Morstein v. National Insurance Svs.

PUBLISH
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
_______________
No. 94-9152
_______________
D. C. Docket No. 1:92-cv-2686-RLV
MARGERY A. MORSTEIN,
Plaintiff-Appellant,
versus
NATIONAL INSURANCE SERVICES, INC.;
PAN AMERICAN LIFE INSURANCE COMPANY;
THE SHAW AGENCY;
SCOTT HANKINS,
Defendants-Appellees.
______________________________
Appeal from the United States District Court
for the Northern District of Georgia
______________________________
(August 19, 1996)
Before TJOFLAT, Chief Judge, and KRAVITCH, HATCHETT, ANDERSON,
EDMONDSON, COX, BIRCH, DUBINA, BLACK, CARNES and BARKETT, Circuit
Judges.
BIRCH, Circuit Judge:
This case was taken en banc to clarify the law in our circuit regarding state law
preemption by the Employee Retirement Income Security Act of 1974 ("ERISA"), 29
U.S.C. §§ 1001-1461 (1985). In this appeal, we must decide whether state law claims
asserted against an independent insurance agent and his agency for fraudulent
inducement to purchase and negligence in processing an application for an ERISA-
governed insurance plan sufficiently relate to an employee benefit plan within the
meaning of section 514(a) of ERISA, 29 U.S.C. § 1144(a), so as to be preempted.
Because we find that the state law claims in this case do not sufficiently relate to the
employee benefit plan to be preempted by ERISA, we reverse the district court's grant
of summary judgment in favor of the insurance agent and his agency.
I. FACTS
Plaintiff-appellant, Margery Morstein, is the president, director, and sole
shareholder of Graphic Promotions, Inc. ("Graphic"). At all times relevant to this appeal,
Morstein was one of two employees of Graphic. In 1991, Morstein met with Scott
Hankins, an insurance broker and employee of the Shaw Agency, for the purpose of
obtaining a replacement policy of major medical insurance for herself and Graphic's
other employee. The policy was to be administered by National Insurance Services,
Inc. ("National") and underwritten by Pan-American Life Insurance Company ("Pan-
American").1 Morstein alleges that during her meeting with Hankins, she advised him
that any policy of major medical insurance that would replace her current policy would
be unacceptable if it excluded from coverage medical treatment related to any
1
Morstein voluntarily dismissed National and Pan-American
before the commencement of this appeal, although they were
defendants in the original action.
2
preexisting medical condition. Morstein asserts that Hankins assured her that the policy
that he proposed would provide the same coverage for preexisting conditions as her
current policy. The policy offered by Hankins was issued to Graphic, and Graphic paid
the initial premium.
Over one year after the policy was issued, Morstein underwent total hip
replacement surgery. When she submitted a claim for payment for this procedure,
National refused payment because it asserted that Morstein's surgery treated a
preexisting condition, which she failed to disclose during the application process.
National then rescinded the policy and refunded to Graphic the premium payments that
were made on behalf of Morstein. Morstein claims that Hankins and the Shaw Agency
fraudulently induced her to purchase a policy of major medical insurance and that she
therefore allowed a separate full-coverage insurance policy to lapse. She further
alleges that Hankins and the Shaw Agency were negligent in processing her application
for insurance and that she has state law claims against them for negligence and fraud.2
Morstein filed an action in state court, alleging negligence, malfeasance,
misrepresentations, and breach of contract. Defendants removed the action to federal
court on the basis that Morstein's claims were governed by ERISA. The district court
denied Morstein's motion to remand and found that defendants were entitled to
summary judgment as to the state law claims against them. The district court
concluded that Morstein's claims "clearly relate to the employee benefit plan
established by Graphic Promotions; therefore, those claims are preempted by ERISA."
R2-29-3. Morstein appealed the district court's grant of summary judgment, and the
2
The Shaw Agency is an independent agency or brokerage that
is authorized to write policies for several insurance companies.
See Hankins Depo. at 11-14. In Georgia, independent insurance
agents are generally considered to be agents of the insured, not
the insurer. European Bakers, Ltd. v. Holman, 338 S.E.2d 702, 704
(Ga. App. 1985), cert. denied (Jan. 17, 1986).
3
original appellate panel in this case reluctantly affirmed the district court's grant of
summary judgment and held that it was bound by our decision in Farlow v. Union Cent.
Life Ins. Co., 874 F.2d 791 (11th Cir. 1989). Morstein v. National Ins. Servs., Inc., 74
F.3d 1135, 1138-39 (11th Cir.), vacated and reh'g en banc granted, 81 F.3d 1031 (11th
Cir. 1996).
The original panel found the facts in this case to be duplicative of the facts in
Farlow.3 Id. at 1137. The panel, therefore, was bound to adhere to the holding of
Farlow that ERISA preempted a designated beneficiary's state law misrepresentation
and negligence claims against an insurance company and its agent.4 Following our
decision in Farlow, several district courts in our circuit, faced with similar state law
claims, have attempted to distinguish their cases from Farlow. See Wiesenberg v. Paul
3
In Farlow, plaintiff was a shareholder, president, and
member of the board of directors of Pace-Plus, Inc. Farlow and his
wife were designated beneficiaries under Pace-Plus's employee
benefit plan. The Farlows alleged that an insurance agent induced
them to purchase a new group health life insurance plan, and that
the insurance agent fraudulently misrepresented that, among other
things, the new policy would provide the same coverage as the
company's old policy. Farlow, 874 F.2d at 792. After switching to
the new policy, Farlow's wife became pregnant. The Farlows then
discovered that, unlike Pace-Plus's old policy, the new policy did
not provide maternity or pregnancy coverage. Id.
4
Our court found the conduct alleged by the Farlows to be
"intertwined" with the refusal to pay benefits:
[T]he conduct alleged in these claims is not only
contemporaneous with [the insurer's] refusal to pay
benefits, but the alleged conduct is intertwined with the
refusal to pay benefits. Finding the Farlows' state law
claims not wholly remote in content from the [insurer's]
plan, we reject the Farlows' contention that simply
because their claims invoke misconduct in the sale and
implementation of the [insurer's] plan, their claims do
not relate to the plan.
Consequently, we hold that ERISA preempts the
Farlows' misrepresentation and negligence claims.
Farlow, 874 F.2d at 794.
4
Revere Life Ins. Co., 887 F. Supp. 1529, 1532-33 (S.D. Fla. 1995) (reasoning that the
decision in Farlow was ambiguous with regard to whether or not its holding applied to
independent insurance agent as well as the insurance company, and turning to law in
other circuits to support its holding that Wiesenberg's state law fraud claims against the
insurance agency and its agent were not preempted by ERISA); Barnet v. Wainman,
830 F. Supp. 610, 611-12 (S.D. Fla. 1993) (finding no preemption of plaintiff's claims
against insurance agent for fraudulent misrepresentation because, unlike Farlow, the
scope of coverage of plaintiff's claim would not be the focus of the litigation); Martin v.
Pate, 749 F. Supp. 242, 246-47 (S.D. Ala. 1990) (finding "the applicability of Farlow to
the facts of this case" to be "questionable" and holding that plaintiff's state law claim of
fraudulent misrepresentation of coverage of policy was not preempted), aff'd sub nom.
Martin v. Continental Investors, 934 F.2d 1265 (11th Cir. 1991) (table).
Our decisions in the ERISA preemption area have been neither consistent nor
clear. Since Farlow was decided, the Supreme Court and several other circuit courts
have issued opinions that clarify the purpose and intent of the ERISA state law
preemption doctrine. Furthermore, the conflict among the district courts in our circuit
demands that we revisit this issue and attempt to provide some clear guidance in the
morass of ERISA preemption law. We find it helpful, therefore, to trace the
development of the preemption doctrine before applying the words of the statute to the
case at bar.
II. ANALYSIS
Morstein alleges that the district court erred in applying the preemption doctrine
under ERISA to bar her state law claims and thus erred in granting summary judgment
in favor of Hankins and the Shaw Agency. We review a grant of summary judgment de
5
novo. Forbus v. Sears Roebuck & Co., 30 F.3d 1402, 1404 (11th Cir. 1994), cert.
denied, __ U.S. __, 115 S. Ct. 906, 130 L. Ed. 2d 788 (1995).
A. ERISA Legislative History
The Supreme Court has described the overall intent of ERISA as follows:
"ERISA is a comprehensive statute designed to promote the interests of employees and
their beneficiaries in employee benefit plans." Shaw v. Delta Air Lines, Inc., 463 U.S.
85, 90, 103 S. Ct. 2890, 2896, 77 L. Ed. 2d 490 (1983); see also Lordmann Enters.,
Inc. v. Equicor, Inc., 32 F.3d 1529, 1533 (11th Cir. 1994), cert. denied, __ U.S. __, 116
S. Ct. 335, 133 L. Ed. 2d 234 (1995). Section 514(a) of ERISA provides that its
provisions "shall supersede any and all State laws insofar as they may now or hereafter
relate to any employee benefit plan described in section 1003(a) of this title and are not
exempt under section 1003(b) of this title." 29 U.S.C. § 1144(a) (1985).5 Unfortunately,
5
Section 1003(a) provides that ERISA applies to all employee
benefit plans established or maintained "by any employer engaged in
commerce or in any industry or activity affecting commerce." 28
U.S.C. § 1003(a) (1985). The exemptions described in section
1003(b) are not applicable in this case. Id. at § 1003(b).
An "employee benefit plan" is defined under ERISA as "an
employee welfare benefit plan or an employee pension benefit plan
or a plan which is both an employee welfare benefit plan and an
employee pension benefit plan." Id. at § 1002(3) (1985).
The medical insurance policies involved in this case qualify
as "employee welfare benefit plans", which, together with the term
"welfare plan," are defined in ERISA section 3(1) as:
any plan, fund, or program which was heretofore or is
hereafter established or maintained by an employer or by
an employee organization, or by both, 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, (A) medical, surgical, or
hospital care or benefits, or benefits in the event of
sickness, accident, disability, death or unemployment, .
. . .
6
the statute does not define the term "relate to," and it has fallen to the courts to deduce
Congress's intent and apply this interpretation to the facts of each case that arises. A
search through the volumes of legislative history of ERISA provides very little
information regarding federal preemption of state law.
The Supreme Court in Shaw relied heavily on the statements of Representative
Dent and Senators Williams and Javits in support of its conclusion that the intent of
Congress was to preempt broadly. Shaw, 463 U.S. at 99-100, 103 S. Ct. at 2901. Both
Representative Dent and Senator Williams emphasized the intent of Congress to
broadly preempt state and local regulation of employee benefit plans. Representative
Dent called the preemption doctrine "the crowning achievement of this legislation," and
promised that it would "eliminat[e] the threat of conflicting and inconsistent State and
local regulation." 120 Cong. Rec. 29,197 (1974). Senator Williams stated that
preemption was "intended to apply in its broadest sense to all actions of State or local
governments, or any instrumentality thereof, which have the force or effect of law." Id.
at 29,933. Only Senator Javits remarked that the final language of the preemption
clause was a product of compromise between the House and Senate versions of the
bill and that further evaluation of preemption policy was necessary.6
Id. at § 1002(1).
6
Senator Javits made the following comments:
Both House and Senate bills provided for preemption
of State law, but--with one major exception appearing in
the House bill--defined the perimeters of preemption in
relation to the areas regulated by the bill. Such a
formulation raised the possibility of endless litigation
over the validity of State action that might impinge on
Federal regulation, as well as opening the door to
multiple and potentially conflicting State laws hastily
contrived to deal with some particular aspect of private
welfare or pension benefit plans not clearly connected to
the Federal regulatory scheme.
Although the desirability of further regulation--at
7
B. Supreme Court Case Law
Because the legislative history is sparse, it has fallen to the courts to interpret the
phrase "relate to" and give it meaning in the context of the facts that arise in each
particular case.7 The Supreme Court noted as early as 1981 that defining boundaries
either the State or Federal level--undoubtedly warrants
further attention, on balance, the emergence of a
comprehensive and pervasive Federal interest and the
interests of uniformity with respect to interstate plans
required--but for certain exceptions--the displacement of
State action in the field of private employee benefit
programs. The conferees--recognizing the dimensions of
such a policy--also agreed to assign the Congressional
Pension Task Force the responsibility of studying and
evaluating preemption in connection with State
authorities and reporting its findings to Congress. If
it is determined that the preemption policy devised has
the effect of precluding essential legislation at either
the State or Federal level, appropriate modifications can
be made.
120 Cong. Rec. 29,942 (1974).
The ERISA Oversight Report of the Pension Task Force of the
Subcommittee on Labor Standards was issued in 1977. Pension Task
Force of Subcomm. on Labor Standards of House Comm. on Educ. and
Labor, ERISA Oversight Report, H.R. Rep. No. 365, 94th Cong., 2d
Sess. (1977). The Task Force concluded that, "[b]ased on our
examination of the effects of section 514, it is our judgment that
the legislative scheme of ERISA is sufficiently broad to leave no
room for effective state regulation within the field preempted.
Similarly it is our finding that the Federal interest and the need
for national uniformity are so great that enforcement of state
regulation should be precluded." Id. at 9.
7
According to Prof. Catherine L. Fisk:
In the twenty-one years since ERISA was enacted, the
Court has rendered decisions with written opinions in
twelve ERISA preemption cases, and has decided a number
of others without opinion. Preemption cases constitute
roughly half of all the ERISA cases the Court has
considered. The relatively large number of ERISA
preemption opinions has not, however, led to clarity in
the law. The lower courts have decided thousands of
preemption cases, yet remain mired in confusion about
8
of the preemption doctrine would not be an easy task. Alessi v. Raybestos-Manhattan,
Inc., 451 U.S. 504, 525, 101 S. Ct. 1895, 1907, 68 L. Ed. 2d 402 (1981). In Alessi,
retired employees challenged a provision in their employer-provided pension plan,
which provided that an employee's retirement benefits are offset by any worker's
compensation awards for which the employee is eligible, as violating a New Jersey
statute that prohibited these offsets. Id. at 507-08, 101 S. Ct. at 1898. The Court
remarked that it "need not determine the outer bounds of ERISA's pre-emptive
language to find this New Jersey provision an impermissible intrusion on the federal
regulatory scheme." Id. at 525, 101 S. Ct. at 1907. The Court noted that, "[o]ther
courts have reached varying conclusions as to the meaning of ERISA's pre-emptive
language in other contexts. . . . We express no views on the merits of any of those
decisions." Id. at n.21 (citations omitted). Nevertheless, the Court indicated that it
leaned towards a broad interpretation: "ERISA makes clear that even indirect state
action bearing on private pensions may encroach upon the area of exclusive federal
basic points. ERISA preemption offers proof that plain
language textualism leads to uncertainty and incoherence
in the law.
Catherine L. Fisk, The Last Article About the Language of ERISA
Preemption? A Case Study of the Failure of Textualism 33 Harv. J.
,
on Legis. 35, 58-59 (1996)(footnotes omitted).
The Supreme Court apparently has not uttered its final word on
the issue of preemption either. The Court recently granted
certiorari in Dillingham Construction N.A., Inc. v. Sonoma County,
57 F.3d 712 (9th Cir. 1995), and requested briefing on the issue of
whether Congress intended, in enacting ERISA, to preempt states'
traditional regulation of wages, apprenticeship, and state-funded
public works construction through a state prevailing wage law that
restricts a contractor's payment of lower apprentice-specific wages
to apprentices who are registered in programs approved as meeting
federal standards. California Div. of Labor Standards Enforcement
v. Dillingham Constr. N.A., Inc., __ U.S. __, 116 S. Ct. 1415, 134
L. Ed. 2d 541 (1996).
9
concern. . . . ERISA's authors clearly meant to preclude the States from avoiding
through form the substance of the pre-emption provision." Id.
The Court next addressed the preemption issue in Shaw v. Delta Air Lines, Inc.,
463 U.S. 85, 103 S. Ct. 2890, 77 L. Ed. 2d 490 (1983). The issue before the Court in
Shaw was whether two New York human rights and disability statutes that prohibited
discrimination on the basis of pregnancy were preempted by ERISA. Id. at 88, 103 S.
Ct. at 2895. The Supreme Court in a prior unrelated case had determined that
discrimination based on pregnancy was not actionable under Title VII of the Civil Rights
Act of 1964. Id.; General Elec. Co. v. Gilbert, 429 U.S. 125, 97 S. Ct. 401, 50 L. Ed.
2d 343 (1976). The Court held that even though ERISA does not contain any
provisions proscribing discrimination in the provision of employee benefits, the New
York laws were "relat[ed] to" employee benefit plans and, therefore, fell under section
514(a). Shaw at 96, 103 S. Ct. at 2899. Citing Black's Law Dictionary in support
thereof, the Court made the following attempt to define "relates to":
A law "relates to" an employee benefit plan, in the normal sense of the
phrase, if it has a connection with or reference to such a plan. Employing
this definition, the Human Rights Law, which prohibits employers from
structuring their employee benefit plans in a manner that discriminates on
the basis of pregnancy, and the Disability Benefits Law, which requires
employers to pay employees specific benefits, clearly "relate to" benefit
plans. We must give effect to this plain language unless there is good
reason to believe Congress intended the language to have some more
restrictive meaning.
In fact, however, 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. It would have been unnecessary to exempt
generally applicable state criminal statutes from preemption in § 514(b),
for example, if § 514(a) applied only to state laws dealing specifically with
ERISA plans.
Id. at 96-98, 103 S. Ct. at 2900 (footnote & citations omitted). Once again, however,
the Supreme Court declined to remark on how broad the preemption language of
ERISA sweeps, except to note that there is some boundary:
10
Some state actions may affect employee benefit plans in too tenuous,
remote, or peripheral a manner to warrant a finding that the law "relates
to" the plan. . . . The present litigation plainly does not present a
borderline question, and we express no views about where it would be
appropriate to draw the line.
Id. at 100 n.21, 103 S. Ct. at 2901 n.21.
The Supreme Court first addressed the issue of whether ERISA preempts state
common law tort and contract claims in Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 107
S. Ct. 1549, 95 L. Ed. 2d 39 (1987). Dedeaux was injured in an employment-related
accident and filed a disability claim with Pilot Life Insurance Company ("Pilot Life"), the
provider of Dedeaux's employer's long term disability employee benefit plan. Id. at 43,
107 S. Ct. at 1551. When Dedeaux's benefits were terminated by Pilot Life, he
instituted a diversity suit against the company alleging tortious breach of contract,
breach of fiduciary duties, and fraud in the inducement. Id. Pilot Life argued that
Dedeaux's state law claims were preempted by ERISA. After discussing the legislative
history of ERISA and emphasizing its broad preemptive intent, the Supreme Court held
that Dedeaux's state law claims were preempted and that the insurance savings clause
did not apply to the claims. The Court did not hesitate in its conclusion that Dedeaux's
common law causes of action, "each based on alleged improper processing of a claim
for benefits under an employee benefit plan, undoubtedly meet the criteria for pre-
emption under § 514(a)." Id. at 48, 107 S. Ct. at 1553.8
8
The sticking-point for the Court came in its determination
of whether the causes of action should be saved under the insurance
savings clause. Pilot Life, 482 U.S. at 48-50, 107 S. Ct. at 1553-
4; 29 U.S.C. § 1144(b)(2)(A). The Court determined that the
savings clause should be interpreted narrowly and that Dedeaux's
claims could not be saved because his common law claims could not
be viewed as laws that "regulate[d] insurance" as they were not
specifically directed toward the insurance industry. Pilot Life,
482 U.S. at 50, 107 S. Ct. at 1554. The Court also looked to the
intent of Congress that the civil enforcement provisions of ERISA
be the exclusive vehicle for actions brought by ERISA plan
participants and beneficiaries, who assert claims for improper
processing of benefits. Id. at 52-54, 107 S. Ct. at 1555-57.
11
In Ingersoll-Rand Co. v. McClendon, 498 U.S. 133, 111 S. Ct. 478, 112 L. Ed.
2d 474 (1990), an employee brought a state law action against his employer alleging
that the employer had wrongfully terminated him in order to avoid contributing to, or
paying benefits under, the employee's pension plan. The Court found that the
employee's claim was preempted under ERISA. Id. at 142, 111 S. Ct. at 484. In
discussing whether the claim "relates to" an employee benefit plan covered by ERISA,
the Court stated that:
[I]n order to prevail, a plaintiff must plead, and the court must find, that an
ERISA plan exists and the employer has a pension-defeating motive in
terminating the employment. Because the court's inquiry must be directed
to the plan, this judicially created cause of action "relate[s] to" an ERISA
plan.
Id. at 140, 111 S. Ct. at 483.
In 1995, the Supreme Court issued its opinion in New York Conference of Blue
Cross & Blue Shield Plans v. Travelers Ins. Co., __ U.S. __, 115 S. Ct. 1671, 131 L. Ed.
2d 695 (1995) (hereinafter "New York Blues"). The issue in New York Blues was
whether ERISA "pre-empts the state provisions for surcharges on bills of patients
whose commercial insurance coverage is purchased by employee health-care plans
governed by ERISA, and for surcharges on [health maintenance organizations (HMOs)]
insofar as their membership fees are paid by an ERISA plan." Id. at __, 115 S. Ct. at
1673-74. The district court in the case had determined that the New York surcharge
law was preempted by ERISA because the surcharges would affect commercial
insurers and HMOs, and, therefore, indirectly affect ERISA plans by increasing plan
costs. Id. at __, 115 S. Ct. at 1675. The Second Circuit affirmed the decision of the
district court and cited Shaw v. Delta Air Lines and Ingersoll-Rand v. McClendon in
support of its finding of broad preemption. See Travelers Ins. Co. v. Cuomo, 14 F.3d
708, 717-19 (2d Cir. 1993), rev'd, __ U.S. __, 115 S. Ct. 1671, 131 L. Ed. 2d 695
(1995).
12
The Supreme Court rejected the conclusions of the Second Circuit and
essentially turned the tide on the expansion of the preemption doctrine:
The governing text of ERISA is clearly expansive. . . . If "relate to" were
taken to extend to the furthest stretch of its indeterminacy, then for all
practical purposes pre-emption would never run its course, for "[r]eally,
universally, relations stop nowhere," H. James, Roderick Hudson xli (New
York ed., World's Classics 1980). But that, of course, would be to read
Congress's words of limitation as a mere sham, and to read the
presumption against pre-emption out of the law whenever Congress
speaks to the matter with generality. That said, we have to recognize that
our prior attempt to construe the phrase "relate to" does not give us much
help drawing the line here.
Id. at __, 115 S. Ct. 1677. The Court next cited the often-quoted language in Shaw that
defined a law "relat[ing] to" an employee benefit plan as one that "'has a connection
with or reference to such a plan.'" Id. at __, 115 S. Ct. 1677 (quoting Shaw, 463 U.S.
at 96-97, 103 S. Ct. at 2900). After acknowledging that the statute in question made
no reference to an employee benefit plan, the Court hinged its analysis on interpreting
the phrase "connection with" from Shaw. The Court then stated:
But this still leaves us to question whether the surcharge laws have a
"connection with" the ERISA plans, and here an uncritical literalism is no
more help than in trying to construe "relate to." For the same reasons that
infinite relations cannot be the measure of pre-emption, neither can infinite
connections. We simply must go beyond the unhelpful text and the
frustrating difficulty of defining its key term, and look instead to the
objectives of the ERISA statute as a guide to the scope of the state law
that Congress understood would survive.
Id. at __, 115 S. Ct. at 1677. The Court went on to reason that a reading of the
preemption provision that is so broad as to displace "all state laws affecting costs and
charges on the theory that they indirectly relate to ERISA plans . . . would effectively
read the limiting language in § 514(a) out of the statute . . . ." Id. at __, 115 S. Ct. at
1679. This conclusion, the Court stated, would contradict the "basic principles of
statutory interpretation" and would go against the Court's prior determination that a
state law is not preempted when the law has too tenuous a connection with the ERISA
plan. Id. at __, 115 S. Ct. at 1679-80. The Court concluded:
13
While Congress's extension of pre-emption to all "state laws relating to
benefit plans" was meant to sweep more broadly than "state laws dealing
with the subject matters covered by ERISA[,] reporting, disclosure,
fiduciary responsibility, and the like," Shaw, 463 U.S., at 98, and n. 19,
103 S. Ct. at 2900, and n. 19, nothing in the language of the Act or the
context of its passage indicates that Congress chose to displace general
health care regulation, which historically has been a matter of local
concern. . . .
Id. at __, 115 S. Ct. at 1679-80 (citations omitted).
C. Application to Morstein's Claims
While the narrow holding in New York Blues, i.e., state laws that govern general
health care regulation and affect ERISA plans only by means of indirect economic
effects are not preempted, is not particularly relevant to the instant case, the broad
guidance that the Court gave in analyzing a state law is helpful. Using the analysis
outlined by the Supreme Court in New York Blues, we look to see whether the state law
claims brought by Morstein have a "connection with" the ERISA plan. To determine
that, we examine whether the claims brought fit within the scope of state law that
Congress understood would survive ERISA.
The Fifth Circuit has found that Congress did not intend for ERISA preemption
to extend to state law tort claims brought against an insurance agent. Perkins v. Time
Ins. Co., 898 F.2d 470, 473 (5th Cir. 1990). Such preemption, reasoned the Fifth
Circuit, would "immunize agents from personal liability for their solicitation of potential
participants in an ERISA plan prior to its formation." Id. We now adopt the rationale
of the Fifth Circuit as stated in Perkins and hold that when a state law claim brought
against a non-ERISA entity does not affect relations among principal ERISA entities as
such, then it is not preempted by ERISA. To the extent that any of our prior opinions
differ from this holding, they should be deemed overruled.9
9
We recognize that the factual circumstance now before us is
not the only one in which a state law claim will not be preempted
14
Morstein is a plan beneficiary who is bringing a suit against the insurance agency
and agent who allegedly fraudulently induced her to change benefit plans. The
insurance agent and agency are not ERISA entities. ERISA entities are the employer,
the plan, the plan fiduciaries, and the beneficiaries under the plan. See Travitz v.
Northeast Dept. ILGWU Health & Welfare Fund, 13 F.3d 704, 709 (3d Cir.), cert.
denied, __ U.S. __, 114 S. Ct. 2165, 128 L. Ed. 2d 888 (1994); Sommers Drug Stores
v. Corrigan Enters., Inc., 793 F.2d 1456, 1467 (5th Cir. 1986), cert. denied, 479 U.S.
1034, 107 S. Ct. 884, 93 L. Ed. 2d 837 (1987). Hankins and the Shaw Agency had no
control over the payment of benefits or a determination of Morstein's rights under the
plan.10
In Variety Children's Hosp., Inc. v. Century Medical Health Plan, Inc., 57 F.3d
1040 (11th Cir. 1995), we held that state law fraud claims can be intertwined with
benefit plans "where state law claims of fraud and misrepresentation are based upon
the failure of a covered plan to pay benefits, the state law claims have a nexus with the
ERISA plan and its benefits system." Id. at 1042. In Variety, the action was brought
by a hospital, via an assignment of the claims of the parents of the beneficiary, against
the plan itself and alleged that the plan had engaged in fraud and misrepresentation by
allegedly denying coverage of an experimental bone marrow transplant performed at
the hospital. Id. These claims involved ERISA entities, the beneficiary (before
by ERISA.
10
Our conclusion contradicts the reasoning offered by this
court in Belasco v. W.K.P. Wilson & Sons, Inc., 833 F.2d 277 (11th
Cir. 1987). There we reasoned that because the preemption doctrine
extended to claims brought by an employee against an employer, it
must extend to claims against insurance agents as well. "This
indicates that the 'broad common-sense meaning' of the term 'relate
to,' . . . is quite broad indeed." Id. at 281 (citation omitted).
Subsequent cases have made clear, however, that employers, unlike
independent insurance agents, are ERISA entities and thus much more
closely "related to" the plan.
15
assignment), and the plan, and the state law claims were based on an interpretation of
the plan's terms. When a state law claim involves the reliance on an insurer's promise
that a particular treatment is fully covered under a policy, however, a claim of
promissory estoppel is not "related to" the benefits plan. See Variety at 1043 & n.5.11
Although the remedy sought may affect the plan in that Morstein's damages
(should she successfully prevail on her claims) against Hankins and/or the Shaw
Agency may be measured based on what she would have received under her old plan,
such indirect relation between a beneficiary and the plan is not enough for preemption.
Forbus, 30 F.3d at 1406-7 (noting that "the mere fact that the plaintiffs' damages may
be affected by a calculation of pension benefits is not sufficient to warrant preemption");
see also Smith v. Texas Children's Hosp., 84 F.3d 152, 155 (5th Cir. 1996). The
Supreme Court in New York Blues made it clear that economic impact alone is not
necessarily enough to preempt a state law. New York Blues, __ U.S. at __, 115 S. Ct.
at 1683. Therefore, the possibility that insurance premiums will be higher or that
insurance will be more difficult to obtain because independent agents will have less
incentive to sell insurance to employers whose employee benefit plans will be governed
by ERISA, does not provide a reason to preempt state laws that place liability on agents
for fraud. These same agents currently face the threat of state tort claims if they make
fraudulent misrepresentations to individuals and entities not governed by ERISA. To
hold these agents accountable in the same way when making representations about
an ERISA plan merely levels the playing field.
11
This type of claim can be contrasted with an action brought
by a beneficiary against an insurance company regarding the scope
of the coverage of the plan. The claim brought by Morstein against
Pan-American and National was of the latter type and would be
preempted, but Morstein's claims against Pan-American and National
are not at issue on appeal.
16
Allowing preemption of a fraud claim against an individual insurance agent will
not serve Congress's purpose for ERISA. As discussed above, Congress enacted
ERISA to protect the interests of employees and other beneficiaries of employee benefit
plans. See Shaw, 463 U.S. at 90, 103 S. Ct. at 2896. To immunize insurance agents
from personal liability for fraudulent misrepresentation regarding ERISA plans would not
promote this objective. If ERISA preempts a beneficiary's potential cause of action for
misrepresentation, employees, beneficiaries, and employers choosing among various
plans will no longer be able to rely on the representations of the insurance agent
regarding the terms of the plan. These employees, whom Congress sought to protect,
will find themselves unable to make informed choices regarding available benefit plans
where state law places the duty on agents to deal honestly with applicants.
III. CONCLUSION
Morstein challenges the district court's conclusion that her state law claims
against an independent insurance agent and his agency for fraudulent inducement to
purchase and negligence in processing her application for an ERISA-governed
insurance plan are preempted by section 514(a) of ERISA. We conclude that these
claims do not fall within ERISA's broad preemptive scope, as they do not have a
sufficient connection with the plan to "relate to" the plan. Accordingly, the district court's
grant of summary judgment in favor of Hankins and the Shaw Agency is REVERSED.
17