Potter v. Blue Shield of Northeastern New York, a Div. of Blue Shield of Western New York Inc.

• Decision Date: 22 June 1995
• Citation: 216 A.D.2d 773,629 N.Y.S.2d 93
• Parties: Judith POTTER, Respondent, v. BLUE SHIELD OF NORTHEASTERN NEW YORK, A DIVISION of BLUE SHIELD of WESTERN NEW YORK INC., Appellant.
• Court: New York Supreme Court — Appellate Division

Page 93

629 N.Y.S.2d 93

216 A.D.2d 773

Judith POTTER, Respondent, v. BLUE SHIELD OF NORTHEASTERN NEW YORK, A DIVISION of BLUE

SHIELD of WESTERN NEW YORK INC., Appellant.

Supreme Court, Appellate Division,

Third Department.

June 22, 1995.

Hinman, Straub, Pigors & Manning P.C. (Beverly Cohen, of counsel), Albany, for appellant.

Du Charme & Catalano (John B. Du Charme, of counsel), Albany, for respondent.

Before CARDONA, P.J., and WHITE, CASEY, PETERS and SPAIN, JJ.

CARDONA, Presiding Justice.

Appeal from an order of the Supreme Court (Canfield, J.), entered June 15, 1994 in Albany County, which denied defendant's motion for partial summary judgment dismissing the third cause of action of the amended complaint.

In February 1990, plaintiff commenced employment with Asterino & Associates Inc. and, on March 1, 1990, enrolled in her employer's group health plan provided by defendant. Beginning in the summer of 1990, plaintiff underwent treatment, including surgery, to alleviate pain from varicose veins. In November 1990, upon review of plaintiff's claims for medical services, defendant concluded that plaintiff's condition was preexisting and, therefore, not covered under the terms of defendant's group health insurance plan.

Plaintiff commenced this breach of contract action seeking to recover $4,117.80 in medical costs. Plaintiff also sought to recover damages in the amount of $100,000, stemming from her claim that she suffered mental anguish, embarrassment, emotional stress and injury to her credit as a result of defendant's breach of its contract.

Defendant answered and, in a counterclaim, sought reimbursement of $2,285 in medical insurance benefits which it claimed to have improperly paid in relation to plaintiff's medical condition. Defendant moved for summary judgment seeking dismissal of the third cause of action of plaintiff's amended complaint, which alleged the extracontractual damages, for failure to state a cause of action. Supreme Court denied the motion. Defendant appeals.

Defendant contends that plaintiff's extracontractual claims are foreclosed by the Federal Employee Retirement Income Security Act of 1974 (see, 29 U.S.C. § 1001 et seq.) (hereinafter ERISA). We agree. The United States Supreme Court has stated that "ERISA comprehensively regulates, among other things, employee welfare benefit plans that, 'through the purchase of insurance or otherwise,' provide medical, surgical, or hospital care, or benefits in the event of sickness, accident, disability, or death" (Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 44, 107 S.Ct. 1549, 1551, 95 L.Ed.2d 39, quoting 29 U.S.C. § 1002[1]. A State law cause of action which seeks a remedy for the violation of rights expressly guaranteed by ERISA is subject to preemption under the statute's broad preemption provision (see, 29 U.S.C. § 1144[a]; Matter of Morgan Guar. Trust Co. of N.Y. v. Tax Appeals Tribunal of N.Y. State Dept. of Taxation & Fin., 80 N.Y.2d 44, 48, 587 N.Y.S.2d 252, 599 N.E.2d 656).

Under ERISA, when plan participants or beneficiaries, like plaintiff, assert the improper processing of a claim for benefits, they are specifically empowered to bring a civil action "to recover benefits due [them] under the terms of [their] plan, to enforce [their] rights under the terms of the plan, or to clarify [their] rights to future benefits under the terms of the plan" (29 U.S.C. § 1132[a][1][B]. Because Congress intended the civil enforcement provisions of ERISA to be plaintiff's exclusive remedies for a violation of her rights under the statute (see, Pilot Life Ins. Co. v. Dedeaux, supra, at 54, 107 S.Ct. at 1556), her cause of action for noncontractual damages, an unauthorized remedy, is not available (see, Massachusetts Mut. Life Ins. Co. v. Russell, 473 U.S. 134, 146-148, 105 S.Ct....