Opinion
3:96 CV 2083 (JGM)
December 15, 1998
Bruce M. Killion, North Haven, CT, for Mary Ann Ellison, plaintiff.
Karen T. Coatsworth and Timothy F. Woodbridge, Kennedy Woodbridge, Rocky Hill, CT, for Connecticut General Life Insurance Co., defendant.
RULING ON DEFENDANT'S MOTION FOR SUMMARY JUDGMENT
On September 26, 1996, plaintiff Mary Ann Ellison filed a one-count complaint against defendant Connecticut General Life Insurance Co. in the Connecticut Superior Court in Hartford. On October 11, 1996, defendant removed the action to this District Court, pursuant to 28 U.S.C. § 86, 1331, 1441 and 1446. (Dkt. #1). In her complaint, plaintiff alleges that on September 12, 1993, defendant terminated payment of long term disability benefits to plaintiff in violation of Connecticut Unfair Insurance Practices Act ["CUIPA"], CONN. GEN. STAT. § 38a-815et seq.
On November 12, 1998, defendant filed a substituted answer and counterclaim (Dkt. #11), claiming, inter alia, that plaintiffs CUIPA claim is preempted by the Employee Retirement Income Security Act of 1974 ["ERISA"], 29 U.S.C. § 1001 et seq., and that Social Security and Workers' Compensation benefits which plaintiff received rendered her ineligible under defendant's long term disability plan, resulting in overpayment of benefits totaling $8,143.04, which sum defendant claims. (Dkt. #11, Counterclaim ¶¶ 3-4, 7-8, 12).
On February 2, 1998, United States Senior District Judge Peter C. Dorsey referred the case to this Magistrate Judge for trial, upon the consent of the parties. (Dkt. #12). In accordance with deadlines agreed to by counsel (see Dkt. #14), on June 19, 1998, defendant filed its Motion for Summary Judgment on plaintiff's claim and defendant's counterclaim, brief in support, and Local Rule 9(c) Statement of Material Facts Not in Dispute ["Defendant's Statement"]. (Dkts. ##15-17). On July 10, 1998, plaintiff filed her objection, brief in opposition to defendant's motion, and Local Rule 9(c) Statement of Material Facts Not in Dispute. (Dkts. ##18-20).
Attached to defendant's brief (Dkt. #17) were eight exhibits: copy of portions of the Long Term Disability Insurance Plan (Exh. A); copy of medical evaluation of plaintiff (Exh. B); copy of plaintiff's Long Term Disability claim (Exh. C); correspondence between plaintiff and Cigna Ins. Co. (Exhs. D-E); copies of plaintiffs claims forms (Exhs. F-G); and copy of case law (Exh. H).
Attached to plaintiffs brief (Dkt. #19) was a medical report of Dr. Julian Lieb and an additional page of the Long Term Disability Plan.
I. FACTUAL BACKGROUND
The following facts apparently are not in dispute: Plaintiff was an employee of Orion Capital Companies which provided benefits for long term disability pursuant to a plan underwritten by defendant. (Defendant's Statement ¶ 1). The long term disability plan was part of an employee welfare benefit plan as defined by ERISA and conferred upon the administrator discretionary authority to determine plaintiff's eligibility for benefits. (Id. ¶ 2). The plan contained a twenty-four (24) month lifetime limitation on monthly benefits for total disability caused by mental illness while not confined to a hospital. (Id. ¶ 3). The plan also provided for a reduction in monthly benefits if plaintiff received disability payments under Social Security and Workers' Compensation. (Id. ¶ 4). In 1991, the plaintiff received medical treatment for depression and submitted a claim for long term disability benefits. (Id. ¶¶ 5-6). Plaintiff's treatment continued through 1993. (Id. ¶¶ 8-11). Applying the twenty-four month lifetime limitation on monthly benefits for total disability caused by mental illness while not confined to a hospital, defendant stopped payments to plaintiff as of September 12, 1993. (Id. ¶ 12). Plaintiff applied for Social Security benefits which were approved March 13, 1993, retroactive to October 1991. (Id. ¶ 13). Plaintiff also filed a claim under the Workers' Compensation Act. (Id. ¶ 14).II. DISCUSSION
The standard for summary judgment is well established. The moving party is entitled to summary judgment if it demonstrates that there are no genuine issues of material fact and that it is entitled to judgment as a matter of law. FED. R. Civ. P. 56(c).
[T]he plain language of Rule 56(c) mandates the entry of summary judgment, after adequate time for discovery and upon motion, 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. In such a situation, there can be "no genuine issue as to any material fact," since a complete failure of proof concerning an essential element of the nonmoving party's case necessarily renders all other facts immaterial. The moving party is "entitled to a judgment as a matter of law" because the nonmoving party has failed to make a sufficient showing on an essential element of her case with respect to which she has the burden of proof.Celotex Corp. v. Catrett, 477 U.S. 317, 322-323 (1985). "[T]h[e] standard [for granting summary judgment] mirrors the standard for a directed verdict under Federal Rule of Civil Procedure 50(a), which is that the trial judge must direct a verdict if, under governing law, there can be but one reasonable conclusion as to the verdict." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 250 (1985).
Defendant first argues that it is entitled to judgment because plaintiff has failed to state a cause of action on which relief can be granted because there is no recognizable private right of action under CUIPA. (Dkt. #17 at 5-6). Defendant also contends that plaintiff's CUIPA claim is preempted by ERISA. (Id. at 9-10). Defendant further maintains that plaintiffs claim also fails based on the express terms of the long term disability plan at issue. (Id. at 10-11). Finally, defendant argues that it is also entitled to summary judgment on its counterclaim because the plan expressly provides for a reduction in benefits where, as here, the claimant received other benefits. (Id. at 19).
In response, plaintiff counters that she has a viable cause of action under CUIPA because her claim is based upon physical symptoms and that the federal courts do not have exclusive jurisdiction over benefit claims under ERISA. (Dkt. # 19 at 2). Plaintiff does not provide any case law in support of these arguments. Additionally, plaintiff argues that if the claim is preempted by ERISA, the Court should liberally construe her claim and treat it as a viable cause of action. (Id.) Finally, plaintiff argues that the termination of long term disability benefits was arbitrary because her mental illness was caused by biological factors.
Plaintiff alleges that defendant wrongfully terminated payment of long term disability benefits in violation of CUIPA. The threshold issue is whether CUIPA provides a private right of action. Neither the Connecticut Supreme Court nor the Connecticut Appellate Court have yet recognized such a private cause of action. See Napoletano v. Cigna Healthcare of Conn., Inc., 238 Conn. 216, 221, n. 5, 680 A.2d 127 (1996), cert. denied, 117 S.Ct. 1106 (1997); Lees v. Middlesex Ins. Co., 229 Conn. 842, 847 n. 4, 643 A.2d 1282 (1994). Although there is a divergence of opinions, many Connecticut Superior Court cases have held that there is no private right of action under CUIPA. See, e.g., Joseph v. Hannan Agency, Inc., No. 323310, 1997 WL 15424, at *1 n. 2 (Conn.Super. Jan. 9, 1997) ( multiple cases cited therein); Stabile v. Southern Connecticut. Hosp. Sys., Inc., No. 326120, 1996 WL 651633, at *3 n. 6 (Conn.Super. Oct. 31, 1996) (same);Brothers v. American Home Assurance Co., No. 94-0364725-S, 1995 WL 519881, at *2-4 (Conn.Super. Aug. 24, 1995) (same).
It is established in this district that CUIPA does not afford a private right of action. In Peterson v. Provident Life Accident Insurance Co., 3:96 CV 2227 (AHN), 1997 WL 527369 at *2 (D. Conn. July 17, 1997), Senior Judge Alan H. Nevas dismissed plaintiff's CUIPA claim based on Connecticut Superior Court decisions which determined that the Connecticut Legislature did not intend to create a private right of action under CUIPA. Id. Judge Nevas, adopting the reasoning of these decisions, concluded that: "(1) the act is regulatory; (2) the act expressly authorizes the insurance commissioner to investigate alleged unfair insurance practices; (3) the act provides an administrative procedure through which the state insurance commissioner can take action against the person allegedly committing an unfair practice; and (4) the act vests enforcement solely with the commissioner." Id. Judge Nevas also observed that "the conclusion that CUIPA does not provide a private right of action does not leave the plaintiff without recourse for an injury allegedly caused by a CUIPA violation." Id. See also Levine v. Provident Life Accident Insurance Co., 3:96 CV 528 (AHN), 1997 WL 317309 (D. Conn. June 5, 1997) (holding same).
Plaintiff's CUIPA claim also fails because plaintiff must allege more than a single violation in order to prevail on her claim. In Maher v. Northwestern Mut. Life Ins. Co., 3:93 CV 737 (JAC), 1994 WL 91861, at *1 (D. Conn. Feb. 14, 1994), former Chief Judge Jose A. Cabranes, relying, inter alia, on Mead v. Burns, 199 Conn. 651, 659, 664, 509 A.2d 11 (1986), dismissed plaintiff's CUIPA claim because plaintiff had not "sufficiently alleged more than a single act of insurer misconduct." Similarly, in United States Fidelity Guaranty Co. v. Resolution Trust Corp., 5:91 CV 680 (TFGD), 1994 WL 369868, at *2 (D. Conn. March 14, 1994), former Magistrate Judge F. Owen Eagan dismissed the CUIPA claim because there was no allegation that the insurance company had failed to settle similar claims of other claimants. "[A] complainant must allege more than a singular failure to settle a claim fairly." Id. (citation omitted). In the present case, plaintiff has not alleged that defendant committed a pattern of wrongful acts.
ERISA also preempts plaintiff's CUIPA claim. ERISA "is a comprehensive statute designed to promote the interest of employees and their beneficiaries in employee benefit plans. The statute imposes on benefit plans requirements regarding participation, funding and vesting, and sets uniform standards for reporting, disclosure and fiduciary responsibility." Burgio and Campofelice, Inc. v. New York State Dep't of Labor, 107 F.3d 1000, 1007 (2d Cir. 1997) (citation omitted). ERISA defines an employee welfare benefit plan as:
[A]ny 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. . . .29 U.S.C. § 1002 (1). In this case, both parties stipulated that the plan at issue is an ERISA plan within the meaning of the statute. (Defendant's Statement ¶ 2).
ERISA's preemption provision provides that the statute "supersede[s] any and all State laws insofar as they may now or hereafter relate to any employee benefit plan." 29 U.S.C. § 1144 (a). In enacting this provision, Congress sought to ensure uniformity in benefits laws and to minimize the possibility of employers incurring undue administrative and financial burdens in an effort to comply with conflicting state laws governing employee benefit plans. See Plumbing Indus. Bd. v. E.W. Howell Co., Inc., 126 F.3d 61, 66 (2d Cir. 1997). "Claims based on improper processing of claim benefits are preempted by ERISA."Bailey-Gates v. Aetna Life Ins. Co., 890 F. Supp. 73, 77 (D. Conn. 1994) (holding that ERISA preempts CUIPA claim). See also Cody v. Durham Life Ins. Co., 754 F. Supp. 18, 22 (D. Conn. 1991) (Dorsey, J.) (same); Fischman v. Blue Cross Blue Shield of Conn., 755 F. Supp. 528, 531 (D. Conn. 1990) (Dorsey, J.) (same);Altieri v. Cigna Dental Health, Inc., 753 F. Supp. 61, 64 (D. Conn. 1990) (Burns, C.J.) (same); Lazaroff v. Blue Cross Blue Shield of Conn., Inc., Civ. No. H88-519 (TDGD), 1989 WL 235958, at *3 (D. Conn. Jan. 11, 1989) (Daly, J.) (same); Stone v. Blue Cross Blue Shield of Conn., Civ. No. N88-147 (AHN), 1988 WL 146645, at *5 (D. Conn. Nov. 30, 1988) (Latimer, M.J.) (same).
In sum, plaintiff's claim fails because CUIPA does not provide a private right of action, plaintiff must allege more than a one instance of an unfair practice and, finally, ERISA preempts her CUIPA claim.
Defendant also seeks a hearing in damages to determine the amount plaintiff must remit due to overpayment of benefits. As stipulated by the parties, plaintiff's treatment for depression commenced in 1991 and continued through 1993 during which time she received long term disability benefits. (Defendant's Statement ¶¶ 6-11). Applying the plan's limitation on monthly benefits, defendant stopped payments to plaintiff as of September 12, 1993. (Id. ¶ 12). Plaintiff applied for Social Security benefits which were approved March 13, 1993, retroactive to October 1991, and filed a claim under the Workers' Compensation Act. (Id. ¶¶ 13-14). Defendant states that the parties are not in agreement as to the amount of benefits plaintiff received from Social Security and Workers Compensation. (Dkt. #17 at 19). Plaintiff did not file a memorandum in objection to defendant's claim. (Dkt. #18, ¶ 4). Accordingly, the court grants defendant's request for a hearing in damages.
III. CONCLUSION
In conclusion, for the reasons stated above, the defendant's Motion for Summary Judgment (Dkt. #15) is granted.
Counsel shall contact the Magistrate Judge's Chambers to arrange a telephonic status conference, in order to schedule the hearing in damages during January or February 1999.
Dated at New Haven, Connecticut, this 15th day of December, 1998.