OPINION
Stephanie Elliot, a terminally ill former paralegal, sued Fortis Benefits Insurance Company, claiming benefits and other damages under a long-term disability insurance policy she had through her employer. She prevailed on her Employee Retirement Income Security Act (ERISA) claims, and recovered policy benefits and attorney’s fees and costs, but lost on For-tis’s motion for judgment on the pleadings on her state law claims, under which she sought non-ERISA compensatory and punitive damages. Although recent case law requires us to reconsider whether ERISA preempts such state law claims, we affirm the judgment of the district court.
I.
Stephanie Elliot was first diagnosed with cancer in 1995. She successfully underwent a right modified mastectomy, chemotherapy, stem-cell transplant and other treatment, and her breast cancer was found to be in complete remission. As of July 9,1997, her oncologists noted that she had “no measurable disease,” and regular examinations deemed her cancer-free as late as September 16, 1999. Nonetheless, to lessen the risk that she would develop cancer in the future, Elliot was placed on Tamoxifen 1 therapy beginning in July 1996. According to her doctor, the Tamoxifen was not prescribed for the treatment of any active cancer or other disease.
Elliot started working as a paralegal at the Crowley Law Firm on September 27, 1999. As part of her compensation, she was enrolled in Crowley’s long-term disability insurance policy with Fortis Benefits Insurance Company. This coverage was effective as of her first day of work. This policy, however, contained restrictions on coverage for pre-existing conditions, which were defined as follows:
A “pre-existing condition” means an injury, sickness, or pregnancy or any related injury, sickness, or pregnancy for which you:
• consulted with or received advice from a licensed medical or dental practitioner; or
• received medical or dental care, treatment, or services, including taking drugs, medicine, insulin, or similar substances during the 3 months that end on the day before you became insured under the long term disability insurance policy.
Defs Statement of Uncontroverted Facts Ex. A at 20, Record at 22. The policy excludes benefits “for any disability caused by a pre-existing condition” until three consecutive months without treatment have passed or the beneficiary has been continuously insured under the policy for twelve consecutive months.
The first sign that Elliot’s health was deteriorating came in December 1999, when her doctor noted elevated levels of Cancer Antigen 27.29, an early portent of cancer. Although her Cancer Antigen 27.29 levels subsequently declined, she suffered from growing headaches and pain in Summer 2000. On August 19, 2000, Elliot was diagnosed with brain and bone cancer. She was taken off Tamoxifen and did not *1141 return to work. At the time of this appeal, she was totally disabled and terminally ill.
For the first three months of her disability, Elliot was paid full salary under Crowley’s short-term disability policy. Elliot then applied to Fortis for long-term disability benefits.
On October 30, 2000, Fortis sent Elliot a letter explaining the pre-existing condition limitation of her policy. The letter, however, in excerpting the policy provision dealing with pre-existing conditions, recited a requirement, not contained in the actual policy, that insureds be “at active work for a full day following” the three consecutive months of nontreatment or twelve consecutive months of coverage required under the policy. According to the new language, it appeared that Elliot would not qualify for coverage unless she returned to active work. The letter explained that Fortis would be conducting “a routine preexisting review” because Elliot’s date of disability, August 19, was within twelve months of the start of her coverage, September 27 of the preceeding year.
After a review of Elliot’s medical history, Fortis denied disability benefits. For-tis reasoned that because Elliot was taking Tamoxifen and undergoing periodic checkups, her earlier breast cancer constituted a pre-existing condition. Because Elliot had a pre-existing condition, she was covered only if she could show three consecutive months of nontreatment or twelve consecutive months of coverage. Fortis found that she had seen doctors and had prescriptions dispensed regularly, with no three-month gap, and that her disability began within twelve months of the start of her coverage. To reach these conclusions, Fortis relied in part on the opinion of Dr. Patrick Cobb, Elliot’s oncologist, who reported to Fortis that Elliot’s current cancer was a metastasis from her earlier breast cancer and that Tamoxifen was prescribed to prevent the recurrence of breast cancer and its metastasis.
Elliot filed suit in the District of Montana against Fortis, making two claims for relief. First, Elliot sought policy benefits under ERISA. Second, she asserted violations of Montana’s Unfair Trade Practices Act (UTPA), 2 MontCode Ann. § 33-18-201, and sought non-ERISA compensatory and punitive damages. She prevailed on the first count, and that is not before us. On the state law claim, the district court granted Fortis’s motion for judgment on the pleadings, Fed.R.Civ.P. 12(c), concluding that the state law claim is preempted by ERISA. Elliot appeals this ruling.
II.
We review
de novo
a Fed.R.Civ.P. 12(c) judgment on the pleadings.
McGann v. Ernst & Young,
The district court based its finding of preemption on two separate ERISA provisions. First, the district court held that the express preemption of ERISA § 514, *1142 29 U.S.C. § 1144, which contains both a preemption and a saving clause, defeated Elliot’s state law claim. Second, the district court noted that even if it were to find the substantive provisions of the UTPA not preempted, ERISA § 502(a), 29 U.S.C. § 1132(a), would preempt the enforcement provision of the UTPA which allows her to enforce the state law rights. We consider in some detail both lines of analysis.
A.
We begin by noting a recent change in the law involving § 1144. Section 1144(a) expressly preempts “any and all State laws insofar as they may now or hereafter relate to any employee benefit plan” in favor of federal regulation under ERISA. However, § 1144(b)(2)(A) saves from preemption “any law of any State which regulates insurance, banking, or securities.” The parties agree that Montana’s UTPA, as applied here against Fortis, would fall under § 1144(a). How do we determine whether the UTPA is included in the class of laws regulating insurance that are saved by § 1144(b)(2)(A) from ERISA preemption?
Until April of the current year, courts determining the reach of the ERISA saving clause (including the district court in this case) used a two-step test set forth in
Metropolitan Life Ins. Co. v. Massachusetts,
But in
Kentucky Ass’n of Health Plans, Inc. v. Miller,
— U.S. —, —,
B.
Because of the similarities between the
Metropolitan Life
and
Kentucky Association
approaches, it is well worth considering the substantial body of case law applying the older test. Of these cases, perhaps the most relevant Supreme Court precedent is
Pilot Life Ins. Co. v. Dedeaux,
In that case, a policyholder had sued Pilot Life for failure to pay benefits under a permanent disability policy that he had obtained through his employment. The Supreme Court held that a Mississippi state cause of action alternatively called “tortious breach of contract” and “the law of bad faith” was preempted by ERISA.
Id.
at 48, 57,
In addition to this straightforward application of the
Metropolitan Life
test,
Pilot Life
also introduced the concept of preemption by ERISA § 502(a), 29 U.S.C. § 1132(a). Accepting an argument made by the Solicitor General, the
Pilot Life
court stated that § 1132 (the private enforcement provision),
4
is “the exclusive vehicle for actions by ERISA-plan participants and beneficiaries asserting improper processing of a claim for benefits.”
Pilot Life,
We have previously followed
Pilot Life.
In
Greany v. Western Farm Bureau Life Ins. Co.,
It would be relatively straightforward to apply the reasoning of
Pilot Life
and
Greany
to the present case. For one, we could look to § 1144 and the
Kentucky Association
test: Is the UTPA “specifically directed toward entities engaged in insurance” and does it “substantially affect the risk pooling arrangement between the insurer and the insured?” According to
Pilot Life,
the fact that Montana recognizes a tort of bad faith in non-insurance contexts,
see Story v. City of Bozeman,
Alternatively, we could look to
Pilot Life’s
§ 1132 preemption. Under that provision of
Pilot Life,
the UTPA could be preempted because UTPA’s civil enforcement provision, Mont.Code Ann. § 33 — 18— 242, violates the implicit requirement that § 1132 is “the exclusive vehicle for actions by ERISA-plan participants and beneficiaries asserting improper processing of a claim for benefits.”
Pilot Life,
In summary, there are three aspects of Pilot Life that still indicate preemption here: 1) claims processing laws are not “specifically directed” at insurance if bad faith claims can be made in other settings, 2) claims processing laws do not affect the risk-pooling arrangement and 3) all state private causes of action for claim processing are preempted by ERISA’s § 1132 enforcement provision. If any one of these Pilot Life conclusions is supported by subsequent case law, we must rely on the holding of Greany and affirm the district court. But we find that subsequent ease law puts the validity of all three of these Pilot Life conclusions into some doubt, making the present case considerably more difficult.
C.
The principal case challenging some of
Pilot Life’s
conclusions is
UNUM Life Ins. Co. of Am. v. Ward,
First,
UNUM
took a much more generous approach than did
Pilot Life
in analyzing whether a law was specifically directed at insurance. The Court found that the California law “by its very terms, ‘is directed specifically at the insurance industry and is applicable only to insurance contracts,”’ and rejected UNUM’s argument that the general disposition of California law against forfeiture, including cases applying something akin to a notice-prejudice rule in non-insurance contexts, somehow defeated the circumstance that the California notice-prejudice rule itself was literally directed at insurance companies.
UNUM,
UNUM
also calls into question
Pilot Life’s
conclusion that a claim processing law does not affect risk allocation. Although this was not a question the
UNUM
court reached, the
UNUM
court noted without disapproval the federal government’s amicus brief argument that “[ijnso-far as the notice-prejudice rule shifts the risk of late notice and stale evidence from the insured to the insurance company in some instances, it has the effect of raising premiums and spreading risk among policyholders.”
UNUM,
Most significantly, perhaps,
UNUM
questioned the preemptive force of ERISA’s civil enforcement provision, 29 U.S.C. § 1132(a). UNUM Life Insurance had argued that § 1132 barred any state cause of action involving claim processing, a broad, literal reading of
Pilot Life.
The
UNUM
court found this argument irrelevant because the
UNUM
plaintiff had not brought the action based on a state cause of action; instead, the California statute became relevant only when cited to meet the insurer’s defense that the plaintiffs claim was untimely. However, the Court specifically noted in its footnote seven the Solicitor General’s argument that the ERISA saving cause, 29 U.S.C. § 1144(b)(2)(A), also saves state causes of action that regulate insurance, i.e., that as long as the state law being enforced is
*1146
saved as a law regulating insurance under § 1144(b)(2)(A), its enforcement provision is also saved from § 1132 preemption.
See UNUM,
D.
Thus, none of
Pilot Life’s
three principles noted above escaped unquestioned by
UNUM.
Following the latter case, we might well find the UTPA to be specifically directed toward entities engaged in insurance, and it is certainly possible that we would find the UTPA to substantially affect the risk pooling arrangement between the insurer and the insured.
See, e.g., Rosenbaum v. Unum Life Ins. Co. of Am.,
No. Civ. 01-6758,
The level of preemptive force of § 1132 was clarified in
Rush Prudential HMO, Inc. v. Moran,
*1147
Applying
Rush Prudential
as controlling here would dictate preemption. But there are two possible distinctions between
Rush Prudential
and the instant case. First, Montana’s UTPA arguably does not fall squarely under
Rush Prudential’s
characterization of
Ingersoll-Rand.
According to
Rush Prudential,
the problem with the state law cause of action in
Ingersoll-Rand
was that it “duplicated the elements of a claim available under ERISA, [but] converted the remedy.”
Rush Prudential,
Section 1132, as construed by
Rush Prudential,
thus preempts Elliot’s claims. Unlike the notice-prejudice rule involved in
UNUM,
which only provided a “relevant rule of decision” for a suit brought under § 1132,
UNUM,
III.
We review a district court’s decision to award attorney’s fees under ERISA for abuse of discretion.
Williams v. Caterpillar, Inc.,
(1) the degree of the opposing parties’ culpability or bad faith; (2) the ability of the opposing party to satisfy an award of fees; (3) whether an award of fees ... would deter others from acting under similar circumstances; (4) whether the parties requesting fees sought to benefit all participants and beneficiaries of an ERISA plan or to resolve a significant legal question regarding ERISA; and (5) the relative merits of the parties’ positions.
Hummell v. S.E. Rykoff & Co.,
Fortis argues that much of the fees Elliot incurred were not compensable under § 1132(g)(1) because those fees were incurred pursuing non-ERISA claims. However, we have held that the
Hummell
factors should be “liberally construed in favor of protecting participants in employee benefits plans.”
McElwaine v. U.S. West, Inc.,
IV.
For the foregoing reasons, we AFFIRM the decision of the district court.
Notes
. Tamoxifen is an antiestrogen drug that has been shown to reduce the risk of recurrence of cancer and the risk of developing new cancers in breast cancer survivors. See generally Nat'l Cancer Inst., Tamoxifen: Questions and Answers, at http://cis.nci.nih.gov/fact/ 7_16.htm (last visited July 24, 2003).
. Elliot alleges that Fortis violated three subsections of the UTPA:
Mont.Code Ann. § 33-18-201 Unfair claim settlement practices prohibited.
No person may ... do any of the following: (1) misrepresent pertinent facts or insurance policy provisions relating to coverages at issue;
(4) refuse to pay claims without conducting a reasonable investigation based upon all available information;
(6) neglect to attempt in good faith to effectuate prompt, fair, and equitable settlements of claims in which liability has become reasonably clear....
. The McCarran-Ferguson Act, Pub.L. No. 79-15, 59 Stat. 33 (1945), was an effort by Congress to protect states' primary regulatory role over the insurance industry. It was in part a reaction to
United States v. SouthEastern Underwriters Ass’n,
. 29 U.S.C. § 1132. Civil enforcement
(a) Persons empowered to bring a civil action. A civil action may be brought—
(1) by a participant or beneficiary....
. There is one related question we do not reach. As argued by Elliot, Ridley requires Montana insurers to make advance payments to policyholders when liability becomes reasonably clear. It is possible that the UTPA will trigger responsibility for these payments before coverage is confirmed under ERISA. If an insured in these circumstances brought an action against her insurance company, and sought no remedies in addition to those that ERISA might eventually provide, it is not entirely clear under Pilot Life, Rush Prudential and our holding today that her lawsuit would be preempted by ERISA. This circumstance, we believe, may be distinguished from the situation here, where an insured is seeking, after the underlying ERISA claims have been resolved, non-ERISA damages for failure to make advance payments under the UTPA.
