ORDER
This matter concerns Plaintiff Marilyn O. Shafer’s claim for life insurance benefits allegedly due under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq.
For the reasons stated below, the Court DENIES Plaintiffs motion regarding the proper standard of review. The Court concludes that while the part of Colo. Rev. Stat. § 10-3-1116(3) (2008) providing for a de novo standard of review, standing alone, would not be preempted, the part of Colo. Rev. Stat. § 10-3-1116(3) providing for a jury trial conflicts with ERISA’s remedial structure by altering the judiciary’s role. Thus, the Court concludes that ERISA preempts, in its entirety, Colo. Rev. Stat. § 10-3-1116(3).
I. BACKGROUND
Plaintiffs deceased husband, Michael Shafer, was a participant in the Schlum-berger Group Welfare Benefits Plan (the “Plan”), effective January 1, 2012. (ECF Nos. 20-2 at 43-44, 20-17 at 1-2, 20-27 at 28-30; Shafer ■ Rec. 0093-94, 0801-02, 1328-30.) STC is the group policyholder of the 2012 Plan. (ECF No. 20-1 at 3; Shafer Rec. 0003.) The Plan provides that the “Plan Administrator” and “other Plan fiduciaries” have “discretionary authority to interpret the terms of the Plan and to determine eligibility for and entitlement to Plan benefits in accordance with the terms of the Plan.” .(ECF No. 20-2 at 36; Shafer Rec. 0086.) The Plan Administrator and Plan Sponsor is STC. (ECF Nos. 20-2 at 32, 20-8 at 26; Shafer Rec. 0082, 0376.) The Plan Administrator and Plan Sponsor are based in Houston, Texas. (ECF Nos. 20-2 at 32, 20-8 at 26; Shafer Rec. 82, 376.)
MetLife issued the 2012 Plan to STC in Texas. (ECF Nos. 20-1 at 2-3, 20-2 at 32; Shafer Rec. 0002-03, 0082.) STC issued the 2012 Plan to Mr. Shafer in Colorado. (ECF No. 20-1 at 23, 38; Shafer Rec. 0002-03, 0038.)
MetLife informed Plaintiff of its decision to deny benefits over the amount of $873,000.00. (ECF No. 20-10 at 30-31; Shafer Rec. 0480-81.) On June 6, 2013, Plaintiff appealed this denial of benefits under the 2012 Plan. (ECF No. 20-21 at 2-10; Shafer Rec. 1002-10.) MetLife confirmed receipt of Plaintiffs appeal letter via fax on June 12, 2013. (ECF No. 20-21 at 12-13; Shafer Rec. 1012-13.) On July 29, 2013, MetLife upheld its denial of benefits for any amount over $873,000.00. (ECF No. 20-21 at 27-28; Shafer Rec. 1027-28.)
On March 3, 2014, Plaintiff filed this lawsuit against Defendants challenging the denial of benefits for any amount over $873,000.00. (ECF No. 1.) By motion for partial summary judgment (ECF No. 26), Plaintiff seeks both de novo review and trial by jury on the claim denial under Colo. Rev. Stat. § 10-3-1116(3).
II. LEGAL STANDARDS
Summary judgment is appropriate only if there is no genuine dispute of material
If a movant properly supports a motion for summary judgment, the opposing party may not rest on the allegations contained in her complaint, but must respond with specific facts showing a genuine factual issue for trial. Fed. R. Civ. P. 56(e); Scott v. Harris,
Only admissible evidence may be considered when ruling on a motion for summary judgment. Jaramillo v. Colo. Judicial Dep't,
III. ANALYSIS
At issue in this matter is Section 10-3-
An insurance policy, insurance contract, or plan that is issued in this state shall provide that a person who claims health, life, or disability benefits, whose claim has been denied in whole or in part, and who has exhausted his or her administrative remedies shall be entitled to have his or her claim reviewed de novo in any court with jurisdiction and to a trial by jury-
Colo. Rev. Stat. 10-3-1116(3) (emphasis added). Further, the Colorado General Assembly declares that this “section is a law regulating insurance.” Colo. Rev. Stat. 10-3-1116(7). -
A. Applicability of Colorado Revised Statute § 10-3-1116(3)
Defendants contend that a predicate condition to the applicability of Section 10-3-1116(3) has not been met, i.e., that the 2012 Plan was not “issued in this state [of Colorado].” (ECF No. 29 at 9-10.) MetLife issued the 2012 Plan to STC in Texas as a “group policyholder.” (ECF Nos. 20-1 at 2-3, 20-2 at 32; Shafer Rec. 0002-03, 0082; ECF No. 29 at 9.) STC administers the 2012 Plan in Texas. (ECF Nos. 20-2 at 32, 20-8 at 26; Shafer Rec. 0082, 0376.) STC, however, then issued the 2012 Plan to Mr. Shafer. (ECF No. 20-1 at 2-3; Shafer Rec. 0002-03.)
Both parties agree that “issued” means one of the following: (1) the preparation and signing of the policy; (2) the delivery and acceptance of the policy; or (3) the preparation, execution and delivery of the policy. (ECF No. 29 at 9; ECF No. 32 at 6.) The parties disagree as to whether “plan issuance” ends at MetLife’s issuing the group policy to STC or whether it continues to STC’s issuing the 2012 Plan to Mr. Shafer.
The principle objective of ERISA is to protect plan participants and beneficiaries. 29 U.S.C. §§ 1001(b), 1001(c), 1103(c)(1), 1104(a)(1), 1108(a)(2), 1132(a)(1)(B); Boggs v. Boggs,
Because ERISA is designed to benefit plan participants or beneficiaries, it would make little sense to limit “issue” as to only the relationship between MetLife and STC. Rather, the Court, in furtherance of ERISA’s principle purpose, holds that STC issued the 2012 Plan to Mr. Shafer because he, and his designated beneficiary, were the intended protected individuals. See Rush Prudential HMO, Inc. v. Moran,
B. Whether ERISA Preempts Colorado Revised Statute § 10-3-1116(3)
Due to ERISA’s “statutory complexity,” “any court forced to enter the ERISA preemption thicket sets out on a treacherous path.” Kidneigh v. UNUM Life Ins. Co. of Am.,
ERISA permits an individual who is denied benefits under an ERISA-governed plan to challenge that denial in a federal district court. See 29 U.S.C § 1132(a)(1)(B). “ERISA does not set out the appropriate standard of review for actions under § 1132(a)(1)(B) challenging benefit eligibility determinations.” Firestone Tire & Rubber Co. v. Bruch,
The parties here, however, contracted in light of the 2008 Colorado statute which provides a person whose insurance claim has been denied with an entitlement to de novo judicial review of that determination and the right to a jury trial. Colo. Rev. Stat. § 10-3-1116(3). The question then becomes whether ERISA preempts Section 10-3-1116(3). Congress left the development ERISA law details to the courts. See Firestone Tire & Rubber,
ERISA’s express preemption clause (“Preemption Clause”) broadly recites that “[ejxcept as provided in subsection (b) of this section, the provisions of this subchap-ter and subchapter III of this chapter shall supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan.... ” 29 U.S.C. § 1144(a). Defendants argue that ERISA preempts Section 10-3-1116(3). However, 29 U.S.C. § 1144(b)(2)(a) (the “Savings Clause”) provides that “nothing in this subchapter shall be construed to exempt or relieve any person from any law of any
Although the Tenth Circuit Court of Appeals has yet to address this particular issue, ie., whether ERISA preempts Section 10-3-1116(3), Menge v. AT & T, Inc., Case No. 14-1210,
1. Express Preemption
A state statute “regulates insurance” within the meaning of the Savings Clause when it is: (1) “specifically directed toward entities engaged in insurance”; and (2) “substantially affect[s] the risk pooling arrangement between the insurer and the insured.” Kentucky Ass’n of Health Plans, Inc. v. Miller,
a. Whether Section 10-3-1116(3) is Directed Toward Entities Engaged in Insurance
Defendants contend that Section 10-3-1116(3) is overly broad because it would apply to all ERISA plan documents and thus, is not specifically directed to entities engaged in insurance. (ECF No. 29 at 11.) Although the statute itself identifies that it is a law regulating insurance, Colo. Rev. Stat. § 10-3-1116(7), the Court finds support that Section 10-3-1116(3) is a statute directed toward entities engaged in insurance in the Supreme Court’s holding in Rush Prudential,
[w]hile the statute designed to [regulate insurance and medicine] undeniably eliminates whatever may have remained of a plan sponsor’s option to minimize scrutiny of benefit denials, this effect of eliminating an insurer’s autonomy to guarantee terms congenial to its own interests is the stuff of garden variety insurance regulation through the imposition of standard policy terms.... It is therefore hard to imagine a reservation of state power to regulate insurance that would not be meant to cover restrictions of the insurer’s advantage in this kind of way.... To the extent that benefit litigation in some federal courts may have to account for the effects of [the statute], it would be an exaggeration to hold that the objectives of [ERISA’s Savings Clause] are undermined.
[w]hatever the standards for reviewing benefit denials may be, they cannot conflict with anything in the text of the statute, which we have read to require a uniform judicial regime of categories of relief and standards of primary conduct, not a uniformly lenient regime of reviewing benefit determinations.
Further, insurance regulation is not preempted merely because it conflicts with substantive plan terms or affects third parties. Kentucky Ass’n,
b. Whether Section 10-3-1116(3) Substantially Affects the Risk Pooling Arrangement Between the Insurer and the Insured
Defendants’ main argument focuses on the meaning of “risk pooling” as used in the second prong of the Kentucky Association test. (ECF No. 29 at 11-14.) The crux of Defendants’ argument is that the term “risk pooling” has a narrow meaning specific to the insurance industry, and this is also its legal meaning as used in Kentucky Association. Defendants argue that “[r]isk pooling is the process of assuming a group of individuals who have a broad cross section of risks, in order to spread the risk among the individuals and predictably calculate costs and premiums.” (ECF No. 29 at 11 (citations omitted).) The Court understands Defendants’ argument to be, that because the moment Section 10-3-1116(3) operates comes after the pool of insureds has been established through risk classification, the statute cannot “substantially affect the risk pooling arrangement between the insurer and the insured.” In other words, at the moment Section 10-3-1116(3) matters, the risk pool is already established, so the statute cannot affect the risk pooling arrangement, and therefore, the second prong of the Kentucky Association test cannot be satisfied.
The Supreme Court, contrary to Defendants’ argument, has held that to fall within the scope of the Savings Clause, a state law does not have to actually spread a policy holder’s risk. Kentucky Ass’n,
Thus, Section 10-3-1116(3) substantially affects risk pooling.
2. Conflict Preemption
Even if a state law regulates insurance such that it falls within the Savings Clause, it may nevertheless be preempted by ERISA’s civil enforcement provisions. See 29 U.S.C. § 1132(a)(1)(B) (“Section 1132”). ERISA’s civil enforcement provisions are the “sort of overpowering federal policy that overrides a statutory provision designed to save state law from being preempted.” Rush Prudential,
In relevant part, ERISA allows a plan participant or beneficiary to file a civil action “to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan.” 29 U.S.C. § 1132(a)(1)(B). Under ERISA, an in
Defendants argue that application of Section 10-3-1116(3) conflicts with congressional objectives by taking away the option of deferential review and mandating a jury trial relating to ERISA benefits claims in Colorado, which would result in a patchwork of different plan interpretations that would vary court-by-court and state-by-state. (ECF No. 29 at 14-21.) The Supreme Court has held that “ERISA induces employers to offer benefits by assuring a predictable set of liabilities, under uniform standards of primary conduct and a uniform regime of ultimate remedial orders and awards when a violation has occurred.” Conkright v. Frommert,
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.
Aetna Health,
For the following reasons, the Court holds that Section 10-3-1116(3) conflicts with ERISA’s remedial scheme, in part, and thus, ERISA preempts Section 10-3-1116(3).
a. Standard of Review
It is worth noting that the de novo standard of review, is already the default standard in an ERISA case, so it is difficult to imagine how Section 10-3-1116(3) which requires that level of review would conflict with the ERISA. See Firestone Tire & Rubber,
b. Right to a Jury Trial
ERISA, by its express terms, does not prohibit a jury trial. The Tenth Circuit has previously held that the Seventh Amendment to the United States Constitution does not guarantee an ERISA claimant a right to a jury trial. Bigley v.
The Court does not find Tenth Circuit precedent holding that ERISA does not permit a jury trial based upon the Seventh Amendment controlling but it is persuasive for its logic. The Tenth Circuit has “decided that the proper common law analogue for a § 1132(a)(1)(B) claim for benefits is ‘an action to enforce a trust’ ... which at common law was an equitable action....” Graham,
Section 10-3-1116(3) offends ERISA because, under Supreme Court precedent, the right to a jury trial “serve[s] as an alternate enforcement mechanism[] outside of ERISA’s civil enforcement provisions.” See Am. Council of Life Ins.,
The Court does not find solace in the fact that under Rule 50(a)(1) of the Federal Rules of Civil Procedure, it might be claimed that the Court retains ultimate decision-making ability. See Fed. R. Civ. P. 50(a)(1). Under ERISA, generally, the Court addresses only the “administrative record” before it. Murphy v. Deloitte & Touche Group Ins. Plan,
The Court does not find Kohut v. Hartford Life & Acc. Ins. Co.,
C. Severability of Colorado Revised Statute § 10-3-1116(3)
“The severability of a statute is an issue of state law.” Panhandle E. Pipeline Co. v. State of Okla. ex rel. Comm’rs of Land Office,
if any provision of this section or its application to any person or circumstances is held illegal, invalid, or unenforceable, no other provisions or applications of this section shall be affected that can be given effect without the illegal, invalid, or unenforceable provision or application, and to this end the provisions of this section are severable.
Colo. Rev. Stat. 10-3-1116(6). The Court reads Section 10-3-1116(6) as permitting it to sever an entire subsection from the underlying statute. The Court does not read Section 10-3-1116(6) as permitting it to sever a portion of a subsection, in this case a portion of a sentence, from the underlying statute. Thus, the Court is unable to sever the right to a jury trial from the entirety of Section 10-3-1116(3). As such, ERISA preempts Section 10-3-1116(3) in its entirety.
IV. CONCLUSION
Based on the foregoing, the Court:
(1) DENIES Plaintiffs motion for partial summary judgment regarding the proper standard of review (ECF No. 26), to wit, the Court will engage in an “arbitrary and capricious” standard of review regarding Defendants’ denying Plaintiff benefits under the 2012 Plan due to the presence of a discretionary clause.
Notes
. Schlumberger Technology Corporation ("STC”) avers that Plaintiff erroneously identified it as "Schlumberger Technologies, Inc.” (ECF No. 29.) Plaintiff does not contest STC’s averment.
. Colo. Rev. Stat. 10-3-1116(1) has been held preempted by ERISA. Timm v. Prudential Ins. Co. of Am.,
. Section 10-3-1116(2) addresses insurance policies, contracts or plans which, offer "health or disability benefits.” Colo. Rev. Stat. § 10-3-1116(2). This matter involves life insurance benefits. (See ECF No. 26 at 1-2.) Accordingly, Plaintiff may not resort to Section 10-3-1116(2) as a basis for her argument in support of de novo review and the right to a jury trial.
