The opinion of the court was delivered by: DAVID N. HURD
Presently before the court are plaintiff's and defendants' motions for summary judgment, regarding claims arising from an alleged violation of the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. §§ 1001-1461. Plaintiff's claim is for restitution and defendants counterclaim for benefits. Opposition to the motions was filed by the parties. Oral argument was heard on June 8, 1995.
In its first cause of action against Roma Inc., plaintiff claims that the company breached its fiduciary duty through false certifications, causing Guardian Life to pay out $ 7,216.07 in benefits, plus interest, for which plaintiff is entitled to restitution.
(Am. Comp. P 29.) In the fifth cause of action against Roma Inc. and the first cause of action against Joan B. Roma, plaintiff claims that Roma Inc. breached its fiduciary duty regarding a proof of death claim for life insurance proceeds and Joan B. Roma received $ 100,910.00 to which she was not entitled. plaintiff seeks restitution from Joan B. Roma or Roma Inc. Id. at 59. In the fourth cause of action against Joan B. Roma, Guardian Life claims that it is entitled to repayment of the $ 100,910.00 in life insurance benefits which it mistakenly paid in reliance on defendants' false certifications. Id. at 82.
Defendants move the court for an order dismissing plaintiff's complaint and awarding judgment on the counterclaim to Joan B. Roma for the payment of further benefits under the Accidental Death and Dismemberment provisions of the Group Policy in the amount of $ 100,000.00.
Guardian Life is a mutual life insurance company incorporated in New York which has established an ERISA regulated group policy known as the "Food and Kindred Products Industry Insurance Trust Fund" for industry employers. The Group Policy provides major medical insurance, term life insurance, and accidental death and dismemberment coverage to employees of participating employers.
On September 17, 1984, Roma Inc. became a participating employer in plaintiff's Group Policy No. G218546 ("Group Policy"). Laurence A. Roma, now deceased, worked for the company in September 1984, and enrolled in the Group Policy.
Although the decedent stopped working for Roma Inc. in March of 1985, the company never notified plaintiff of the decedent's termination and continued to claim him as a full-time active employee. Roma Inc. continued to pay premiums and receive benefits, including medical expenses and basic life insurance, for the decedent under the Group Policy from March 1985 until his death in March of 1993.
From March 1985 until his death, the decedent worked and received wages from various businesses in California, Pennsylvania, and New York. Internal Revenue Service ("IRS") forms of the decedent and testimony of Anthony F. Roma, president of Roma Inc., and Patricia Grassi, office manager for Roma Inc., support the fact that the decedent was not employed by the company after March of 1985. Roma Inc. never submitted to Guardian Life the necessary "Change Reports" for the decedent, which should have reported his change of address and employment status.
Relying on the information supplied by defendant, Guardian Life continued to pay for medical expenses incurred by the decedent following the end of his employment in the amount of $ 7,216.07.
Relying on a proof of death claim form signed by Joan B. Roma as the claimant, plaintiff paid the decedent's life insurance proceeds to her in the amount of $ 100,910.00.
A. Summary Judgment Standard.
Summary judgment must be granted when the pleadings, depositions, answers to interrogatories, admissions and affidavits show that there is no genuine issue as to any material fact, and that the moving party is entitled to summary judgment as a matter of law. Fed. R. Civ. P. 56; Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247, 91 L. Ed. 2d 202, 106 S. Ct. 2505 (1986); Lang v. Retirement Living Pub. Co., 949 F.2d 576, 580 (2d Cir. 1991). The moving party carries the initial burden of demonstrating an absence of a genuine issue of material fact. Fed. R. Civ. P. 56; Celotex Corp. v. Catrett, 477 U.S. 317, 323, 91 L. Ed. 2d 265, 106 S. Ct. 2548 (1986); Thompson v. Gjivoje, 896 F.2d 716, 720 (2d Cir. 1990). Facts, inferences therefrom, and ambiguities must be viewed in a light most favorable to the nonmovant. Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586, 89 L. Ed. 2d 538, 106 S. Ct. 1348 (1986); Project Release v. Prevost, 722 F.2d 960, 968 (2d Cir. 1983).
When the moving party has met the burden, the non-moving party "must do more than simply show that there is some metaphysical doubt as to the material facts." Matsushita Elec. Indus. Co., 475 U.S. at 586. At that point, the non-moving party "must set forth specific facts showing that there is a genuine issue for trial." Fed. R. Civ. P. 56: Liberty Lobby Inc., 477 U.S. at 250; Matsushita Elec. Indus. Co., 475 U.S. at 587. To withstand a summary judgment motion, evidence must exist upon which a reasonable jury could return a verdict for the nonmovant. Liberty Lobby, Inc., 477 U.S. at 248-249; Matsushita Elec. Indus. Co., 475 U.S. at 587. Thus, summary judgment is proper where there is "little or no evidence . . . in support of the non-moving party's case." Gallo v. Prudential Residential Servs., 22 F.3d 1219, 1223-1224 (2d Cir. 1994) (citations omitted).
Plaintiff contends that federal law preempts state law in this case, while defendants argue that state law applies. The statute of limitations provided in New York Law would bar portions of plaintiff's claims for reimbursement of medical insurance benefits. However, under federal law plaintiff's claims would not be time barred.
ERISA provisions "supersede any and all state laws insofar as they may now or hereafter relate to any employee benefit plan" described in the title. 29 U.S.C. § 1144(a). ERISA describes an "employee benefit plan" as "any plan, fund, or program which was heretofore or is hereafter established or maintained by an employer . . . 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 . . . benefits in the event of sickness, accident, disability, death or unemployment." Id. § 1002(1).
The Group Policy created by Guardian Life with Roma Inc. comes under an ERISA regulated group policy known as the "Food and Kindred Products Industry Insurance Trust Fund" for industry employers. The Group Policy clearly represents an "employee benefit plan" because the plan provides major medical insurance, term life insurance, and accidental death and dismemberment coverage ...