Court Opinion

ID: 9603819
Source: CourtListenerOpinion
Date Created: 2023-08-22 02:09:58.924842+00
Date Added: 2024-06-11T18:02:14.258073
License: Public Domain

ANDREWS, Presiding Judge,
dissenting.
Because the claims at issue here are both expressly and impliedly preempted by ERISA, I respectfully dissent.
The sole issue in this case is whether Bauer and Wright are entitled to pay the generic amount for the prescriptions provided by their medical benefit plan. That Bauer and Wright have attempted to avoid ERISA preemption of their complaint by casting it as one for “unjust enrichment” does not save it. It is the interpretation of the terms of the benefit plan at issue that determines the outcome of their claims.
As stated above, ERISA § 514 (a) provides that ERISA supersedes any and all state laws as they “relate to” any employee benefit plan covered by ERISA. “Congress used the words ‘relate to’in § 514 (a) in their broad sense. To interpret § 514 (a) to preempt only state laws specifically designed to affect employee benefit plans would be to ignore the remainder of § 514.” Shaw v. Delta Air Lines, 463 U. S. 85, 98 (103 SC 2890, 77 LE2d 490) (1983).
Federal courts “have uniformly held that state law challenges to the denial of benefits under an employee benefit plan are preempted.” Howard v. Parisian, Inc., 807 F2d 1560,1564 (11th Cir. 1987). As the majority stated, there is no dispute that the medical benefit plans are governed by ERISA. Accordingly, because Bauer and Wright’s cause of action was brought to remedy only the denial of benefits under an ERISA-regulated benefit plan, it falls within the scope of and is completely preempted by ERISA § 502 (a) (1) (B). Aetna Health v. Davila, 542 U. S. 200 (124 SC 2488, 2502, 159 LE2d 312) (2004).
That the state law claim in this case seeks damages for unjust enrichment and therefore is not directly related to the benefit plan, does not demand a different result.
[Where] the existence of a pension plan is a critical factor in establishing liability under the (applicable state law) . . . (the) cause of action relates not merely to pensions benefits, but to the essence of the pension plan itself. [Ingersoll-Rand Co. v. McClendon, 498 U. S. 133, 139-140 [(111 SC 478, 483, 112 LE2d 474) (1990)]. Accordingly, state law claims have been preempted by ERISA which sought damages arising from denial of plan benefits on the basis of fraud, intentional infliction of emotional distress, breach of covenant of good faith and fair dealing, tortious interference with contract, *388and unfair trade practices. See Howard v. Parisian, Inc., 807 F2d 1560, 1564 (11th Cir. 1987).
Norton v. North Ga. Foods, 211 Ga. App. 684, 686 (440 SE2d 263) (1994).
The state law claims are also impliedly preempted. As previously stated, ERISA § 514 (a) expressly preempts any and all state laws as they relate to any employee benefit plan covered by ERISA. Further, even where there is no express preemption, a cause of action will be preempted if it conflicts directly with an ERISA cause of action. Ingersoll-Rand Co., supra at 142.
ERISA § 502 (a) (1) (B) provides: “A civil action may be brought — (1) by a participant or beneficiary —... (B) 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 USC § 1132 (a) (1) (B). Under this provision, “[i]f a participant or beneficiary believes that benefits promised to him under the terms of the plan are not provided, he can bring suit seeking provision of those benefits. Aparticipant or beneficiary can also bring suit generically to ‘enforce his rights’ under the plan, or to clarify any of his rights to future benefits____Firestone Tire &c. Co. v. Bruch, 489 U. S. 101, 115 (109 SC 948, 103 LE2d 80) (1989).” Aetna, supra at 2496.
As appellants point out, appellees could have sought to recover any excessive co-payments under ERISA § 502 (a) (1) (B) since the plan is obligated to pay them a prescription drug benefit minus the applicable co-payment. And, their entitlement to a lower generic co-payment depends entirely on their rights and obligations under the benefit plan. As stated in Aetna, when a claim is based on the denial of coverage for medical care, which logically would include prescription medication, and the individual is entitled to such coverage only because of the terms of an ERISA-regulated employee benefit plan, then the suit falls within the scope of ERISA § 502 (a) (1) (B). Aetna, supra at 2496. Because § 502 (a) provides the exclusive remedy for enforcement of any rights or obligations created by an ERISA plan, any state law cause of action that conflicts with this provision is also preempted. Ingersoll-Rand Co., supra at 142.
I find that Morstein v. Nat. Ins. Svcs., 93 F3d 715 (11th Cir. 1996), relied on by the majority, is distinguishable. In Morstein, the president and sole shareholder of a company sued an independent insurance agent and his company, claiming that he fraudulently induced her to purchase a policy of major medical insurance. Id. at 717. The court held that this claim did not fall within the scope of ERISA’s preemption because it did not have sufficient connection to the plan itself to “relate to” the plan. Id. at 724. In the instant case, however, *389benefits under the plan are the basis for the claim and the reasoning in Morstein does not apply.
Decided July 13, 2005
Holland & Knight, Susan W. Housen, Laurie W. Daniel, for appellants.
Fine & Block, Kenneth I. Sokolov, for appellees.
The majority goes to great lengths to distinguish Aetna. First, the opinion states that the plaintiffs in Aetna were denied benefits based on the terms of their ERISA plans. I fail to see how that is different from the case before us. Second, I am puzzled as to the purpose of the majority’s discussion of “complete” preemption, citing Butero v. Royal Maccabees Life Ins. Co., 174 F3d 1207 (11th Cir. 1999). That case discusses “superpreemption,” which concerns the existence of federal subject matter jurisdiction. Id. at 1212. As the majority acknowledges before it goes through the four elements required for complete or superpreemption, that is not applicable in this case.
Moreover, to the extent the majority contends the claims are not preempted because the defendants are not fiduciaries under the plan, that is not the law. See Howard, supra at 1564.
Also, contrary to the majority’s contention, Bauer and Wright’s claims are cognizable under ERISA § 502 (a) (1) (B). And, as previously stated, “any state-law cause of action that duplicates, supplements, or supplants the ERISA civil enforcement remedy conflicts with the clear congressional intent to make the ERISA remedy exclusive and is therefore pre-empted.” Aetna, supra at 2495.
Accordingly, Bauer and Wright’s claims are expressly preempted under ERISA as arising from and relating to an employee benefit plan. See ERISA § 514 (a), 29 USC § 1144 (a); Shaw, supra. The claims are also impliedly preempted because they conflict directly with and are duplicative of an ERISA cause of action under § 502 (a). Ingersoll-Rand Co., supra at 142. Therefore, I respectfully dissent from the majority’s holding to the contrary.
I am authorized to state that Presiding Judge Johnson and Presiding Judge Blackburn join in this dissent.