Opinion
Civ. No. 3:98-CV-1078-D.
April 13, 2000.
MEMORANDUM OPINION
This is an action by plaintiff Darrell K. Tyler, Sr. ("Tyler") against defendant Hocutt, Inc. ("Hocutt") to recover medical expenses pursuant to § 502(a)(1)(B) of ERISA, 29 U.S.C. § 1132(a)(1)(B), the ERISA civil enforcement mechanism. Tyler alleges that Hocutt violated ERISA by failing to forward his enrollment form accepting medical insurance benefits to Trustmark Insurance Company ("Trustmark"), the company that provided group health insurance benefits under Hocutt's plan. He maintains that this caused him to incur $201,483.17 in medical bills that would otherwise have been covered by Trustmark under the terms of the Hocutt plan. The parties tried the case to the court on April 10 and 11, 2000. The court finds that Tyler is not entitled to prevail on his claim. It sets out its findings of fact and conclusions of law in this memorandum opinion, as permitted by Fed.R.Civ.P. 52(a).
Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001-1461.
The court by January 27, 2000 order dismissed Tyler's state-law claims on the basis of ERISA preemption. See Jan. 27, 2000 Order at 2.
The court assumes that Hocutt is the proper party-defendant under ERISA and that Hocutt's conduct is not entitled to deferential review under an abuse of discretion standard. Hocutt does not assert that it is an improper party to Tyler's ERISA claim and does not argue that the court must review its conduct only for abuse of discretion.
Through Trustmark, Hocutt provided medical insurance to its full-time employees after they completed a 90-day period of probationary employment. Hocutt paid the premiums for this medical insurance. Provided Trustmark received an employee's enrollment form within 31 days after he became eligible for coverage, the employee would be covered under the policy without being required to demonstrate insurability. If the form was not timely received, however, the employee would be deemed a late enrollee and would be required to establish insurability. Trustmark required that a late enrollee complete an evidence of insurability form, and Trustmark's decision concerning approval of coverage depended on what that information and the enrollee's medical history showed. Medical insurance for a Hocutt employee's family members was also available under the Trustmark policy, but the employee was required to pay the premium for this coverage.
Tyler decided during the 31-day period of eligibility to decline the medical insurance. He advised Hocutt orally that he refused coverage. Consequently, Hocutt did not transmit his enrollment form to Trustmark. During 1995, before the date his employment commenced at Hocutt on September 14, 1995, Tyler received medical care at Parkland Memorial Hospital ("Parkland"), the Dallas County public hospital. See PXl. This care included services for severe hypertension, see id. at 000009, 000020, and 000079, and for chronic renal insufficiency, secondary to hypertension, id. at 000018. Tyler received care at the Parkland Renal Clinic dating back to March 2, 1995, id. at 000019 and 000021. The month before Tyler started his employment at Hocutt, Parkland physicians diagnosed him as suffering inter alia from high blood pressure, id. at 000017, and chronic renal failure, id. at 000009. During the relevant 31-day period that followed completion of his probationary status at Hocutt, Tyler did not want the medical insurance that Hocutt provided its employees because he was already receiving care at Parkland and the Trustmark insurance did not include Parkland physicians in its provider guide. Tyler chose not to obtain medical insurance coverage for his family because he did not want to pay the premium that would be required.
Although Tyler emphasizes that coverage was free to Hocutt employees and questions the logic of asserting that he would decline insurance that was provided at no cost, the trial evidence reflects other instances in which, as here, Hocutt employees initially declined medical coverage but later requested it. See PXS 47, 49, 55, 57, 58, and 59.
Tyler did not notify Hocutt that he wanted medical insurance under the Trustmark policy until January 1997. Hocutt sent the enrollment form to Trustmark the same month, together with the form of an employee who had started employment at Hocutt on April 4, 1996 but who did not elect medical insurance coverage until January 3, 1997. See PXS 46 and 47. In January 1997, however, Tyler was a late enrollee. To obtain coverage under the Trustmark policy, he was required to demonstrate insurability. Because of Tyler's medical condition, Trustmark either would not have insured him at all or would have insured him under a policy that included riders that excluded coverage for the medical services that are at issue in this case. Therefore, Tyler's decision to decline medical insurance under the Trustmark policy during the relevant 31-day period that followed completion of his probationary employment precludes him from recovering from Hocutt.
Hocutt is entitled to judgment dismissing Tyler's ERISA claim.