Malan F. Johnston v. Paul Revere Life Insurance Company, Now Known as Provident Insurance CompanyMalan F. Johnston v. Paul Revere Life Insurance Company, Now Known as Provident Insurance Company
Malan F. Johnston (“Johnston”) appeals from a final judgment entered in the United States District Court for the District of Nebraska in favor of Paul Revere Life Insurance Company (“Paul Revere”).
1
See Johnston v. Paul Revere Life Insurance Co.,
No. 8:96CV305 (D.Neb. Jan. 21, 2000) (Judgment). For reversal, Johnston argues that: (1) the district court erred in holding that his state law claim for equitable relief pursuant to
The district court had jurisdiction pursuant to 28 U.S.C. § § 1331 and 1332. We have jurisdiction pursuant to
Background
The undisputed facts establish that Johnston was a professional pilot employed by Western Pathology Consultants, P.C. (‘Western Pathology”). In 1991, Western Pathology decided to update its long term disability policy for its professional and supervisory employees and contacted Richard Mead, an insurance agent for Paul Revere, who had provided insurance services to Western Pathology for over twenty-five years.
The updated plan was designed to provide “own occupation” coverage to assure income during an employee’s earning lifetime if the employee became disabled from рerforming his or her professional occupation. It was determined that benefits for plan participants would be provided through individual policies purchased by the employee and issued by Paul Revere. 2 Eligible employees of Western Pathology-met with Mead, who explained plan benefits and completed the necessary enrollment forms provided by Paul Revere. Employees were given the choice of paying the premiums themselves or having Western Pathology make their payments. To facilitate payment, Western Pathology was billed for monthly premiums, would pay the premiums in a lump sum, and then add the amount of each employee’s individual premium to the employee’s W-2 form at the end of the tax year. Also, Mead delivered policy forms to Western Pathology.
Prior to issuing a policy for Johnston, Paul Revere issued twelve policies for employees of Western Pathology, all of which included “own occupation” coverage. In 1991, Johnston met with Mead who explained the plan benefits and “own occupation” coverage. Mead also completed for Johnson a Paul Revere disability policy application, which Johnston signed. This application stated that “[acceptance by the Proposed Insured/Owner of any policy
After the policy was issued, Mead received a message from a Paul Revere representative stating that the policy was issued as submitted. However, on the policy as issued, a handwritten note in the comments portion of the application stated “delete own occ.” Mead did not read the policy before delivering it to Western Pathology, nor did he communicate to Johnston that there was a change in the policy. Mead did, however, inform both Johnston and Western Pathology that the policy was issued as “applied for.” In 1993, Johnston became disabled and submitted a claim to Paul Revere, which claim was honored, although own occupation coverage was denied: At this time he first learned that the policy application had been changed to delete own occupation coverage. 3
Procedural History
Johnston initially filed a claim in Nebraska state court seeking declaratory relief and alleging that Paul Revere wrongfully altered his application for disability insurance in violation of
In May 1998, the district court ruled that the matter was preempted by ERISA § 514,
Paul Revere filed an answer to the amended complaint, and Johnston filed a third amended complaint, alleging a breach of fiduciary duty under ERISA § 409, 29 U.S.a. § 1109, and discrimination under ERISA § 510, 29 U.s.c. § 1140, and again renewing the state law claim. On August 5, 1999, the district court granted Paul Revere's motion to dismiss as to Johnston's state law and ERISA discrimination claims, but denied the motion as to the ERISA breach of fiduciary duty claim. 7 See Johnston v. Paul Revere Life Insurance Company, No. 8:96CV305 (D.Neb. Aug. 5, 1999) (Memorandum and Order). 8
On August 28, 1999, Johnston renewed his motion to re-open discovery. This latter motion was denied, and the matter was set for a pre-trial conference, during which the magistrate judge struck four of Johnston's non-expert witnesses because their names had not been disclosed during discovery and also struck two of Johnston's exhibits. Johnston sought review of this ruling to the district court. In November 1999, Paul Revere filed a motion for summary judgment on Johnston's only remaining claim, a breach of fiduciary duty under ERISA, which motion the district court granted. See Johnston v. Paul Revere Life Insurance Company, No. 8:96CV305 (D.Neb. Jan. 21, 2000) (Memorandum and Order). The district court held that neither the language of the application or the policy required Paul Revere to notify Johnston directly that it declined to provide own occupation coverage and that Paul Revere did not have a past policy of communicating directly with applicants about decisions denying requested coverage. The court further rejected Johnston's position that Paul Revere handled "virtually every aspect of plan administration" and, therefore, became a de facto plan administrator. The court concluded that Paul Revere and Mead performed traditional roles of insurer and agent and that neither exercised the degree of discretion that would make them ERISA fiduciaries. See id., slip op. at 9-10. The district court also denied Johnston's appeal of the order striking experts and exhibits. See id. This appeal followed.
Discussion
On appeal, Johnston first argues that the district court erred in dismissing his state law claim as preempted by ERISA. "We review the district court's decision on ERISA preemption de novo because it is a question of federal law involving statutory interpretation." Wilson v. Zoellner,
However, not all state law claims that somehow affect a plan as defined by ERISA are preempted. (See discussion below regarding the definition of an ERISA plan pursuant to
ERISA Plan
As a preliminary matter, we must determine if the disability insurance policy at issue was a “plan” within the mеaning of ERISA because the existence of a “plan” is a prerequisite to the jurisdiction of ERISA.
See Bannister v. Sorenson,
Upon review of the undisputed facts in this matter, we hold that a reasonable person could conclude that Western Pathology did establish a plan within the meaning of ERISA that offered disability benefits to its employees. Alsо, a reasonable person could further ascertain the intended benefits, beneficiaries, the source of financing, and procedures for receiving benefits of the disability plan at issue. Because Western Pathology engaged in the ongoing administration of the plan by assisting in the application process, by maintaining the policy forms, by processing paperwork in conjunction with Mead, and by facilitating the payment of premiums, the plan embodied a set of administrative practices. We, therefore, hold, in agreement with the district court, that “a reasonable person [could] conclude that Western Pathology did establish a plan that offered benefits to its employees, as evidenced by the offering of retirement and disability insurance policies to employees” and “by the administrative processing required of Western Pathology to provide such benefits.” Memorandum and Order of May 4, 1998, slip op. at 6. We, therefore, hold that the disability policy at issue was part of a “plan” within the meaning of ERISA.
ERISA Preemption
We next consider whether John-, ston’s state law clаim is preempted by ERISA. Johnston’s state claim is preempted if the Nebraska statute upon which Johnston relies “relate[s] to” an employee benefit plan within the meaning of ERISA § 514(a),
This court has held that a variety of tests are helpful when determining the effect of state law on an ERISA plan.
See Bannister,
(1) whether the state law negates a plan provision; (2) the effect on primary ERISA entities and impact on plan structure; (3) the impact on plan administration; (4) the economic impact on the plan; (5) whether preemption is consistent with other provisions of ERISA; and (6) whether the state law at issue is an exercise of traditional state power.
Id.,
citing
Arkansas Blue Cross,
We hold that Johnston’s claim against Paul Revere arose from the administration of an ERISA plan, including the application for and subsequent issuance of a disability policy. Thus, pursuant to the analysis in Bannister, the state law has an impact on plan administration. We further find, in agreement with the district court, that Johnston’s state law claim has a connection with and relates to an employee benefit plan and that, therefore, ERISA operates to preеmpt his state claim unless the ERISA savings clause is applicable. See Memorandum and Order of May 4, 1998, slip op. at 10.
ERISA Savings Clause
We must now determine whether Johnston’s claim pursuant to
We first conclude that the Nebraska statute at issue does not clearly regulate insurance as a matter of common sense. As the district court noted, and we
Considering the second and third McCarran-Ferguson factors, we further hold, in agreement with the district court, that the “Nebraska statute does not dictate terms that must be included in an insurance policy, nor does it add anything substantive to the insurer-insured relationship or alter the bargain between them. Instead, the statute merely prohibits conduct that predates formаtion of the insurer-insured relationship-.” Memorandum and Order of Aug. 5, 1999, slip op. at 7. The Nebraska statute merely establishes a pre-contract prohibition governing the application procedure and does not govern or dictate the actual content of insurance policies.
9
Because none of the McCarran-Ferguson factors are met, we hold, in agreement with the well-reasoned analysis of the district court, that Johnston’s claim is not saved from ERISA preemption pursuant to
ERISA Fiduciary
We next consider Johnston’s argument on appeal that, contrary to the conclusion of the district court in its summary judgment, Paúl Revere was acting as a fiduciary within the meaning of ERISA § 3(21)(A),
(i) he exercises any discretionary authority or discretionary control respecting management of such plan or ... dispоsition of its assets,
(ii) he renders investment advice for a fee or other compensation ... or
(iii) he has any discretionary authority or discretionary responsibility in the administration of such plan.
ERISA § 3(21)(A),
“Discretion” is the “benchmark for fiduciary status under ERISA” pursuant to the explicit wording of ERISA § 3(21)(A),
This court held in
Kerns v. Benefit Trust Life Insurance Co.,
These principles, which guide the court in making a determination as to whether an insurance company is an ERISA fiduciary, apply equally to an independent insurance broker such as Mead.
See Kerns,
Johnston relies on
Olson v. E.F. Hutton & Co.,
Under circumstances similar to those presented here, this court held in
Molasky v. Principal Mutual Life Insurance Co.,
Conclusion
We affirm the decision of the district court holding that Johnston’s state claim is preempted by ERISA and that this claim is not saved from preemption by the ERISA savings clause. Additionally, we affirm the decision of the district court holding that Paul Revere and Mead were not ERISA fiduciaries and that they did not breach the duties imposed by ERISA upon fiduciaries. Therefore, we need not decide whether the district court abused its discretion by striking four of Johnston’s witnesses from his witness list. Accordingly, the judgment of the district court is affirmed.
Notes
. The Honorable Joseph F. Bataillon, United Stales District Judge for the District of Nebraska.
. The policies purchased through Paul Revere were actually "wrap around” policies. Employees of Western Pathology could elect to participate in a short term disability policy issued by another insurance company; this policy would provide benefits during the first two years of disability. The long term disability policy purchased through Paul Revere was designed to provide minimal benefit during the first two years of disability, but would provide a largеr benefit after that period until the participant reached the age of sixty-five.
. "Own occupation” coverage is desirable because, pursuant to such coverage, if Johnston were to generate sufficient income from other employment, his monthly benefit under the policy would not be reduced. Without such coverage, the benefit would be reduced.
. After losing his medical certificate pursuant to the report of a flight physician, Johnston worked a variety of jobs. However, he did not generate sufficient income to effect a reduction in his monthly benefit under the terms of the policy as issued. Under these circumstances Johnson appropriately filed a complaint seeking declaratory judgment.
See
.
No alteration of any written application for any policy of sickness and accident insurance shall be made by any person other than the applicant without his or her written consent, except that insertions may be made by the insurer, for administrative purposes, only, in such a manner as to indicate clearly that such are nоt to be ascribed to the applicant.
. The Honorable William G. Cambridge, Chief Judge, United States District Court for the District of Nebraska.
. Although the district court had previously ruled that Johnston's state law claim was preempted by ERISA, Johnston asserted that the decision of the United States Supreme Court in UNUM Life Ins. Co. v. Ward,
. The Honorable Joseph F. Bataillon, United States District Judge for the District of Me-braska.
.The California statutory provision at issue in
UNUM,
a “notice-prejudice rule,” is distinguishable from
. In the Memorandum and Order filed May 4, 1998, the district court did not consider all three McCarran-Ferguson factors, but rather relied on its finding that the Nebraska statute does not transfer or spread the risk. In the Memorandum and Order filed August 5, 1.999, the district court acknowledged that all three factors should be considered pursuant to the Supreme Court's analysis in
UNUM. See UNUM,
.
. Johnston suggests that Paul Revere "acted as the de facto plan administrator.” Reply Brief for Appellant at 3. ERISA provides that if an employer, such as Western Pathology, has no plan document designating a plan administrator, the employer is the plan administrator.
See