Kodes v. Warren Corp., Civil Action No. 97-11441-KPN.
| Decision Date | 11 September 1998 |
| Docket Number | Civil Action No. 97-11441-KPN. |
| Citation | 24 F.Supp.2d 93 |
| Parties | Ann M. KODES and Robert V. Kodes, Plaintiffs, v. WARREN CORPORATION, Liberty Life Assurance Company of Boston and Diane Wing, Defendants. |
| Court | U.S. District Court — District of Massachusetts |
Terrence A. Low, Rosen, Greenhut, Catugno & Low, Springfield, MA, for Plaintiffs.
Kevin D. O'Leary, Cummings & Lockwood, Hartford, CT, Daniel H. Rider, Jr., Longmeadow, MA, for Defendants.
MEMORANDUM WITH REGARD TO DEFENDANT WARREN CORPORATION and DIANE WING'S MOTION TO DISMISS (Docket No. 34), DEFENDANT LIBERTY LIFE ASSURANCE COMPANY'S MOTION FOR SUMMARY JUDGMENT (Docket No. 37) and PLAINTIFFS' MOTION FOR PARTIAL SUMMARY JUDGMENT (Docket No. 39)
Robert V. Kodes ("Kodes") and Ann M. Kodes (together "Plaintiffs") have sued Warren Corporation ("Warren"), Liberty Life Assurance Company of Boston ("Liberty") and Diane Wing ("Wing") (together "Defendants") pursuant to the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001 et seq. Kodes, a former employee of Warren, seeks to obtain payment under the Group Benefits Plan sponsored by Warren and administered by Liberty for medical services rendered to his wife, Ann Kodes.
In a six count complaint, Plaintiffs allege violations of both ERISA and Connecticut law and have filed a motion for summary judgment on three of those counts, Counts IV, V and VI, each of which asserts a state law claim. Plaintiffs have also asked the court to sanction Defendants for their failure to provide certain plan information as required by ERISA. In turn, Liberty has filed a cross motion for summary judgment with respect to all six counts. Similarly, Warren and Wing have filed a motion to dismiss all of Plaintiffs' claims, which motion, with the agreement of all the parties, has been converted to one for summary judgment.
The parties have consented that the matter be heard by the court pursuant to 28 U.S.C. § 636(c) and Fed.R.Civ.P. 73(b). For the following reasons, the court will deny Plaintiffs' motion, allow Liberty's motion and grant Warren and Wing's motion in part.
In accordance with Fed.R.Civ.P. 56(c), summary judgment will be granted if "there is no genuine issue as to any material fact" and "the moving party is entitled to a judgment as a matter of law." Magee v. United States, 121 F.3d 1, 3 (1st Cir.1997). Once the moving party has demonstrated that no genuine issue of material fact exists, the burden is on the opposing party to contradict that demonstration by coming "forward with specific provable facts which establish that there is a triable issue." Aponte Matos v. Toledo Davila, 135 F.3d 182, 186 (1st Cir.1998). A genuine issue is one which a reasonable fact finder could resolve in favor of the non-moving party. Id.
Not every genuine factual conflict, however, necessitates a trial. "It is only when a disputed fact has the potential to change the outcome of the suit under the governing law if found favorably to the non-movant that the materiality hurdle is cleared." Parrilla-Burgos v. Hernandez-Rivera, 108 F.3d 445, 448 (1st Cir.1997) (internal quotations omitted).
The facts are to be viewed in a light most favorable to the non-movant. Dykes v. DePuy, Inc., 140 F.3d 31, 36 (1st Cir.1998). When deciding cross motions for summary judgment, the court must consider each motion separately and draw inferences against each movant in regard to their respective motions. Reich v. John Alden Life Ins. Co., 126 F.3d 1, 6 (1st Cir.1997). See also Blackie v. State of Maine, 75 F.3d 716, 721 (1st Cir.1996). Summary judgment may be granted when there is no dispute as to any material fact and only questions of law remain. See id.
Kodes was an "active full-time employee" at Warren and eligible for coverage under Warren's Group Benefits Plan ("Plan"). The Plan was administered by Liberty. Defendants maintain that, as Plan participants, Plaintiffs received a Summary Plan Description. (Id.)
On April 5, 1989, Kodes sustained a work related injury, after which he was unable return to work on a regular basis. (Kodes Aff. ¶ 2.) Warren's workers' compensation carrier, The Hartford Insurance Group, provided Kodes with weekly disability benefits. (Id. ¶¶ 2 and 3.)
Plaintiffs represent that, after Kodes' injury, they continued to receive medical coverage under the Plan sponsored by Warren and administered by Liberty. Payments were made for medical services rendered to Ann Kodes on July 7, 1993, as well as for prescription drugs through November 15, 1993. Payments were also made for Plaintiffs' daughter's medical treatment on August 1 and September 29, 1993. (Id.)
According to Warren, Plaintiffs were covered by the Plan as long as they continued to make a ten dollar weekly contribution. (Cornish Aff. ¶ 5.) Under the Plan, coverage would expire the last day of the last period during which a participant failed to make the required contribution. (Rec. for Jud. Rev. Exhibit F.) Plaintiff did not contribute to the Plan after August 11, 1990, and was notified "several times" that he was required to make this contribution. (Cornish Aff. ¶ 5.) Nonetheless, Warren continued coverage for Kodes and his dependents until September 30, 1993, at which time Warren claims to have terminated benefits because of non-payment. (Id. ¶ 6.)
At some point, the exact date being unclear, Liberty sent Warren an "ADJUSTMENT INDEX" for the period between October 1 and October 31, 1993, which indicated that Kodes, and in turn his dependents, were terminated as of October 1, 1993. (Rec. for Jud. Rev. Exhibit C.) At about the same time, Warren completed a "TRANSMITTAL FORM," apparently sent "To Paid Prescriptions, Inc.," indicating the same. (Id. Exhibit D.)
In November 1993, Ann Kodes was seen by Dr. Demosthenes Dasco at the Neurosurgical and Neurological Group. Dr. Dasco diagnosed her with a brain tumor and recommended surgery. (Pl. Mem. Opp. Summ Judg. Ann Kodes Aff. ¶ 2.) Surgery was performed at Baystate Medical Center on November 11, 1993. (Id. ¶ 8.) Plaintiffs' version of the events differ significantly from Defendants' from this point forward.
According to Plaintiffs, on or about November 4, 1993, Dr. Dasco's assistant called Liberty and received verbal approval for Ann Kodes' medical treatment. (Id. ¶ 3.) As promised, Dr. Dasco, as well as Plaintiffs, received confirmation telegrams on or about November 9, 1993. (Id. ¶ 4.)
Sometime thereafter, Liberty sent Warren a number of Explanation of Benefits forms which indicated that claims for medical services rendered Ann Kodes between October 25, 1993, and April 8, 1994, were denied. These forms were dated November 18, 1993, through May 11, 1994. (Def. Prop. Rec. (Docket No. 46) Exhibit E.) The transmittal forms stated that "THESE SERVICES WERE INCURRED AFTER TERMINATION OF COVERAGE." (Id.) The forms then explained as follows:
IF YOUR CLAIM IS DENIED, IN WHOLE OR IN PART, YOU HAVE THE RIGHT TO HAVE THE PLAN REVIEW AND RECONSIDER YOUR CLAIM. A WRITTEN APPEAL MUST BE MADE WITHIN 60 DAYS OF THE RECEIPT OR DENIAL, AND SENT TO THE ADDRESS SHOWN ABOVE.
(Id.) Plaintiff did not appeal or otherwise contact Warren. (Cornish Aff. ¶ 8.) The last medical services provided to Ann Kodes which were covered by Warren were rendered on September 13, 1993. (Def. Prop. Rec. Exhibit E.)
In a February 26, 1997 letter, Plaintiffs requested certain Plan information from Liberty. No response was received. In a February 27, 1997 letter, Plaintiffs also requested Plan information from Warren's plan administrator, Diane Wing. (Rec. for Jud. Rev. Exhibit A). Unable to reach Plaintiffs by telephone, Warren faxed them a letter dated April 10, 1997, requesting additional information. (Id. Exhibit B.) Plaintiffs did not respond. (Derby Aff. (Docket No. 36) ¶ 14.) Warren finally sent the requested Plan information for 1992, 1993 and 1994 to Plaintiffs on December 29, 1997, after suit had been commenced.
Plaintiffs seek summary judgment on their state law claims, Count IV, V and VI. Plaintiffs maintain that they are entitled to summary judgment because Defendants failed to comply with the requirements of certain Connecticut statutes governing medical insurance. In response, Warren and Wing (together "Warren") seek summary judgment with respect to those same three counts, asserting that Plaintiffs' claims are preempted by ERISA. Since they are inextricably intertwined, Warren's and Plaintiffs' cross motions for summary judgment will be addressed together.
As a preliminary matter, the court is confronted with Plaintiffs' assertion that Defendants may not even have been providing coverage under an ERISA-governed plan for the time period in question. If true, Plaintiff's assertion would undermine their claims in Count I and III of their complaint that Defendants, in violation of ERISA, failed to notify Plaintiffs of termination of coverage, failed to adequately disclose steps for administrative review, and breached their fiduciary duties. Be that as it may, the court addresses Plaintiffs' assertion that an ERISA-governed plan, and therefore ERISA preemption, may not be in issue.
There is no dispute that, while Kodes was an "active full-time employee" with Warren, he was a "covered employee" within the meaning of Warren's Plan and that the Plan was subject to ERISA. There is also no dispute that, when Kodes was no longer an active full-time employee and was receiving workers' compensation benefits, Warren continued to provide health insurance coverage.
Plaintiffs, however, present...
To continue reading
Request your trial
-
Andrews-Clarke v. Lucent Technologies, Inc.
...that claim denied even though plan administrator failed to issue proper notice of denial of benefits); but see Kodes v. Warren Corp., 24 F.Supp.2d 93, 102-03 (D.Mass.1998) (limitation period on wrongful denial of benefits claim did not begin to run because plaintiff did not receive adequate......
-
Paul Revere Life Insurance Co. v. Payne, CA 942575
...akin to a contract claim looks hopeless"; breach of contract claim against insurer preempted). Accord Wickman, 908 F.2d at 1082; Kodes, 24 F.Supp.2d at 100; Spaulding Reliance Standard Life Ins. Co., 835 F.Supp. 23, 30 (D.Mass. 1993). See also Harris, supra at 147-48 (breach of contract cla......
-
Kieft v. American Exp. Co.
...exhaustion is not required where a claimant has not received a notice of denial or has received inadequate notice. Kodes v. Warren Corp., 24 F.Supp.2d 93, 102 (D.Mass.1998). See also McLean Hosp. Corp. v. Lasher, 819 F.Supp. 110, 123 (D.Mass.1993) (citing DePina v. Gen. Dynamics Corp. 674 F......
-
Nicholson v. Prudential Ins. Co. of Am.
...administrator, even one who makes the initial claim determination, is not a fiduciary" for ERISA purposes. Kodes v. Warren Corp., 24 F.Supp.2d 93, 101 (D.Mass.1998). Prudential cannot reasonably be considered to be other than a third-party administrator with respect to the Staples short-ter......