid the use of state-law mechanisms of executing judgments against ERISA welfare benefit plans, even when those mechanisms prevent plan participants from receiving their benefits.” Id. at 831-32. Thus, Mackey leaves open the possibility that a particular application of an ERISA-neutral, common-law cause of action may be preempted when that particular application necessarily implicates an ERISA plan.
Indeed, in a case decided after Mackey, the Court reached exactly that conclusion. In Ingersoll-Rand Co., the plaintiff brought a common-law unlawful termination action against his employer, alleging that the employer fired him shortly before his pension would have vested in order to avoid contributing to it.
*191 “ ‘[W]e have virtually taken it for granted that state laws whiсh are “specifically designed to affect employee benefit plans” are pre-empted under § 514(a).’Mackey, [486 US at 829 ], In Mackey the statute’s express reference to ERISA plans established that it was so designed; consequently, it was pre-empted. The facts here are slightly different but the principle is the same: The Texas cause of action makes specific reference to, and indeed is premised on, the existence of a pension plan. In the words of the Texas court, the cause of action ‘allows recovery when the plaintiff proves that the principal reason for his termination was the employer’s desire to avoid contributing to or paying benefits under the employee’s pension fund.’779 S.W.2d, at 71 . Thus, in order to prevail, a plaintiff must plead, and the court must find, that an ERISA plan exists and the employer had a pension-defeating motive in terminating the employment. Because the court’s inquiry must be directed to the plan, this judicially created cause of action ‘relate[s] to’ an ERISA plan.”
Id. at 140. The “Texas cause of action” to which the Court refers, and therefore the proper focus of the inquiry, is not the generic common-law action for unlawful termination; many such claims would not implicate ERISA. Rather, the focus is on the particular cause of action involving a particular case of allegedly unlawful termination, and that particular cause of action is preempted because it necessarily implicates an employee benefit plan. The unavoidable conclusion is that the application of a general, ERISA-neutral, common-law cause of action has “reference to” ERISA and is preempted, when that cause of action explicitly involves an employee benefit plan covered by ERISA and in order to prevail the plaintiffs complaint and the court’s decision must necessarily refer to the plan. This general rule, however, does not apply if, as in Mackey, some other provision of ERISA shows that Congress intended to permit the state action.
Under that precept, in this case ERISA has preemptive force. Liberty’s complaint derives from and is based on an employee benefit plan. It alleges that “defendant William Kemp was covered under a group health insurance policy issued by Liberty to his employer,” that “[t]he policy provides in Section 5.8 that when plaintiff has paid benefits on behalf
Because nothing in ERISA indicates that Congress intended to permit common-law breach of contract claims, the fact that Liberty’s breach of contract claim has reference to an employer-sponsored plan justifies reversing the trial court in this case. Additionally, however, we also conclude that Liberty’s action is preempted because it interferes with one of Congress’s most important objectives in enacting ERISA.
B. Does Liberty’s claim interfere with the objectives of ERISA?
ERISA has several objectives. In Boggs v. Boggs,
“to ensure that plans and plan sponsors would be subject to a uniform body of benefits law; the goal was to minimize the administrative and financial burden of complying with conflicting directives among States or bеtween States and the Federal Government * * *, [and to prevent] the potential for conflict in substantive law * * * requiring the tailoring of plans and employer conduct to the peculiarities of the law of each jurisdiction.”
Ingersoll-Rand Co.,
Further, one of the ways in which state laws can conflict with the Congress’s uniformity objective is by providing “alternative enforcement mechanisms.” New York Blue Cross,
Pilot Life Ins. Co. dealt with common-law claims brought by a policyholder against an insurer, and its holding refers to the paragraph of Section 502(a) dealing with civil actions brought by plan participants or beneficiaries. We see no reason why the same logic would not apply to civil actions brought by a plan provider against a participant or beneficiary; such actions present the same potential for destroying uniformity. We therefore conclude that, if Liberty’s claim is not one of the remedies that Section 502(a) authorizes, then it
Section 502(a) contains six subsections. Four enumerate actions that can be brought only by plan participants, beneficiaries, and the Secretary of Labor. Section 502 (a)(1), (4)-(6). Liberty is not and does not claim to be a participant (an employee or former employee who “is or may become eligible tо receive a benefit,” 29 USC section 1002(7)) or a beneficiary (“a person designated by a participant * * * who is or may become entitled to a benefit,” 29 USC section 1002(8)), and obviously it is not the Secretary of Labor. Of the two remaining sections, one deals with actions regarding fiduciary duties and is not relevant to this case. Section 502(a)(2). Thus, as Liberty acknowledges, only one subsection identifies a civil action that could be relevant here: Section 502(a)(3), which provides that an action may be brought
“by a participant, beneficiary, or fiduciary (A) to enjoin any act or practice which violates any provision of this title or the terms of the plan, or (B) to obtain other appropriate equitable relief (i) to redress such violations or (ii) to enforce any provisions of this title or the terms of the plan[.]”
Thus, even if we were to assume that Liberty is an ERISA fiduciary,
It is not. The complaint specifies only one claim: a claim for money damages for breach of contract. In Great-West Life & Annuity Ins. Co.,
That conclusion compels us to conclude, in turn, that Liberty’s action here is legal аnd not equitable. It therefore is not one of the remedies that Congress included in ERISA— with its “carefully crafted and detailed enforcement scheme,” Mertens,
We acknowledge that at least one other federal court has reached the opposite conclusion under similar facts. Liberty urges us to follow Trustees of AFTRA Health Fund v. Biondi,
In distinguishing Ingersoll-Rand Co., the court noted a “key difference between” that case and Trustees:
“In Ingersoll-Rand, the Court held that the common law cause of action created by the Supreme Court of Texas was ‘specifically designed’ to affect employee benefit plans’ * * *. Id. (citation omitted).”
Trustees of AFTRA Health Fund, 303 F3d at 777-78. The Trustees court attempts to distinguish Ingersoll-Rand Co. by arguing that the common-law wrongful termination action that was preempted there was “specifically designed” to target ERISA and was ERISA-specific, hence preempted, whereas Trustees involved a generic, non-ERISA-specific, common-law fraud action, and therefore should not be preempted. However, the phrase upon which this distinction rests, “specifically designed,” appears in Ingersoll-Rand Co. in the following context:
“ ‘[W]e have virtually taken it for granted that state laws which are “specifically designed to affect employee benefit plans” are pre-empted under § 514(a).’ Mackey, [486 US at 829 ]. In Mackey the statute’s express reference to ERISA plans established that it was so designed; consequently, it was pre-empted. The facts here are slightly different but the principle is the same: The Texas cause of action makes specific reference to, and indeed is premised on, the existence of a pension plan.”
Ingersoll-Rand Co.,
The second argument against preemption in Trustees centered on the premise that, if the fraud claim is preempted, then ERISA plan administrators would be powerless to “recover damages caused by a plan participant’s fraudulent conduct.” Trustees of AFTRA Health Fund,
“a plaintiff could seek restitution in equity, ordinarily in the form of a constructive trust or an equitable lien, where money or property identified as belonging in good conscience to the plaintiff could be traced to particular funds or property in the defendant’s possession.”
In sum, Liberty’s breach of contract claim to enforce a reimbursement provision in its ERISA-controlled employee health plan explicitly and necessarily has reference to an employee benefit plan, and it also conflicts with ERISA’s exclusive remedy provision. Therefore, ERISA preempts it.
Reversed.
Notes
Scalia, J., concurring in California Dio. of Labor Standards Enforcement v. Dillingham Constr., N.A., Inc.,
We do not infer from this conclusion that Congress also intended to permit common-law contract claims. As discussed below, Congress listed available civil
Liberty presents itself as a fiduciary without any supporting argument; we accept that characterization only for the purposes of argument and explicitly do not decide whether it is correct.
Concurrence Opinion
concurring.
In light of the United States Supreme Court’s decisions regarding the Employment Retirement Security Act of 1974 (ERISA), Congress should, in fairness to both insurers and policyholders, amend section 502(a)(3)(A) of the act to permit insurers to recover directly from policyholders amounts that are duplicated by amounts recovered from a third party that causes injury to the policyholder. Under the existing language of the act, ERISA policyholders are unjustly enriched because they are entitled to retain the benefits paid by insurers even though they have subsequently received compensation from third-party wrongdoers for the identical losses. In light of the Court’s holding in Great-West Life & Annuity Ins. Co. v. Knudson,
