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).
B. ERISA Preemption.
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 to employees of participating employers. Therefore, this case is governed by federal ERISA law.
Section 514(a) of ERISA broadly preempts state law causes of action that "relate to" an ERISA-regulated plan. See, e.g., Shaw v. Delta Airlines, Inc., 463 U.S. 85, 98, 77 L. Ed. 2d 490, 103 S. Ct. 2890 (1983). One factor pointing in favor of preemption is the "expectation that a federal common law of rights and obligations under ERISA-regulated plans would develop." Diduck v. Kaszycki & Sons Contractors, Inc., 974 F.2d 270, 280-281 (2d Cir. 1992) (citing Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 56, 95 L. Ed. 2d 39, 107 S. Ct. 1549 (1987)).
Defendants argue, citing Bader v. Purdom, that New York state law should apply because New York is the forum state. 841 F.2d 38 (2d Cir. 1988). In Bader, New York residents brought an action against residents of Ontario, Canada, for injuries received by their child when she was bitten by a dog during a visit to Canada. Id. A thorough reading of Bader reveals that it has little in common with the case currently before the court. Bader involves a choice of law between countries regarding where the injury took place. Further, Bader does not involve a New York law overriding a federal statute of preemption.
According to the court in Diduck, the ERISA statute broadly preempts State law causes of action that "relate to an ERISA regulated plan." 974 F.2d at 280. Testimony of Anthony F. Roma verifies the fact that the Group Policy was implemented as an "employee benefit plan" within the purpose of ERISA. (Anthony F. Roma Dep. at 4.) Federal law preempts New York State law because the plaintiff's claim relates to a federally regulated benefit plan. See Diduck, 974 F.2d at 280.
The statute of limitations provided under ERISA allows for six years after the date of discovery of such breach or violation before a claim is barred. 29 U.S.C. § 1113. Because ERISA preempts state law, it follows that none of the claims for which summary judgment is sought are time-barred.
C. Breach of Fiduciary Duties and Restitution.
Guardian Life claims Roma Inc. breached its fiduciary duties by providing false information on medical and life insurance claim forms. This breach caused plaintiff to make payments on behalf of the decedent for $ 7,216.07 in medical expenses
and $ 100,910.00 in life insurance proceeds. Guardian Life requests an order granting restitution from Roma Inc. or Joan B. Roma.
Under ERISA, in addition to persons named as fiduciaries by a benefit plan, anyone who exercises discretionary control or authority over the plan's management, administration, or assets is an ERISA "fiduciary." 29 U.S.C. § 1002(21)(A). Fiduciaries are assigned a number of detailed duties and responsibilities which include, "the proper management, administration and investment of [plan] assets, the maintenance of proper records, the disclosure of proper information, and the avoidance of conflict of interest." Mertens v. Hewitt Assocs., U.S. , 113 S. Ct. 2063, 2067, 124 L. Ed. 2d 161 (1993) (citing Massachusetts Mut. Life Ins. Co. v. Russell, 473 U.S. 134, 142-143, 87 L. Ed. 2d 96, 105 S. Ct. 3085 (1985)); see 29 U.S.C. § 1104(a)). Fiduciaries must discharge their duties "with the care, skill, prudence and diligence under the circumstances then prevailing that a prudent man acting in a like capacity and familiar with such matters would use in the conduct of an enterprise of a like character and with like aims." 29 U.S.C. § 1104(a)(1)(B).
If a fiduciary fails to fulfill the requirements of its duties, specific remedies are available against it. 29 U.S.C. § 1109(a). The fiduciary is liable for:
Damages (to make good to [the] plan any losses to the plan resulting from each such breach), for restitution (to restore to [the] plan any profits of such fiduciary which have been made through use of assets of the plan by the fiduciary) and for such other equitable or remedial relief as the court may deem appropriate.