ALPHONSE M. SANTINO, Plaintiff-Appellant, v. PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY, Defendant-Appellee.
No. 00-1926
UNITED STATES COURT OF APPEALS FOR THE SIXTH CIRCUIT
Argued: November 1, 2001; Decided and Filed: December 20, 2001
2001 FED App. 0432P (6th Cir.); 276 F.3d 772
Before: MARTIN, Chief Judge; BATCHELDER, Circuit Judge; SARGUS, District Judge.
RECOMMENDED FOR FULL-TEXT PUBLICATION Pursuant to Sixth Circuit Rule 206; Appeal from the United States District Court for the Eastern District of Michigan at Detroit. No. 99-70301—Denise Page Hood, District Judge.
COUNSEL
ARGUED: Vincent P. Hoyumpa, Clinton Township, Michigan, for Appellant. K. Scott Hamilton, DICKINSON WRIGHT, PLLC, Detrоit, Michigan, for Appellee. ON BRIEF: Vincent P. Hoyumpa, Clinton Township, Michigan, for Appellant. K. Scott Hamilton, DICKINSON WRIGHT, PLLC, Detroit, Michigan, for Appellee.
OPINION
BOYCE F. MARTIN, JR., Chief Judge. Plaintiff Alphonse M. Santinо appeals the district court‘s determination that the
I.
Santino is a physician specializing in urology. In 1984, Santino, then one of three shareholders in Wayne-Macomb Urology Associates P.C., applied for disability insurance from Provident Life and Accident Insurance Company. On his application, Santino listed the Wayne-Macomb clinic as his employer and answered “yes” to the question: “Will your employer pay for all Accident and Sickness disability coverage to be carried by you with no portion of the premium to be included in your taxable income?” Provident Life issued two disability insurаnce policies to Santino. Both policies provide: “No [legal] action may be brought after three years from the time written proof of loss is required to
In 1994, Santino suffered an illness that prevented him from providing urological patient care. He submitted disability claims under both policies. Because Santino could still perform administrative functions at the Wayne-Macomb clinic, Provident Life classified his illness as a “residual disаbility.” On January 20, 1995, Provident Life informed Santino of its disability classification. Santino accepted Provident Life‘s classification and began receiving “residual disability” payments.
In December 1998, Santino filed suit against Provident Life in Michigan state court, asserting for the first time that Provident Life should have considered his illness a “total disability.” Claiming that ERISA preemptеd Santino‘s state claims, Provident Life removed the case to the Eastern District of Michigan. The district court denied Santino‘s motion to remand and dismissed his lawsuit as untimely. Santino аppealed.
II.
The district court‘s ruling that ERISA preempts Santino‘s state law claims is a legal conclusion, which this Court reviews de novo. See Agrawal v. Paul Revere Life Ins. Co., 205 F.3d 297, 299 (6th Cir. 2000). ERISA regulates “employee welfare benеfit plans,” which “‘through the purchase of insurance or otherwise’ provide ... benefits in the event of ... disability.” Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 44 (1987) (quoting
Santino argues that the policies do not constitute an “employee welfare benefit plan” because he is not an “employee” under ERISA. He further argues that his
A.
An “employee welfare benefit plan” must provide benefits to at least one employee. See
ERISA defines an “employеe” as “any individual employed by an employer.”
Santino claims that his shareholder status and his authority within the Wayne-Macomb clinic make him an “employer” under ERISA, see
Santino also argues that thе Department of Labor‘s ERISA regulations prevent him from being an “employee.” Relying on
Section 2510.3-3(c)(1), however, does not exclude joint shareholders from the ERISA definition of “employee.” On its face, the regulation applies only tо “an individual” who “wholly own[s]” a business. Moreover, the Department of Labor interprets
Because Santino is an ERISA “employee” and the policies provide him with benefits in the event of disability, we find that the policies constitute an ERISA “employеe welfare benefit plan.”
B.
To have standing to bring an ERISA claim under an “employee welfare benefit plan,” an individual must be a “participant” or “beneficiary” оf that plan.
In Fugarino, this Court relied on
Although this Court has not addressed whether joint shareholders are excluded from ERISA coverage, several circuits have found that shareholder status does not preclude ERISA coverage. See Sipma v. Mass. Casualty Ins. Co., 256 F.3d 1006, 1011-12 (10th Cir. 2001); Englehardt v. Paul Revere Life Ins. Co., 139 F.3d 1346, 1351 (11th Cir. 1998); Prudential Ins. Co. of America v. Doe, 76 F.3d 206, 209 (8th Cir. 1996); Madonia v. Blue Cross & Blue Shield of Virginia, 11 F.3d 444, 449-50 (4th Cir. 1993). Moreover, in Agrawal, we suggested that Fugarino‘s holding should be limited to sole proprietors or sole shareholders. Agrawal, 205 F.3d at 302-03 (noting that Fugarino‘s holding is “not thoroughly consistent with the goals of ERISA“); see also Madonia, 11 F.3d at 449-50 (“Disallowing shareholders ... from being plan ‘participants’ would ... frustrate[] the statutоry purpose of ensuring similar treatment for all claims relating to employee benefit plans.“). Accordingly, we hold that a joint shareholder is not precluded from being a “participant” of an “employee welfare benefit plan” under ERISA.
Because Santino has standing to sue under ERISA as a “participant” in an “employeе welfare benefit plan,” his state claims are preempted.
III.
Although ERISA does not provide a statute of limitations for benefit claims, this Court has noted that such claims are governed by the most analogous state statute of limitations,
The policies require Santino to bring any claim within three years of his written proof of loss. Santino agreеd to the terms of the policies. Moreover, he accepted benefits under the policies for more than three years without complaint. Provident Life infоrmed Santino of its “residual disability” determination on January 25, 1995 and he failed to bring his lawsuit until December 1998. Therefore, his lawsuit is time barred.
Because we find that Santino‘s claim is time barrеd, we need not address the district court‘s finding that Provident Life correctly characterized Santino‘s illness as a “residual disability.”
IV.
ERISA preempts Santino‘s state law claims and his lawsuit is time barred; therefore, we AFFIRM the district court‘s decision.
