LANCE M. AFRICK, District Judge.
Before the Court is a motion
Plaintiff, Ambre P. McGinn, filed the complaint in the above-captioned matter "individually and on behalf of her minor children, Joseph L. McGinn, IV and Shane P. McGinn."
Plaintiff alleges that on March 17, 2011, her husband was traveling up a ramp on the Pontchartrain Expressway when he was ejected from his motorcycle due to an alleged hit-andrun accident, thrown over the ramp's barrier onto the ground below, and died.
Plaintiff filed this lawsuit in Louisiana state court, alleging bad faith and breach of contract in violation of state law.
In the instant motion, plaintiff disputes that ERISA preempts her state law claims and now moves to "deny and rescind [defendant's] coverage and protection under [ERISA]."
Defendant responds that the instant case is governed by ERISA because "[i]t is clear from the express terms of the Plan that it is governed by ERISA, that Laitram is the Plan Sponsor and Plan Administrator, and that MetLife is the designated Claims Administrator charged with discretionary authority to make claim determinations."
Summary judgment is proper when, after reviewing the pleadings, the discovery and disclosure materials on file, and any affidavits, the court determines there is no genuine issue of material fact. See Fed. R. Civ. P. 56. "[A] party seeking summary judgment always bears the initial responsibility of informing the district court of the basis for its motion and identifying those portions of [the record] which it believes demonstrate the absence of a genuine issue of material fact." Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). The party seeking summary judgment need not produce evidence negating the existence of material fact, but need only point out the absence of evidence supporting the other party's case. Id.; Fontenot v. Upjohn Co., 780 F.2d 1190, 1195 (5th Cir. 1986).
Once the party seeking summary judgment carries its burden pursuant to Rule 56, the nonmoving party must come forward with specific facts showing that there is a genuine issue of material fact for trial. Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986). The showing of a genuine issue is not satisfied by creating "`some metaphysical doubt as to the material facts,' by `conclusory allegations,' by `unsubstantiated assertions,' or by only a `scintilla' of evidence." Little v. Liquid Air Corp., 37 F.3d 1069, 1075 (5th Cir. 1994) (citations omitted). Instead, a genuine issue of material fact exists when the "evidence is such that a reasonable jury could return a verdict for the nonmoving party." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). The party responding to the motion for summary judgment may not rest upon the pleadings, but must identify specific facts that establish a genuine issue. Id. The nonmoving party's evidence, however, "is to be believed, and all justifiable inferences are to be drawn in [the nonmoving party's] favor." Id. at 255; see also Hunt v. Cromartie, 526 U.S. 541, 552 (1999).
ERISA preempts "any and all State laws insofar as they may now or hereafter relate to any employee benefit plan." 29 U.S.C. § 1144(a); see also id. § 1132(a)(1)(B); Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 44-45 (1987); Hernandez v. Jobe Concrete Prods., Inc., 282 F.3d 360, 362 (5th Cir. 2002). "The Supreme Court has adopted a broad construction of section 514(a) [ of ERISA, codified as 29 U.S.C. § 1144(a)], holding that `ERISA's civil enforcement remedies were intended to be exclusive' in order to prevent the remedies available to ERISA beneficiaries from being `supplemented or supplanted by varying state laws.'" Hogan v. Kraft Foods, 969 F.2d 142, 144 (5th Cir. 1992) (quoting Pilot Life, 481 U.S. at 56).
A "two-part analysis [determines] whether a state law claim is preempted under ERISA." Hernandez, 282 F.3d at 362 n.3. First, "a court examine[s] whether the benefit plan at issue constitutes an ERISA plan; and second, [it] determine[s] whether the claims `relate to' the plan." Id. (citing Ingersoll-Rand Co. v. McClendon, 498 U.S. 133, 138-40 (1990)).
The U.S. Court of Appeals for the Fifth Circuit "devised a comprehensive test for determining whether a particular plan qualifies as an `employee welfare benefit plan.'" Meredith v. Time Ins. Co., 980 F.2d 352, 355 (5th Cir. 1993). Courts should consider "whether a plan: (1) exists; (2) falls within the safe-harbor provision established by the Department of Labor; and (3) satisfies the primary elements of an ERISA `employee benefit plan'—establishment or maintenance by an employer intending to benefit employees." Id.; see also Shearer v. Sw. Serv. Life Ins. Co., 516 F.3d 276, 279 (5th Cir. 2008); House v. Am. United Life Ins. Co., 499 F.3d 443, 448 (5th Cir. 2007); Quatroy v. Quatroy, No. 08-1582, 2008 WL 4091006, at *2 (E.D. La. Aug. 27, 2008) (Lemelle, J.). If a plan fails on any of these counts, it is not an ERISA plan. Meredith, 980 F.2d at 355.
First, in determining if a plan exists, the court examines "whether from the surrounding circumstances a reasonable person could ascertain the intended benefits, beneficiaries, source of financing, and procedures for receiving benefits." Meredith, 980 F.2d at 355 (quoting Donovan v. Dillingham, 688 F.2d 1367, 1373 (11th Cir. 1982)).
Second, a plan falls within the safe-harbor provision and, thus, "is not an ERISA plan if (1) the employer does not contribute to the plan; (2) participation is voluntary; (3) the employer's role is limited to collecting premiums and remitting them to the insurer; and (4) the employer received no profit from the plan." Id. (citing 29 C.F.R. § 2510.3-1(j)(1) to (4)). A plan must satisfy all four criteria in order to be exempt under the safe-harbor provision. Id.
Third, courts consider whether a plan satisfies the "`primary elements of an ERISA `employee welfare benefit plan' as defined by the statute: (1) whether an employer established or maintained the plan; and (2) whether the employer intended to provide benefits to its employees.'" Id. (quoting MDPhysicians & Assoc., Inc. v. State Bd. of Ins., 957 F.2d 178, 183 (5th Cir. 1992), cert. denied, 506 U.S. 861 (1992)); see also 29 U.S.C. § 1002(1).
Finally, "a state law [claim] `relates to' a benefit plan, `in the normal sense of the phrase, if it has a connection with or reference to such a plan.'" Hogan, 969 F.2d at 144 (quoting Metro. Life Ins. Co. v. Massachusetts, 471 U.S. 724, 739 (1985)). The Fifth Circuit "ha[s] previously held that claims asserting breach of contract, breach of the covenant of good faith and fair dealing, and the intentional infliction of emotional distress[] are all `related to' ERISA plans." Hernandez, 282 F.3d at 362 n.3 (citing Hogan, 969 F.2d at 144-45).
ERISA also provides that every employee benefit plan must be established and maintained in a written document that "provide[s] for one or more named fiduciaries who jointly or severally shall have authority to control and manage the operation and administration of the plan." 29 U.S.C. § 1102(a)(1) (emphasis added). "`An ERISA fiduciary includes anyone who exercises discretionary authority over the plan's management, anyone who exercises authority over the management of its assets, and anyone having discretionary authority or responsibility in the plan's administration.'" Reich v. Lancaster, 55 F.3d 1034, 1046 (5th Cir. 1995) (quoting Pacificare Inc. v. Martin, 34 F.3d 834, 837 (9th Cir. 1994)); see 29 U.S.C. § 1002(21)(A).
Courts "`give[] the term fiduciary a liberal construction in keeping with the remedial purpose of ERISA.'" Reich, 55 F.3d at 1046 (alteration in original) (quoting Am. Fed'n of Unions Local 102 Health & Welfare Fund v. Equitable Life Assurance Soc'y of the U.S., 841 F.2d 658, 662 (5th Cir. 1988)). "`[D]iscretion is the benchmark for fiduciary status under ERISA.'" Id. at 1048 (quoting Maniace v. Commerce Bank, 40 F.3d 264, 267 (8th Cir. 1994)). ERISA demands only that an employee benefit plan has presiding fiduciaries, and it does not address which fiduciaries should have which responsibilities; these determinations are made between a given plan's participants and detailed in the plan instrument. See, e.g., Cathey v. Dow Chem. Co. Med. Care Program, 907 F.2d 554, 558 (5th Cir. 1990) ("[L]itigation has focused upon the language of ERISA-regulated plans and whether the instruments vest discretionary authority concerning entitlements with the fiduciary or administrator.").
In determining whether plaintiff's state claims are preempted, the Court must initially determine whether the Plan was in fact an ERISA plan. Hernandez, 282 F.3d at 362 n.3. First, the Plan must meet the existence requirement. Meredith, 980 F.2d at 355. The Plan documents detail the intended benefits such as life insurance and accidental death insurance,
Second, the Plan must not fall within the safe-harbor exception established by the Department of Labor. When an employer pays its employees' plan premiums, the policy falls outside the safe-harbor provision because it fails the first safe-harbor requirement: absence of employer contribution. 29 C.F.R. §§ 2510.3-1(j)(1); Read v. Sun Life Assurance Co. of Canada, 268 F. App'x 369, 371 (5th Cir. 2008); Tatum v. Special Ins. Servs., 82 F. App'x 877, 878 (5th Cir. 2003). Because the Plan provides that "[n]o contribution is required for Basic Life Insurance, Basic Dependent Life and Basic Accidental Death and Dismemberment Insurance," Laitram contributed to the plan by providing this insurance coverage free of charge to its employees.
Third, the Plan must also "satisf[y] the primary elements of an ERISA `employee benefit plan'—establishment or maintenance by an employer intending to benefit employees.'" Meredith, 980 F.2d at 355. ERISA defines an employee welfare benefit plan as:
29 U.S.C. § 1002(1); see also House, 499 F.3d at 450. The Plan fits squarely within this definition. The Plan was established and maintained by Laitram for the purpose of providing its employees and their beneficiaries with benefits in the event of sickness, accident, disability, or death through the purchase of insurance from defendant.
Finally, in order for ERISA to preempt plaintiff's state law claims, such claims must also "relate to" the Plan. Hernandez, 282 F.3d at 362 n.3. Plaintiff has asserted breach of contract and bad faith claims against defendant,
Plaintiff contends that ERISA does not preempt her state law claims because defendant failed to comply with the statutory requirements of ERISA—specifically, that MetLife did not involve a "plan administrator" in the claims procedure.
ERISA requires that every employee benefit plan must be managed and administered by fiduciaries with discretionary authority. See 29 U.S.C. §§ 1002(21)(A), 1102(a)(1); Reich, 55 F.3d at 1046. The Plan lists Laitram as the "Plan Administrator"
The Plan explains the "Discretionary Authority of Plan Administrator and Other Plan Fiduciaries":
Because MetLife has the authority to review claims, determine approvals or denials, and review appeals, MetLife is a fiduciary.
Plaintiff's contention that only "plan administrators" can review and determine benefit claims is wholly unsupported by ERISA and relevant case law. Aside from generally requiring the presence of a fiduciary with discretionary authority, courts focus on the language of the ERISA-regulated plan at issue. See, e.g., Chandler v. Hartford Life, 178 F. App'x 365, 369 (5th Cir. 2006); Cathey, 907 F.2d at 558. Courts have allowed fiduciaries who are not "plan administrators" to make benefit determinations. See, e.g., Parsons v. Metro. Life Ins. Co., No. 13-60895, 2014 WL 2547733, at *1 (5th Cir. June 6, 2014); Chandler, 178 F. App'x at 369; Rusch v. United Health Grp. Inc., No. 12-00128, 2013 WL 3753947, at *7 (S.D. Tex. July 15, 2013) (Ramos, J.); Firman v. Becon Constr. Co., 789 F.Supp.2d 732, 736, 739-40 (S.D. Tex. 2011) (Werlein, J.), aff'd sub nom. Firman v. Life Ins. Co. of N. Am., 684 F.3d 533 (5th Cir. 2012).
"A plan claims administrator makes two general decisions when deciding whether to pay benefits: (1) finding the facts underlying the claim and (2) determining `whether those facts constitute a claim to be honored under the terms of the plan.'" Firman, 789 F. Supp. 2d at 739 (quoting Schadler v. Anthem Life Ins. Co., 147 F.3d 388, 394 (5th Cir. 1998)); see also Parsons, 2014 WL 2547733, at *1; Chandler, 178 F. App'x at 369. Because MetLife is the claims administrator under the Plan, it was entirely proper under ERISA for MetLife to make these decisions regarding plaintiff's accidental death claim. Plaintiff's argument that ERISA preemption does not apply is without merit.
Finally, plaintiff alleges that she was denied due process because the same claims examiner who originally denied her accidental death benefits claim may have also reviewed and denied her appeal.
ERISA requires that "every employee benefit plan shall . . . (2) afford a reasonable opportunity to any participant whose claim for benefits has been denied for a full and fair review by the appropriate named fiduciary of the decision denying the claim." 29 U.S.C. § 1133 (emphasis added); see also 29 C.F.R. § 2560.503-1(h)(1). The Fifth Circuit has rejected the argument that "the word review contemplates an examination and evaluation of the file by someone other than the various people who initially denied the claim." Sweatman v. Commercial Union Ins. Co., 39 F.3d 594, 598 (5th Cir. 1994) (internal quotation marks omitted); see also Oatis v. ITT Hartford Ins. Grp., No. 96-1200, 1996 WL 732526, at *2 (E.D. La. Dec. 17, 1996) (Berrigan, J.) ("ERISA does not require appellate review by a different entity than that making the initial determination."). Plaintiff's argument is substantially identical to the one rejected in Sweatman. Accordingly, plaintiff's due process argument "is both legally and factually inaccurate." Sweatman, 39 F.3d at 598.
For the foregoing reasons,
The Court further notes that the only evidence attached to plaintiff's motion is the police report regarding decedent's accident, R. Doc. No. 21-8, and plaintiff does not establish that such evidence is competent summary judgment evidence. See Fed. R. Civ. P. 56(c)(2). The rest of the "evidence" discussed by plaintiff is a narrative description of MetLife's "records referenced by Bates Stamp pages," R. Doc. No. 21-5, at 3, but none of the described documents are in the record.