Court Opinion

ID: 9687616
Source: CourtListenerOpinion
Date Created: 2023-08-24 16:39:25.666297+00
Date Added: 2024-06-11T18:18:29.313783
License: Public Domain

White, P.J.
(concurring in part and dissenting in part). I respectfully dissent from the majority’s conclusion that plaintiffs’ claims are preempted by the Employee Retirement Income Security Act (erisa), 29 USC 1001 et seq. While the words "relates to” have been given a broad meaning, the preemption clause does not preempt laws that have only a "tenuous, remote, or peripheral” effect on an erisa plan. Shaw v Delta Air Lines, Inc, 463 *586US 85, 97; 103 S Ct 2890; 77 L Ed 2d 490 (1983). It has been observed:
A preemption provision designed to prevent state interference with federal control, of erisa plans does not require the creation of a fully insulated legal world that excludes these plans from regulation of any purely local transaction. [Rebaldo v Cuomo, 749 F2d 133, 138 (CA 2, 1984).]
Plaintiffs’ breach of contract claim is not preempted. Plaintiffs have not sued General Motors or the erisa plan for breach of contract. Rather, they assert that the action of Blue Cross and Blue Shield of Michigan (bcbsm) in unilaterally changing the provider reimbursement level for certain covered services constitutes a breach of the existing contract. This claim only tangentially relates to the erisa plan. It does not address the relationship between the plan and its subscribers, but, rather, the prior contractual relationship between bcbsm and the providers. Congress did not intend to preempt a state court’s application of general contract law merely because one of the contracting parties also contracts with an erisa plan that might be affected by the first contract.
Furthermore, although the circuit court granted bcbsm summary disposition with regard to this claim, I believe there were genuine issues of material fact regarding whether bcbsm changed the reimbursement level in violation of the existing agreement, or, as claimed by bcbsm, simply changed the covered services.
Nor are plaintiffs’ claims of tortious interference with business relationships preempted. Again, plaintiffs have not sued General Motors or the plan, but, rather, bcbsm. The common law regarding tortious interference, like the law of contracts, *587is a law of general application that only tangentially affects the erisa plan. While it is true that at least one of the actions claimed by plaintiffs to be illegal involves an element of the plan — the plan provision providing that physicians are paid $3 to draw blood if they send the blood to a panel laboratory, but not otherwise — the law that the plan allegedly violates, MCL 445.162; MSA 14.375(22),1 is a law of general application. Congress did not intend that erisa plans be exempted from general regulatory laws, addressing traditional areas of state authority, that do not affect relations between the principal erisa entities — the employer, the plan, the fiduciary, and the beneficiaries. Firestone Tire & Rubber Co v Neusser, 810 F2d 550, 553-556 (CA 6, 1987).
With respect to the tortious interference claim, I conclude that plaintiffs’ claim should not have been dismissed. To establish a prima facie case of tortious interference with a business relationship, plaintiffs must show: (1) the existence of a valid business relationship (not necessarily evidenced by an enforceable contract) or expectancy; (2) knowledge of the relationship or expectancy on the part of the defendant; (3) intentional interference inducing or causing a breach or termination of the relationship or expectancy; and (4) resultant damage. Bonelli v Volkswagen of America, Inc, 166 Mich App 483, 496; 421 NW2d 213 (1988). There must be the intentional doing of an act that is wrongful per se or the intentional doing of a lawful act with malice and without legal justification for the purpose of invading the plaintiffs’ contractual rights or business relationship. Id. *588Plaintiffs adequately pleaded a prima facie case, including reference to statutory violations constituting wrongful acts per se, and there was a genuine issue whether bcbsm tortiously interfered with plaintiffs’ business relationships.
Additionally, I conclude that plaintiffs’ claims under the Prudent Purchaser Act (ppa), MCL 550.51 et seq.; MSA 24.650(51) et seq., are not preempted. Assuming for the moment that the ppa "relates to” an employee health benefit plan under the erisa, the savings clause excepts from the preemption clause laws that regulate insurance. Section 514(b)(2)(A), 29 USC 1144(b)(2)(A). The majority concludes that the state law provisions that form the basis of plaintiffs’ claims do not regulate the business of insurance "because Premier plus is at this point solely a program for self-funded employee benefit plans,” Ante, p 582. The majority explains "[t]he health plan is self-funded; defendant does not function as an insurer. If plaintiffs were to succeed in this suit, the state laws they invoke would be used essentially to regulate a self-funded erisa plan, not an insurance plan. Thus, plaintiffs may not invoke the savings clause in § 514(b)(2)(A).” Ante, p 582. In response to plaintiffs’ argument that, notwithstanding bcbsm’s role as administrator of the gm program, bcbsm is an insurance company subject to regulation, the majority states "[preemption should not depend on the arbitrary distinction between programs with administrators that happen to engage in the business of insurance and those with administrators that do nothing but manage self-funded benefit plans.” Ante, p 583.
I conclude that plaintiffs’ claims alleging a violation of the ppa seek to enforce laws that regulate insurance, notwithstanding that in the instant case Premier plus was implemented as part of a *589self-funded erisa plan. Bcbsm is regulated under a statute that regulates insurance, MCL 550.1101 et seq.; MSA 24.660(101) et seq. (Act 350), and is regulated under that statute even when it acts only as a plan administrator. Act 350 permits bcbsm to promulgate plans in accordance with the ppa, and the ppa specifically applies to bcbsm as a "health care corporation” incorporated under Act 350. The ppa also specifically regulates third-party administrators the same as insurers. Under these circumstances, I would hold that the ppa is a law "that regulates insurance.”
Nor is the insurance savings clause rendered ineffective by the "deemer clause.”2 Plaintiffs do not seek to have General Motors or the plan deemed to be an insurance company. Rather, plaintiffs challenge the process employed by bcbsm in formulating and implementing the Premier plus plan. The distinction between "programs with administrators that happen to engage in the business of insurance and those with administrators that do nothing but manage self-funded benefits plans” is not arbitrary. The Legislature has chosen to regulate bcbsm and, recognizing the economic power wielded by bcbsm and other similar organizations, has determined that it is necessary to regulate the manner in which such organizations, including third-party administrators, formulate prudent purchaser agreements and offer participation in such agreements to health care providers. Congress did not intend that bcbsm’s activities, comprehensively regulated under state statute, must go unregulated and unchecked when the activity involved is the formulation, implementation, and administration of an erisa plan, when these activities would otherwise be regulated if the underlying plan was not an erisa plan. Rather, *590Congress intended to defer to the state’s regulation of companies, such as bcbsm, that are in the insurance business.
Turning to the question whether plaintiffs have a private cause of action under Act 350 or the ppa, I agree with the circuit court that plaintiffs’ remedy under Act 350 was to file a complaint with the Insurance Commissioner to compel enforcement of the act. MCL 550.1619; MSA 24.660 (619). The ppa does not contain a similar restriction, and I conclude that plaintiffs could properly invoke the equity jurisdiction of the circuit court to seek to enjoin implementation of a plan that was not implemented according to the ppa or to obtain other appropriate relief. See Michigan State Employees Ass’n v Dep’t of Mental Health, 120 Mich App 39; 328 NW2d 11 (1982).
With regard to the antitrust claim, while not approved, the plan was apparently "permitted” by the Insurance Commissioner, and accordingly the circuit court did not err in concluding that the antitrust statute3 did not apply. Should it ultimately be determined that the Insurance Commissioner will not permit the plan, I would allow plaintiffs to reinstate their claim.
Lastly, I agree with the majority’s discussion in part iv and its conclusion that the circuit court did not err in entering its December 20, 1991, and March 18, 1992, orders, or in denying bcbsm’s motion for security pending appeal.

 While the circuit court determined that this statute was not violated, I believe there was a genuine issue whether bcbsm devised and acted as an intermediary in a plan in which doctors received compensation for sending patient specimens to specified laboratories.

 Section 514(b)(2)(B), 29 USC 1144(b)(2)(B).

 MCL 445.774; MSA 28.70(4).