Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-alnd-6_04-cv-02886/USCOURTS-alnd-6_04-cv-02886-0/pdf.json

Nature of Suit Code: 791
Nature of Suit: Employee Retirement Income Security Act (ERISA)
Cause of Action: 28:1441eri - Petition for removal - E.R.I.S.A.

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1The plaintiff did not respond to defendant Blue Cross and Blue Shield’s motion for

summary judgment. 

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF ALABAMA

JASPER DIVISION

JAMES KEETON, 

Plaintiff,

vs. CASE NO. CV-04-J-2886-J

THE PITTSBURG AND MIDWAY

COAL MINE COMPANY and 

BLUE CROSS AND BLUE SHIELD 

OF ALABAMA, INC., 

Defendants.

MEMORANDUM OPINION

Pending before the court is defendant Pittsburg and Midway Coal Mine

Company’s motion for summary judgment (doc. 18), memorandum of law (doc. 19)

and evidence in support of said motion (doc. 20) and defendant Blue Cross and Blue

Shield of Alabama’s motion for summary judgment (doc. 21) and memorandum in

support of said motion (doc. 22). The plaintiff filed evidence and a memorandum in

opposition to Pittsurg and Midway Coal Mine Company’s motion (docs. 23 and 24)

and the defendant filed a reply (doc. 26).1 Having considered the pleadings, evidence

and memoranda of the parties, the court finds as follows:

The plaintiff filed an amended complaint (doc. 9) in this action under the

Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001,

FILED

 2005 May-19 PM 05:53

U.S. DISTRICT COURT

N.D. OF ALABAMA

Case 6:04-cv-02886-IPJ Document 27 Filed 05/19/05 Page 1 of 11
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et seq., asserting that defendant Pittsburg and Midway Coal Mine Company (“P&M”)

wrongfully terminated benefits to his wife, retroactive to the date of their separation.

Amended Complaint, ¶¶ 8-9. The plaintiff alleges that defendant P&M was obligated

to provide coverage for his wife until their divorce became final. Id., ¶¶ 15-16. The

amended complaint requests this court to declare the rights and legal relationship of

the parties under the Plan and order defendants to reinstate coverage to the plaintiff’s

wife (Count I), and further demands judgment against the defendants for the money

he has expended to provide health insurance coverage for his wife due to her

termination from coverage with defendants (Count II). 

FACTUAL BACKGROUND

The plaintiff and his wife, Susan Gail Keeton, separated on February 28, 2002,

although the plaintiff had filed for divorce on October 14, 2001. Plaintiff depo. at 10,

12, 42. The plaintiff is employed by defendant P&M and has worked there since April

21, 1997. Id., at 15. Defendant P&M provides health insurance to its employees and

their dependents through the 2002 United Mine Workers of America (“UMWA”)

Benefit Plan (the “Plan”), which is self-funded. Affidavit of Hicks, ¶ 2. The Plan

incorporates health insurance and other benefits from the collective bargaining

agreement between P&M and the UMWA which is called the Coal Wage Agreement.

Id. Pursuant to the Plan, “Eligible Dependents” include:

A spouse who is living with or being supported by an eligible Employee

or Pensioner.

Case 6:04-cv-02886-IPJ Document 27 Filed 05/19/05 Page 2 of 11
2Tyron Hicks is the Human Resources & Labor Relations Supervisor for defendant P&M. 

He reports directly to Jeff Lowe. Lowe depo. at 9. 

3

 .... 

For purposes of this section D, a person shall be considered dependent

upon an eligible Employee, Pensioner or spouse of such Employee,

Pensioner or spouse provides over one-half of the support to such

person.

Defendant exhibit 12 to plaintiff depo., at 4-5; defendant exhibit 13 to plaintiff depo.

See also Lowe depo. at 32-33. The plaintiff did not have to pay an increased premium

to provide coverage to his spouse or children. Plaintiff depo. at 40. 

Susan Keeton was removed from plaintiff’s health insurance on June 10, 2003,

when Jeffrey Lowe, manager of administration for P&M, found out that the plaintiff

was no longer living with his wife. Plaintiff depo. at 24-25, 28; Lowe depo. at 7, 10-

11, 15; Hicks depo. at 10.2 The plaintiff never requested that she be removed from

coverage. Hicks depo. at 35. Lowe and Hicks explained to plaintiff that his wife was

no longer eligible for coverage because he was neither living with her nor providing

support. Lowe depo. at 11, 21-22; Hicks depo. at 12. The plaintiff’s original purpose

in going to Lowe was to have his son removed from his insurance coverage because

the son was no longer eligible. Plaintiff depo. at 26-27, 35; defendant exhibit 2 to

plaintiff depo.; Hicks depo. at 12. Lowe took plaintiff to Tyron Hicks’ office to

confirm the eligibility requirements and complete the necessary form. Lowe depo. at

19-20; Hicks depo. at 10. 

Case 6:04-cv-02886-IPJ Document 27 Filed 05/19/05 Page 3 of 11
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The plaintiff alleges that, at the time he completed the form to have his son

removed from his insurance, he did not remember the notation “drop wife and son, no

longer living together or providing support” being on the form. Plaintiff depo. at 32,

35. See defendant exhibit 2 to plaintiff depo. However, the plaintiff states everything

else was on the form, including his wife’s name, except for Hicks’ signature. Plaintiff

depo. at 78-79; defendant exhibit 2 to plaintiff depo. Hicks’ agrees he wrote “drop

wife and son” on the form. Hicks depo. at 14. The plaintiff returned to Lowe’s office

the next day to request that his wife be returned to coverage. Plaintiff depo. at 29. 

In July, 2003, the plaintiff was court ordered to provide his wife with $1,500.00

per month alimony. Plaintiff depo. at 37-38; defendant exhibit 3 to plaintiff depo.

The plaintiff returned to Lowe’s office to ask that his wife be reinstated on the

insurance. Plaintiff depo. at 79-80. The plaintiff wanted to keep coverage on his soon

to be ex-wife due to a court order that he provide it. Id., at 29, 38-39; Hicks depo. at

36. Lowe told him that because he was not living with his wife, she could not be

returned to coverage. Plaintiff depo. at 81. Because Susan Keeton was removed from

coverage, the plaintiff had to pay her coverage through COBRA. Id., at 40-41;

defendant exhibit 4 to plaintiff depo. Ms. Keeton has had coverage through COBRA

since the day Hicks received her completed COBRA application and a check for the

first month’s coverage. Hicks depo. at 33-34. 

The plaintiff served nineteen days in jail in September, 2003 on contempt

charges, in part for not having his wife reinstated on his insurance and in part for not

Case 6:04-cv-02886-IPJ Document 27 Filed 05/19/05 Page 4 of 11
3Pursuant to a July 29, 2003 court order, the plaintiff had to pay $1,500.00 per month as

alimony. Defendant exhibit 3 to plaintiff depo. This order did not mention health care

insurance. No evidence of any court order requiring the plaintiff to pay health care insurance for

Susan Keeton is before the court. 

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paying alimony.3

 Plaintiff depo. at 33, 36. After he was released from jail, the

plaintiff obtained a form from Hicks to have Susan Keeton put back on his insurance

coverage. Id., at 36, 53-54; Lowe depo. at 24-26, 36; Hicks depo. at 21. Hicks

actually provided the plaintiff the form in question more than once. Hicks depo. at 22.

Under defendant P&M’s benefit plan, as long as the plaintiff was providing more than

half of his wife’s support, she was eligible for coverage on his insurance. Defendant

exhibit 9 to plaintiff depo. However, the form completed by his wife for reinstatement

was not completed correctly. Plaintiff depo. at 53-54, 68-69, 82-83; defendant

exhibits 5, 6 and 9 to plaintiff depo. Lowe explained that because the benefit plan

required the employee to pay at least half the spouse’s support for insurance coverage

purposes, defendant P&M needed Susan Keeton’s financial information. Lowe depo.

at 34. He also needed documentation to support the amounts claimed on the form

Susan Keeton completed. Id., at 40-41; Hicks depo. at 23-24. 

The UMWA benefit plan includes dispute resolution procedures. Hicks’

affidavit, ¶ 2. The plaintiff filed a Resolution of Dispute (“ROD”) on October 29,

2003, based on defendant P&M’s failure to reinstate his wife on his insurance.

Plaintiff depo. at 66-67; defendant exhibit 8 to plaintiff depo.; Lowe depo. at 32. The

ROD alleges that he is paying more than half of his wife’s support and is still legally

Case 6:04-cv-02886-IPJ Document 27 Filed 05/19/05 Page 5 of 11
4The Circuit Court of Walker County, Alabama, entered a final divorce decree in Keeton

v. Keeton, DR 01-0550, on April 19, 2005. Plaintiff’s response to defendant P&M’s motion for

summary judgment, at 3 and 13. The court questions whether the plaintiff has any ongoing duty

to provide health insurance for her, given that she is no longer a “spouse.” If no such duty is

continuing, the only issue left for the court is whether the plaintiff is entitled to recovery of his

past expenditures for Susan Keeton to have COBRA coverage. 

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married to her, so she should be on his insurance.4

 Plaintiff depo. at 75. This claim

has not been finally resolved under the dispute resolution procedures of the UMWA

collective bargaining agreement with defendant P&M. Hicks’ affidavit, ¶¶ 2, 5. 

According to the benefit plan, disputes are subject to the following procedures:

The Plan Administrator is authorized to promulgate rules and regulations

to implement and administer the Plan, and such rules and regulations

shall be binding upon all persons dealing with the Beneficiaries claiming

benefits under this Plan. The Trustees of the UMWA Health and

Retirement Funds will resolve any disputes ... to assure consistent

application of the Plan provisions under the 2002 NBCWA. The

Trustees shall develop procedures for the resolution of such disputes. In

the event the Trustees decide such dispute, such decision of the Trustees

shall be final and binding on the parties. If the Trustees are unable to

resolve the dispute, such dispute shall be referred to a permanent

arbitration panel of up to three members selected by mutual agreement

of the UMWA and the BCOA and maintained by the Trustees. A dispute

referred in this manner shall be decided by one member of the arbitration

panel, determined on a rotating basis, whose decision shall be final and

binding on the parties. 

Exhibit A to Hicks’ affidavit, at 19.

STANDARD OF REVIEW

Under Federal Rule of Civil Procedure 56(c), summary judgment is proper “if

the pleadings, depositions, answers to interrogatories, and admissions on file, together

Case 6:04-cv-02886-IPJ Document 27 Filed 05/19/05 Page 6 of 11
5The plaintiff makes an argument for the first time in his response concerning whether the

benefit plan is consistent with the Coal Wage Agreement and ERISA. The court finds the

plaintiff has never plead such a claim. The plaintiff also challenges for the first time in his

response to defendant P&M’s motion for summary judgment whether that defendant properly

7

with the affidavits, if any, show that there is no genuine issue as to any material fact

and that the moving party is entitled to a judgment as a matter of law.” Celotex Corp.

v. Catrett, 477 U.S. 317, 322 (1986). The party moving for summary judgment

always bears the initial responsibility of informing the court of the basis for its motion

and identifying those portions of the pleadings or filings which it believes

demonstrates the absence of a genuine issue of material fact. Id. at 323. The burden

then shifts to the nonmoving party to “go beyond the pleadings and by ... affidavits,

or by the ‘depositions, answers to interrogatories, and admissions on file’ designate

‘specific facts showing that there is a genuine issue for trial.’” Celotex, 477 U.S. at

324, Fed.R.Civ.Pro 56(e). In meeting this burden, the nonmoving party must

demonstrate that there is a “genuine issue for trial.” Fed.R.Civ.P. 56(c); Matsushita

Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986), see also Anderson

v. Liberty Lobby, Inc., 477 U.S. 242, 249 (1986); Clark v. Coats & Clark, Inc., 929

F.2d 604, 608 (11th Cir.1991). 

LEGAL ANALYSIS

The sole issue before the court is whether defendant P&M wrongfully refused

to reinstate Susan Keeton on the plaintiff’s health insurance.5 Because this case is

Case 6:04-cv-02886-IPJ Document 27 Filed 05/19/05 Page 7 of 11
applied the terms of COBRA. Plaintiff’s response, at 11-12. Again, such an issue is not

properly before this court. See e.g. In re Andrx Corporation, Inc., 296 F.Supp.2d 1356, 1367

(S.D.Fla.2003), citing Fisher v. Metropolitan Life Ins. Co., 895 F.2d 1073, 1078 (5th Cir.1990)

("As the district court correctly noted, this claim was not raised in [the plaintiff's] second

amended complaint, but, rather, was raised in response to the defendants' motions for summary

judgment, and, as such, was not properly before the court."); Shanahan v. City of Chicago, 82

F.3d 776, 781 (7th Cir.1996) ("A plaintiff may not amend his complaint through arguments in

his brief in opposition to a motion for summary judgment"). 

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brought under ERISA, the court applies the standards set forth in Williams v.

BellSouth Telecommunications, Inc., 373 F.3d 1132 (11th Cir.2004). However, the

court does not need to determine whether the proper standard for review is arbitrary

and capricious or heightened arbitrary and capricious. Under either standard, in

considering defendant P&M’s decision not to reinstate Susan Keeton on plaintiff’s

health insurance, the court must first determine, de novo, whether the plan

administrator’s decision was “wrong.” Bellsouth, 373 F.3d at 1138; see also HCA

Health Systems v. Employers Health Ins. Co., 240 F.3d 982 (11th Cir.2001). Based on

the information that the plaintiff provided to the defendant, as well as to this court, the

court is of the opinion that the decision is not wrong, for the reasons set forth below.

The plaintiff argues his wife should have been reinstated as a dependent on his

health insurance. He was told that, in order to accomplish this, he had to be providing

more than one half of her support. For this purpose, he was provided a form by Hicks

which he has never completed. The plaintiff’s wife completed the form, but provided

no supporting information. Based on this, defendant P&M told the plaintiff it could

Case 6:04-cv-02886-IPJ Document 27 Filed 05/19/05 Page 8 of 11
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not reinstate Susan Keeton as a dependent. The plaintiff took no further steps to

provide the requested information to his employer. See plaintiff’s response at 6 (“the

Plaintiff admits that he has been unable to provide P&M or the Trustees with any

information concerning Mrs. Keeton’s income or household expenses at any time

since this matter arose in June of 2003...”); plaintiff affidavit, ¶¶ 8-9 . Instead, he filed

a ROD and, prior to receiving a final decision on that, he filed this litigation. Given

these facts, the court cannot conclude that the decision of defendant P&M was wrong,

regardless of the standard by which that decision is reviewed. See HCA Health

Systems, 240 F.3d at 993; Bellsouth, 373 F.3d at 1138.

The plaintiff has failed to exhaust his administrative remedies, which is a

prerequisite to suit under the law of this circuit. Counts v. American General Life and

Accident Insurance Co., 111 F.3d 105, 107 (11th

 Cir.1997). In his response, the

plaintiff argues he should be exempt from the requirement that he exhaust his

administrative remedies because the Trustees have yet to reach a decision. Plaintiff’s

response, at 5. Thus, the plaintiff argues his attempts at exhaustion are futile. Id.

Additionally, the plaintiff argues that the administrative process is “unlikely to result

in an adequate remedy because the ROD only speaks to the contractual dispute raised

Case 6:04-cv-02886-IPJ Document 27 Filed 05/19/05 Page 9 of 11
6The plaintiff further states as follows:

The issue before the Court, and that issue which should properly be considered by

the Trustees, is not whether P&M has complied with the language of the Plan in

reaching its decision to terminate coverage for Mrs. Keeton, but whether the Plan

properly conforms to the provisions of ERISA and the intent of the Wage

Agreement. 

Plaintiff’s response, at 5-6. The court disagrees. The plaintiff has alleged no basis on which he

may challenge the provisions of the benefit plan, which is a contract between the UMWA union

and defendant P&M. The plaintiff later refines this argument to explain he is challenging

whether the UMWA Benefit Plan could use the definition of “spouse and dependents” found in

the Dental Plan section of the Wage Agreement. He states that the use of the restrictive

definition found in the Dental Plan is contrary to the purpose of ERISA. Plaintiff’s response, at

10. As discussed at note 5, the court is of the opinion this argument has not been properly raised. 

Even if the plaintiff had raised this claim properly, the Coal Wage Agreement states that

“[t]his description is intended merely to highlight certain information; it is not a complete

statement of all of the provisions of the Plans and Trusts, nor is it intended to be a Summary Plan

Description as defined in the Employee Retirement Income Security Act of 1974, and is

qualified in its entirety by, and subject to the more detailed information contained in the Plans

and Trusts.” Coal Wage Agreement of 2002, at 50. In other words, the Wage Agreement merely

summarizes, to no legal effect, the information containing in the UNMA Benefit Plan. 

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by it and fails to address the statutory inadequacy of the 2002 UMWA Benefit Plan.”6

Plaintiff’s response, at 5. As the court noted above, the plaintiff has not properly

raised this claim. The plaintiff also concedes that a literal reading of the plan

provisions could lead to a conclusion that the plaintiff’s wife was not eligible for

coverage at the time she was removed from coverage. Plaintiff’s response, at 6.

While the court is of the opinion that the plaintiff has failed to exhaust his

administrative remedies, the court has reached the merits of this case. Therefore, the

issue of exhaustion is moot. 

Plaintiff’s only explanation for naming Blue Cross as a defendant in this

litigation is that is “who I send the money to.” Plaintiff depo. at 85. Plaintiff offers

Case 6:04-cv-02886-IPJ Document 27 Filed 05/19/05 Page 10 of 11
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no evidence that defendant Blue Cross could, independently of defendant P&M,

reinstate Susan Keeton on the plaintiff’s health insurance. Defendant Blue Cross

removed Susan Keeton as a dependent eligible for coverage based on defendant

P&M’s instruction. No evidence before the court establishes that defendant Blue

Cross would not reinstate coverage for Susan Keeton should it be instructed to do so

by defendant P&M. As such, the plaintiff has failed to state a claim upon which relief

may be granted against this defendant. See Rule 12(b)(6), Fed.R.Civ.Pro. 

 In consideration of the foregoing, the courtshall grant both defendants’ motions

for summary judgment by separate Order.

DONE this the 19th day of May, 2005.

 

INGE PRYTZ JOHNSON

U.S. DISTRICT JUDGE 

Case 6:04-cv-02886-IPJ Document 27 Filed 05/19/05 Page 11 of 11