Opinion
Case No. 3:05 CV 7291.
December 7, 2005
MEMORANDUM OPINION
This matter is before the Court on the unopposed Motion for Partial Summary Judgment (Doc. No. 10) of Defendant Medical Mutual of Ohio ("MMO"). For the following reasons, Defendant's motion is granted.
BACKGROUND
Plaintiffs Rodney R. and Kathleen L. Shaull were insured under a group health insurance policy issued and administered by MMO. The Shaulls claim MMO denied coverage and failed to pay medical bills as required by the contract of insurance. They sued MMO in Sandusky County, Ohio, Common Pleas court, asserting claims for breach of contract (Count One) and bad faith (Count Two). MMO removed to this Court on the basis of ERISA preemption, under Metropolitan Life Insurance Co. v. Taylor, 481 U.S. 58, 64 (1987), and Smith v. Provident Bank, 170 F.3d 609, 613 (6th Cir. 1999).
MMO argues ERISA preempts both of Plaintiffs' claims. It moves for summary judgment on the bad faith claim and urges the Court to construe the breach of contract cause of action as a claim for benefits under ERISA Section 502(a)(1)(B), 29 U.S.C. § 1132(a)(1)(B). MMO's arguments are well-taken.
DISCUSSION
A. Summary Judgment Standard
Summary judgment is appropriate where "the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law." FED. R. CIV. P. 56(c). The moving party bears the initial responsibility of "informing the district court of the basis for its motion, and identifying those portions of `the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any,' which it believes demonstrate the absence of a genuine issue of material fact." Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S. Ct. 2548, 2553, 91 L. Ed. 2d 265 (1986). The movant may meet this burden by demonstrating the absence of evidence supporting one or more essential elements of the non-movant's claim. Id. at 323-25. Once the movant meets this burden, the opposing party "must set forth specific facts showing that there is a genuine issue for trial." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 250, 106 S. Ct. 2505, 2541, 91 L. Ed. 2d 202 (1986) ( quoting FED. R. CIV. P. 56(e)).
Once the burden of production has so shifted, the party opposing summary judgment cannot rest on its pleadings or merely reassert its previous allegations. It is not sufficient "simply [to] show that there is some metaphysical doubt as to the material facts." Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586, 106 S. Ct. 1348, 1356, 89 L. Ed. 2d 538 (1986). Rather, Rule 56(e) "requires the nonmoving party to go beyond the pleadings" and present some type of evidentiary material in support of its position. Celotex, 477 U.S. at 324, 106 S. Ct. at 2553; see also Harris v. General Motors Corp., 201 F.3d 800, 802 (6th Cir. 2000). Summary judgment must be entered "against a party who fails to make a showing sufficient to establish the existence of an element essential to that party's case, and on which that party will bear the burden of proof at trial." Celotex, 477 U.S. at 322, 106 S. Ct. at 2552. "In considering a motion for summary judgment, the Court must view the facts and draw all reasonable inferences therefrom in a light most favorable to the nonmoving party." Williams v. Belknap, 154 F. Supp. 2d 1069, 1071 (E.D. Mich. 2001) (citing 60 Ivy Street Corp. v. Alexander, 822 F.2d 1432, 1435 (6th Cir. 1987)). However, "`at the summary judgment stage the judge's function is not himself to weigh the evidence and determine the truth of the matter,'" Wiley v. U.S., 20 F.3d 222, 227 (6th Cir. 1994) (quoting Anderson, 477 U.S. at 249); therefore, "[t]he Court is not required or permitted . . . to judge the evidence or make findings of fact." Williams, 154 F. Supp. 2d at 1071. The purpose of summary judgment "is not to resolve factual issues, but to determine if there are genuine issues of fact to be tried." Abercrombie Fitch Stores, Inc. v. Am. Eagle Outfitters, Inc., 130 F. Supp. 2d 928, 930 (S.D. Ohio 1999). Ultimately, this Court must determine "whether the evidence presents a sufficient disagreement to require submission to a jury or whether it is so one-sided that one party must prevail as a matter of law." Anderson, 477 U.S. at 251-52; see also Atchley v. RK Co., 224 F.3d 537, 539 (6th Cir. 2000).
B. ERISA and Plaintiffs' State-Law Claims
ERISA preempts all state laws "insofar as they may now or hereafter relate to an employee benefit plan," 29 U.S.C. § 1144(a), the definition of which includes "any plan, fund, or program . . . established or maintained by an employer or by an employee organization . . . to the extent that such plan, fund, or program was established or is maintained for the purpose of providing for its participants or their beneficiaries, through the purchase of insurance or otherwise . . . medical, surgical, or hospital care or benefits, or benefits in the event of sickness, accident, disability, death or unemployment. . . ." 29 U.S.C. § 1002(1), (3).
"Congress' intent in enacting ERISA was to completely preempt the area of employee benefit plans and to make regulation of benefit plans solely a federal concern. . . . [V]irtually all state law claims relating to an employee benefit plan are preempted by ERISA. It is not the label placed on a state law claim that determines whether it is preempted, but whether in essence such a claim is for the recovery of an ERISA plan benefit." Cromwell v. Equicor-Equitable HCA Corp., 944 F.2d 1272, 1276 (6th Cir. 1991) (internal citations omitted). ERISA preempts claims for bad faith and breach of contract that are based on the denial of benefits allegedly due under an ERISA plan. Ramsey v. Formica Corp., 398 F.3d 421, 424-25 (6th Cir. 2005) (citing Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 57 (1987); Tolton v. Am. Biodyne, Inc., 48 F.3d 937, 942 (6th Cir. 1995); and Cromwell, 944 F.2d at 1276).
When ERISA preempts state law claims brought in state court, the defendant may remove the claims to federal court, where the complaint "will be treated as alleging a federal cause of action, notwithstanding that on its face, the plaintiff's complaint alleges only a state-law cause of action." Peters v. Lincoln Elec. Co., 285 F.3d 456, 468 (6th Cir. 2002). ERISA allows an employee benefit plan participant or beneficiary to bring a civil action to "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 U.S.C. § 1132(a)(1)(B).
MMO appended to its Motion for Summary Judgment the application for coverage under the plan at issue. (Doc. No. 10, Ex. A-2). The application was made on behalf of Ohio Missions, a church, which indicated it sought coverage for its two employees, the Shaulls. Plaintiffs have presented no evidence to refute the conclusion that the plan is indeed an "employee benefit plan" to which ERISA applies. ERISA therefore preempts Plaintiffs' state-law bad faith and breach of contract claims, which are based on the denial of benefits.
As noted in Peters, this Court may construe Plaintiffs' claims as federal causes of action. The Court will treat the breach of contract claim as a claim for benefits under 29 U.S.C. § 1132(a)(1)(B). However, the Court will grant summary judgment in favor of MMO on the bad faith claim. While that claim might arguably be treated as one brought under 29 U.S.C. § 1132(a)(3) for breach of fiduciary duty, beneficiaries may not premise such claims on the denial of benefits. Wilkins v. Baptist Healthcare System, Inc., 150 F.3d 609, 615-16 (6th Cir. 1998).
CONCLUSION
Based on the foregoing, Defendant's Motion for Partial Summary Judgment (Doc. No. 10) is granted as to Count Two. The Court will treat Count One as a claim under 29 U.S.C. § 1132(a)(1)(B) for benefits due under an employee benefit plan.
IT IS SO ORDERED.