Opinions and documents
UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF MISSISSIPPI
ABERDEEN DIVISION
JAMES “JIMMY” EMMETT EDWARDS PLAINTIFF
V. CIVIL ACTION NO. 1:22-CV-145-KHJ-MTP
GUARDIAN LIFE INSURANCE OF AMERICA DEFENDANT
ORDER
Before the Court is Defendant Guardian Life Insurance of America’s
(“Guardian”) [12] Motion for Partial Summary Judgment and [23] Motion to Strike;
and Plaintiff James “Jimmy” Emmett Edwards’s (“Mr. Edwards”) [29] Motion for
Leave to File Surrebuttal Brief and [30] Motion to Take Depositions. For the
following reasons, the Court grants Guardian’s Motion for Partial Summary
Judgment, grants in part and denies in part its Motion to Strike, and denies Mr.
Edwards’s motions.
I. Background
This case arises from Guardian canceling decedent Pam Edwards’s life
insurance policy. Compl. [1] ¶¶ 4, 13. Until her death, Mrs. Edwards owned and
operated Allure Salon in Starkville, Mississippi. Edwards Aff. [17-1] at 1. Mrs.
Edwards worked with other beauty technicians, but the parties dispute whether
they were employees or independent contractors. , [13] at 1; [18] at 3.
In December 2007, Mrs. Edwards bought a life insurance policy from
Attorney Debbie Jaudon. Jaudon Aff. [17-2] at 1. Her application for insurance
listed the plan-holder as Allure Salon and represented that she had four full-time
employees intended to be insured. [12-1] at 5. When Guardian notified her that
it had approved coverage, it said “Allure Salon . . . has been approved with the
effective date of [December 15, 2007].” [12-2] at 6. Allure then paid all monthly
premiums and maintained the insurance plan until Guardian terminated the
coverage. Wiltrout Aff. [12-1] ¶ 9.
Mrs. Edwards was diagnosed with cancer in 2019, and her physical and
mental condition declined until her death in 2022. [17-1] at 2–3. During that
time, Guardian sent two letters to Allure with Mrs. Edwards’s name on the address.
[1-1]; [1-2]. The first was a pre-notification letter dated October 28, 2021,
notifying her that Guardian had to cancel her coverage effective January 1, 2022,
because “[her] company ha[d] fallen below the required participation level.” [1-1].
The second letter notified her that Guardian canceled the coverage effective
January 15, 2022. [1-2].
When Mrs. Edwards died, Jaudon told Mr. Edwards that his wife had an
$85,000.00 insurance policy. at 2. Mr. Edwards had never heard about the life
insurance policy, and he could not find documentation of it after Mrs. Edwards’s
death. [17-1] at 2–3. When Jaudon contacted Guardian to make a claim,
Guardian told Jaudon it had canceled the policy. [17-2] at 2. She then told Mr.
Edwards that Guardian was claiming the policy had been canceled, but she did not
2
believe them because she never received a copy of the notice of cancelation.
Jaudon further claims she did not receive the two letters from Guardian until after
Mrs. Edwards’s death. [17-1] at 3; [17-2] at 2.
Mr. Edwards filed this action on October 4, 2022, alleging Guardian did not
give sufficient notice of cancellation and acted in bad faith by not disclosing the
reasons for the canceled policy until after Mrs. Edwards’s death. [1] ¶ 9. He
seeks $85,000.00 based on the “face amount of the coverage,” punitive damages, and
attorneys’ fees and costs. at 4. Guardian moves for partial summary judgment on
the issue of whether the Employee Retirement Income Security Act of 1974
(“ERISA”), 29 U.S.C. § 1001, governs this action and preempts any state-law claims.
[13] at 1. It argues ERISA does apply, and the only claim that should move forward
is Mr. Edwards’s claim for benefits under ERISA, 28 U.S.C. § 1132(a)(1). ; [1] ¶
12.
Mr. Edwards attached two affidavits with his Response: Jaudon’s and his
own. [17-1]; [17-2]. Guardian moves to strike certain portions of those affidavits
for lack of personal knowledge, speculation, or hearsay. [24] at 2–5. Because Mr.
Edwards’s argument partially relies on that evidence, the Court considers the
Motion to Strike before the Motion for Partial Summary Judgment.
II. Motion to Strike
A. Standard
“An affidavit or declaration used to support or oppose a motion [for summary
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judgment] must be made on personal knowledge, set out facts that would be
admissible in evidence, and show that the affiant or declarant is competent to
testify on the matters stated.” Fed. R. Civ. P. 56(c)(4). The same rules governing
admissibility of evidence at trial apply to summary judgment.
, 555 F.3d 383, 387–88 (5th Cir. 2009) (citation omitted). A
“party objecting to the admission of [an] affidavit . . . bears the burden of proving
the preliminary facts required to show its inadmissibility.”
, No. 13-6608, 2016 WL 81716, at *3 (E.D. La. Jan. 7, 2016) (citing
, 608 F.3d 284, 295 (5th Cir. 2010)). The Court
has broad discretion in its admissibility determinations. , 555 F.3d at 387
(citation omitted).
B. Analysis
1. Jaudon Affidavit
Guardian first argues the Court should exclude two of Jaudon’s statements
because they show her lack of personal knowledge on the facts asserted in the
statements:
• “I do not know whether [the salon technicians] were
employees or . . . independent contractors operating their
own business.” [17-2] at 1.
• “I do not know whether Guardian ever sent [Mrs.
Edwards] a copy of the policy or any other documents.”
at 2.
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[24] at 2, 3. Edwards does not respond to Guardian’s objection to the first
statement, and neither party offers any authority on whether an affiant can say
they “do not know” whether a fact is true. Instead, Guardian only says in passing
that Jaudon admits her lack of personal knowledge about the two statements.
Because Guardian does not meet its burden of proving those statements’
inadmissibility, the Court denies its Motion to Strike as to those statements.
Guardian next seeks to strike three statements as either hearsay or “negative
hearsay”:
• “I remember Pam Edwards telling me that she wanted to
be sure that she had something to leave her husband,
Jimmy Edwards, and that she wanted to have life
insurance on her daughter . . . .” [17-2] at 1.
• “I never told Pam Edwards that she was a ‘plan
administrator,’ [or] . . . that she had any duties to perform
as a plan administrator.”
• “I told [Edwards] that [Mrs. Edwards] had insurance.”
at 2.
[24] at 2–4. Edwards argues the first statement constitutes Jaudon’s
then-existing state of mind which excludes it from the definition of hearsay. [28] at
2 (citing Fed. R. Evid. 803(3)). To the second and third objections, Edwards argues
“[w]hat Jaudon did not tell Pam Edwards is not a statement at all.” at 2–3
(emphasis omitted).
For the first statement, Edwards’s state-of-mind argument fails. Rule 803(3)
specifically does “not includ[e] a statement of or belief to prove the fact
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or believed unless it relates to the validity or terms of the declarant’s
will.” Fed. R. Evid. 803(3) (emphasis added). Jaudon’s statement that she
remembered what Mrs. Edwards told her about the life insurance policy is one of
memory, and it does not concern the validity of a will. [17-2] at 1. Guardian is
correct that the statement is hearsay, and the Court grants the Motion to Strike as
to that statement.
The second and third statements’ admissibility turns on whether Guardian’s
negative-hearsay theory is valid. Guardian offers no federal authority on that
theory and instead relies on two state supreme court cases. [24] at 3 (citing
, 262 S.E.2d 27, 27 (S.C. 1980); , 362
P.2d 855, 858 (Mont. 1961)). Neither are binding on this Court, and both fail to
support Guardian’s argument legally and factually. First, relied on other
states’ authority, 262 S.E.2d at 27–28, and cited none, 362 P.2d
at 858. Second, both cases involved testimony to whether someone other than the
witness made a statement. , 262 S.E.2d at 27–28 (holding plaintiff’s
friend could not testify that “he had never heard [the plaintiff] complain of any
injury prior to subject collision in personal-injury action); , 362 P.2d at
855–58 (holding plaintiff could not testify to what decedent did not say).
Here, Jaudon’s statements are concern what she herself did not say.
Specifically, Jaudon said she did not tell Mrs. Edwards that she was a plan
administrator or tell Mr. Edwards that Mrs. Edwards had life insurance. The Court
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is unaware of any “negative hearsay” theory that precludes such testimony, and
Guardian fails to meet its burden of proving those statements are inadmissible. The
Court denies Guardian’s Motion to Strike with respect to those statements.
Finally, Guardian moves to strike two statements as speculative:
• “I do not believe any insurance company would have sold
[Mrs. Edwards] a policy after her serious cancer diagnosis
. . . .” [17-2] at 2.
• “I do not believe [Mrs.] Edwards received notice” of
cancellation.
Guardian is correct that Edwards cannot rely on those statements. “[F]acts
alleged on ‘understanding,’ like those based on ‘belief’ or on ‘information and belief,’
are not sufficient to create a genuine issue of fact.” ,
223 F. App’x 369, 375 (5th Cir. 2007) (per curiam) (quoting
, 573 F.3d 1370, 1377 (9th Cir. 1978)) (affirming district court’s exclusion
of affiant’s statement that his “understanding” was that two individuals were
co-supervisors). Because Jaudon’s statements about her “belief” cannot create a fact
question, the Court grants Guardian’s Motion to Strike those statements.
2. Edwards Affidavit
Next, Guardian argues the Court should exclude Mr. Edwards’s “conclusory
statement that Mrs. Edwards had no employees and that her workers were
independent contractors.” [24] at 4. Specifically, Guardian argues the following
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language shows his lack of personal knowledge as to whether Allure’s technicians
were independent contractors:
“. . . I never looked at the bank statements at all.
[Mrs.] Edwards dealt exclusively with the bank account. I
never knew what money was going into or out of the bank
account, other than [Mrs.] Edwards was paying the
contractors from the bank account . . . I never knew that
she had purchased any life insurance policy.”
[17-1] at 2. The Court declines to strike those statements for reasons similar to why
it declined to exclude Jaudon’s statements for lack of personal knowledge. Because
Guardian cites no authority on whether an affiant can testify to what they do not
know, it fails to meet its burden of proving the inadmissibility of those statements.
Guardian also argues the following language constitutes hearsay:
“Jaudon . . . informed me after [Mrs.] Edwards’s death
that she had a life insurance policy . . . of $85,000. At a
later date, Debbie Jaudon informed me that the insurance
company was claiming that the policy had been cancelled.
Debbie Jaudon informed me, however, that she did not
believe it had been cancelled, because she . . . did not
receive any copy of any notice of cancellation . . . Debbie
Jaudon [also] informed me that she received [the letters
notifying Mrs. Edwards of her policy cancellation] only
after the death of [Mrs.] Edwards.”
[17-1] at 2–3. None of those statements concern whether the Guardian-issued life
insurance policy falls under ERISA—specifically here, whether Mrs. Edwards had
employees or independent contractors. In other words, Mr. Edwards did not offer
those statements to prove any facts relevant to Guardian’s Motion for Partial
Summary Judgment. Even if the statements did constitute hearsay, the Court did
8
not consider those statements in its summary-judgment analysis. For those reasons,
the Court declines to strike those statements for purposes of Guardian’s Motion for
Partial Summary Judgment.
C. Conclusion
The Court grants in part and denies in part Guardian’s [23] Motion to Strike.
The Court strikes from the record those statements about Jaudon’s beliefs and
memory, and it will not consider them for purposes of Guardian’s [12] Motion for
Partial Summary Judgment. The Court denies the Motion to Strike as to the
remaining objections, including Jaudon’s lack of personal knowledge, negative
hearsay, and all objections to Mr. Edwards’s Affidavit. With that in mind, the Court
turns to Guardian’s Motion for Partial Summary Judgment.
III. Motion for Partial Summary Judgment
A. Standard
Summary judgment is appropriate if the movant shows “no genuine dispute
as to any material fact” exists, and the movant is entitled to judgment as a matter
of law. Fed. R. Civ. P. 56(a). “A fact is ‘material’ if, under the applicable substantive
law, ‘its resolution could affect the outcome of the action.’” ,
941 F.3d 743, 747 (5th Cir. 2019) (quoting
, 627 F.3d 134, 138 (5th Cir. 2010)). A dispute is “genuine” if the
evidence demonstrates that a “reasonable [factfinder] could return a verdict for the
nonmoving party.’” , 936 F.3d 318, 321 (5th Cir. 2019)
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(quoting , 477 U.S. 242, 248 (1986)). The Court
views all facts, evidence, and reasonable inferences in the non-movant’s favor.
, 550 U.S. 372, 378 (2007).
If the non-movant bears the burden of proof at trial, the movant need only
demonstrate the record lacks evidentiary support for the non-movant’s claim.
, 615 F.3d 350, 355 (5th Cir. 2010). The movant must “cit[e] to
particular parts of materials in the record” or “show[] that the materials cited do not
establish the absence or presence of a genuine dispute, or that [the] adverse party
cannot produce admissible evidence to support the fact.” Fed. R. Civ. P. 56(c)(1). The
moving party need not “present evidence proving the absence of a material fact
issue . . . [but] may meet its burden by simply pointing to an absence of evidence to
support the nonmoving party’s case.” , 402 F.3d 536,
544 (5th Cir. 2005) (citation omitted). But “unsubstantiated assertions are not
competent summary judgment evidence.” , 136 F.3d
455, 458 (5th Cir. 1998).
If the movant meets its burden, “the burden shifts to the non-movant to
produce evidence of the existence of such an issue for trial.” , 615 F.3d at 355
(quotation omitted). The non-movant must present more than “speculation,
improbable inferences, or unsubstantiated assertions.” , 936 F.3d at 321
(citation omitted). The nonmovant’s failure “to offer proof concerning an essential
element of its case necessarily renders all other facts immaterial and mandates a
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finding that no genuine issue of fact exists.”
, 465 F.3d 156, 164 (5th Cir. 2006) (citation omitted). Notably, “Rule 56 does
not impose upon the district court a duty to sift through the record in search of
evidence to support a party’s opposition to summary judgment.” , 136 F.3d at
458.
B. Analysis
Guardian argues Mrs. Edwards’s life insurance policy is an employee-benefit
plan subject to ERISA, and ERISA preempts Edwards’s state-law breach-of-contract
claim. [13] at 3–10. Edwards argues fact questions exist as to whether the plan
benefitted “employees.” [18] at 3.1
ERISA applies to “any employee[-]benefit plan if it is established or
maintained by any employer engaged in commerce or in any industry or activity
affecting commerce . . . .” 29 U.S.C. § 1003(a)(1). If ERISA applies, it “preempts
state laws insofar as they . . . relate to any employee[-]benefit plan,” unless an
exception applies. , 394 F.3d 262, 275 (5th Cir.
1 Edwards also argues a fact question exists as to whether Mrs. Edwards received
the cancellation notice. [18] at 3. But receipt of a cancellation notice is irrelevant to
whether an employee-benefit plan exists. , 499 F.3d
443, 448 (5th Cir. 2007) (recognizing the “establishment or maintenance [of a plan] by an
employer intending to benefit employees” as the “primary elements of an ERISA employee
benefit plan . . . .”). If an employee-benefit plan exists, allegations about lack of a
cancellation notice relate to benefit administration, and ERISA preempts such claims.
, , 439 F.3d 767, 771–72 (8th Cir. 2006) (holding ERISA
preempted state-law fraud action based on insurer’s alleged mishandling of benefit claim
because action related to benefit administration). If no employee-benefit plan exists, then
ERISA does not preempt such claims.
11
2004) (quotation omitted). To determine whether an insurance policy is an
employee-benefit plan, the Fifth Circuit asks whether a plan: “(1) exists; (2) falls
within the safe-harbor provision established by the Department of Labor; and (3)
satisfies the primary elements of an ERISA employee[-]benefit plan—establishment
or maintenance by an employer intending to benefit employees.”
, 499 F.3d 443, 448 (5th Cir. 2007) (citing
, 980 F.2d 352, 355 (5th Cir. 1993)). The Court addresses each element in turn.
1. Existence
Whether a plan exists turns on “whether . . . a reasonable person could
ascertain the intended benefits, beneficiaries, source of financing, and procedures
for receiving benefits.” , 2:17-CV-214,
2018 WL 3015253, at *2 (S.D. Miss. June 15, 2018) (quoting , 980 F.2d at
355). That is generally a question of fact. , 499 F.3d at 448 (citation omitted).
But “where the factual circumstances are established as a matter of law or
undisputed, [the Fifth Circuit] has treated the question as one of law . . . .” For
example, in , the parties did not dispute that “an intentional benefit plan
existed at the firm.” at 449. In those cases, courts generally move straight to the
safe-harbor-provision element.
Edwards makes two existence arguments: (1) Allure did not have “employees”
other than Mrs. Edwards because Allure’s technicians were independent
contractors, and (2) the life insurance policy itself cannot be an ERISA plan.
12
[18] at 5–6, 12. The Court addresses each argument in turn.
a. Employees v. Independent Contractors
Edwards relies on
, 541 U.S. 1 (2004), for the principle that an employee-benefit plan cannot
exist if an employer does not have employees other than the owner. In ,
whether the employer had at least one employee other than the owner was a
condition of whether the owner could participate in an ERISA-covered pension plan,
not whether the plan existed. But does hold that “[p]lans that cover
only sole owners or partners and their spouses . . . fall outside [ERISA]’s domain.”
541 U.S. at 21. And the Fifth Circuit has clarified that whether a plan has
employees “appli[es] to the determination of the existence of an employee[-benefit]
plan.” , 499 F.3d at 450. It follows that an employee-benefit plan existed if the
life insurance policy benefitted at least one employee other than Mrs. Edwards.
With that in mind, the Court must decide whether Allure’s technicians were
employees or independent contractors. Because ERISA “offers little guidance in
providing a definition of employee,” the Fifth Circuit has turned to common-law
agency rules to determine whether an employee is an independent contractor.
, 898 F.2d 1096, 1102 n.6 (5th Cir. 1990);
, 91 F. App’x 950, 951–52 (5th Cir. 2004) (noting
plaintiff-employees must establish common-law employee status to receive
benefits). The Fifth Circuit uses the factors set forth in
13
, 503 U.S. 318 (1992), to determine whether an employee is
an independent contractor. , 91 F. App’x at 952. Those factors include:
the skill required; the source of the instrumentalities and
tools; the location of the work; the duration of the
relationship between the parties; whether the hiring
party has the right to assign additional projects to the
hired party; the extent of the hired party’s discretion over
when and how long to work; the method of payment; the
hired party’s role in hiring and paying assistants;
whether the work is part of the regular business of the
hiring party; whether the hiring party is in business; the
provision of employee benefits; and the tax treatment of
the hired party.
503 U.S. at 323–24 (quoting , 490 U.S. 730,
751–52 (1989)). Courts also consider “the hiring party’s right to control the manner
and means by which the product is accomplished.” at 323 (quoting , 490 U.S.
at 751–52).
Neither party analyzed those factors in their initial briefing—Guardian first
mentions them in its Reply, [26] at 5–7—and the record lacks sufficient evidence
to analyze them all. The available evidence, though, does establish facts that
indicate Allure’s technicians were employees: (1) Mrs. Edwards owned Allure’s
“building and . . . all of the equipment in the building,” [17-1] at 1–2; (2) she
received all payments from customers then paid each technician a percentage of the
income that technician had generated, at 2; and (3) she set the hours of operation
for Allure rather than the technicians setting their own hours, [25-3] at 12. In
other words, Mrs. Edwards controlled the “manner and means by which [Allure’s
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services are] accomplished.” , 503 U.S. at 323–24. And notably, no
evidence indicates the technicians worked for any other salon.
, No. 3:17-CV-2049, 2018 WL 4103723, at *15 (N.D. Tex.
Aug. 29, 2018) (citing , 612 F.3d 843, 846 (5th
Cir. 2010)) (noting “[t]he Fifth Circuit has generally found that an individual who
does not work exclusively for an employer is an independent contractor” in context
of Fair Labor Standards Act). Applying the factors to the available evidence,
Allure had employees rather than independent contractors.2
b. Life-Insurance Policy as an ERISA Plan
Edwards also argues a life insurance policy itself cannot be an ERISA plan.
[18] at 12. The Fifth Circuit has already rejected that argument, recognizing the
“common practice [of] employers to provide health care benefits to their employees
through the purchase of a group health insurance policy . . . .”
, 904 F.2d 236, 240 (5th Cir. 1990) (citing
2 This conclusion disposes of both Edwards’s [29] Motion for Leave to File Sur-Reply
and his [30] Motion to Take Depositions. First, because the Court determines Allure had
employees based on the evidence, it does not reach Guardian’s equitable-estoppel argument.
[26] at 2–4. No sur-reply is necessary, so the Court denies Edwards’s [29] Motion for
Leave to file Sur-Reply.
Second, “Rule 56(f) authorizes a district court to ‘order a continuance to permit . . .
depositions to be taken . . . .” , 667 F. App’x 463, 465 (5th Cir. 2016)
(quoting Fed. R. Civ. P. 56(f)). The Court has “broad discretion” to do so. (quoting
, 254 F.3d 595, 606 (5th Cir. 2001)). Edwards believes
the Court needs the depositions of Allure’s technicians to determine whether they are
independent contractors or employees. [30-1]. But the facts establishing that they were
employees come from Edwards’s own Affidavit, [17-1] at 1–2, and Allure’s publicly
available website, [25-3] at 12. For those reasons, the Court also denies Edwards’s [30]
Motion to Take Depositions.
15
, 471 U.S. 724, 727 (1985)).3 Instead, it adopted the Eleventh
Circuit’s test for whether an insurance policy is an ERISA plan—“[a] formal
document designated as ‘[an ERISA Plan]’ is not required” if, “from the surrounding
circumstances[,] a reasonable person can ascertain the intended benefits, a class of
beneficiaries, the source of financing, and procedures for receiving benefits.”
(citing , 688 F.2d 1367, 1373 (11th Cir. 1982) (en banc)).
The circumstances show that the Guardian-issued life insurance policy is an
ERISA plan. First, the policy expressly labeled its intended benefits as “
Group Term Life Insurance” and “ Basic Accidental Death and
Dismemberment Benefits.” [12-1] at 32, 39 (emphasis added). Second, Mrs.
Edwards’s application listed Allure as the plan-holder and identified the class of
beneficiaries as “all full[-]time” employees, not independent contractors. [12-1] at 5,
7. Where the application asked how many full-time employees Allure had and
intended to insure, Mrs. Edwards filled in both blanks with “4.” at 5. Allure was
the source of financing for the policy because Mrs. Edwards selected
non-contributory insurance for employees and paid 100% of the premiums out of
Allure’s account. [12-1] at 2, 6. Finally, the policy details the employees’
eligibility, coverage, and right to make a claim. [12-1] at 26, 28.
3 Most other federal circuits agree. , 801 F. App’x 861,
865 (3rd Cir. 2020) (collecting cases from other federal circuits holding an insurance policy
may be an ERISA plan).
16
Based on the evidence that Allure’s technicians were employees rather than
independent contractors, and the terms of the policy benefitting those employees, an
ERISA plan existed in Mrs. Edwards’s insurance policy. Edwards fails to provide
sufficient evidence to the contrary, so the Court moves to the safe-harbor-provision
element.
2. Safe Harbor
Because the life insurance policy qualifies as an ERISA plan, the next
question is whether the plan “falls within the safe-harbor provision established by
the Department of Labor.” , 499 F.3d at 448. Guardian argues it does not
satisfy the necessary factors to fall within that regulation. [13] at 5–6; 29 C.F.R.
§ 2510.3–1(j). Edwards does not mention the safe-harbor regulation aside from a
statement in its Reply to Guardian’s Motion to Strike, in which he appears to argue
ERISA’s law-regulating-insurance exception applies to Mrs. Edwards’s life
insurance policy. [28] at 1–2 (“although there is contrary authority, the better
view is that the insurer also has the burden of proving that the case is not within
the safe harbor[—]law regulating insurance[—]exception to ERISA.”). The Court
will address that exception after it determines whether the life insurance policy
falls within the Department of Labor’s safe-harbor provision.
“[T]o qualify as an ERISA plan, the plan cannot fall within the Department of
Labor’s safe harbor exclusion.” , 499 F.3d at 449. The safe-harbor provision
applies to a plan that satisfies four criteria: “(1) the employer does not contribute to
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the plan; (2) participation is voluntary; (3) the employer’s role is limited to collecting
premiums and remitting them to the insurer; and (4) the employer receives no profit
from the plan.” (citing 29 C.F.R. § 2510.3-1(j)).
The Guardian-issued life insurance policy stops at the first criteria because
Allure paid 100% of the policy’s premiums. [12-1] at 2, 6. The safe-harbor
provision does not apply to the life insurance policy, and the Court need not address
the remaining elements. , No. 15-105, 2015 WL
5794523, at *4 (W.D. La. Sept. 30, 2015) (citing , 980 F.2d at 355)
(concluding safe-harbor provision did not apply to employer-funded ERISA plan and
declining to address remaining elements).
3. Primary Elements
Finally, the Court must determine whether the insurance policy “satisfies the
primary elements of an ERISA employee[-]benefit plan—establishment or
maintenance by an employer intending to benefit employees.” , 499 F.3d
at 448. Guardian argues Allure meets that standard. [13] at 7–9. Edwards does
not specifically address that standard but instead relies on his argument that
Allure had independent contractors rather than employees. [18] at 4–6.
“The final prong of the test is satisfied when (1) an employer
established or maintained the plan; and (2) the employer intended to provide
benefits to its employees.” , 2015 WL 5794523, at *4 (citing , 980
F.2d at 355). The first element is self-explanatory; the second element has nuances
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when the owner is an employee-beneficiary. , 499 F.3d at 450 (citing cases
and discussing whether ERISA applies to a plan that benefits a working owner).
But “a plan covering both working-owner employers . . . as well as [other] employees
is governed by ERISA.” (citing , 541 U.S. at 16–17).
Guardian’s policy meets the third prong. Allure established and
maintained the policy because Mrs. Edwards identified Allure as the plan-holder,
and Allure paid 100% of the premiums. [12-1] at 2, 5–7. The policy also
identified the class of beneficiaries as “all full[-]time” employees and specifically
listed four employees to benefit from the plan. at 5, 7. The policy may have
benefitted Mrs. Edwards, but the addition of at least one other employee rendered it
“a plan covering both [a] working-owner employer[ ] . . . as well as employees.”
, 499 F.3d at 450. ERISA covers such plans.
Because Guardian’s insurance policy meets the test, the policy falls
under ERISA. The Court turns to whether ERISA preempts any state-law claims
related to the plan, which turns on whether an exception applies. The only
exception Mr. Edwards relies on is the law-regulating-insurance exception.
4. Law-Regulating-Insurance Exception
ERISA has a “deliberately expansive” preemption clause.
, 781 F.3d 182, 198 (5th Cir. 2015) (quoting
, 481 U.S. 41, 46 (1987)). But “the statute contains a
savings clause providing that ‘nothing . . . exempt[s] . . . any person from any law of
19
any [s]tate which regulates insurance, banking, or securities.” (quoting 29 U.S.C.
§ 1144(b)(2)(A)). Edwards’s Complaint alleges Mississippi’s common law prohibiting
cancellation of an insurance policy after the insured becomes uninsurable is a law
regulating insurance. [1] ¶ 11. He then argues § 1144(b)(2)(A)’s
law-regulating-insurance exception applies to Guardian’s policy. [28] at 1–2
(conflating law-regulating-insurance exception with Department of Labor’s
safe-harbor provision under test). To clarify, the question is not whether
the policy falls under the law-regulating-insurance exception; it is whether the state
statutes giving rise to the plaintiff’s state-law claims fall under that exception.
, 781 F.3d at 198 (reviewing dismissal of plaintiff’s claims under Texas
Insurance Code sections by determining whether those sections constituted laws
regulating insurance).
The law Edwards relies on comes from
, 389 So. 2d 920 (Miss. 1980). In , the Mississippi Supreme Court held
that an insurance company could not cancel a policy “after the onset of [the
insured’s] fatal illness.” 389 So. 2d at 922. Specifically, an insurance company had
canceled the insured’s policy after he suffered a heart attack and died six days later.
at 921. Even though no one knew whether the heart attack would be fatal on
the day the insurance company canceled the policy, the Mississippi Supreme Court
found that allowing cancellation of a policy under similar circumstances would be
unconscionable. at 922.
20
A “law which regulates insurance . . . must (1) be directed toward entities
engaged in insurance, and (2) substantially affect the risk pooling arrangement
between the insurer and the insured.” , 394 F.3d at 276 (citing
538 U.S. 329, 341–42 (2003)) The Fifth Circuit takes a
“common-sense view of [the first element] and look[s] to whether the [law] is
specifically directed toward entities engaged in insurance.” , 781 F.3d at 198
(citing , 538 U.S. at 342).
Edwards cannot rely on as a law regulating insurance for two reasons.
First, effectively created a breach-of-contract claim where an insurer cancels
a policy “after the onset of [a] fatal illness.” 389 So. 2d at 922. The Mississippi
Supreme Court noted that allowing an insurer to cancel a policy after the insured
became uninsurable would be unconscionable. In doing so, it recognized the
constitutional protection of the Contract Clause. (citing U.S. Const. art. I § 10).
Despite Edwards’s assertion that he “is not relying upon Mississippi general
contract law,” his Complaint expressly characterizes his state-law claim as “breach
of an insurance contract.” [1] at 1. And “laws of general application that have some
bearing on insurers do not qualify” as a law “specifically directed toward” the
insurance industry. , 538 U.S. at 334; , 788 F.
Supp. 608, 610 n.4 (D. Me. 1992) (collecting cases and noting “state common law
contract claims are not saved under the savings clause from pre-emption by
ERISA”); , 904 F.2d 295, 297 (5th Cir. 1990) (quoting
21
, 481 U.S. 58, 62 (1987)) (characterizing state-law claims as
“common law of general application that is not a law regulating insurance”),
, 524 U.S. 74 (1998)).
Because Edwards relies on as part of a breach-of-contract claim, he cannot
characterize as a law “specifically directed toward” the insurance industry.4
Second, is factually distinguishable from this case in two ways—the
type of insurance policy and the reasons for cancelation. To the former,
involved a personal life insurance policy rather than an employee-benefit plan.
389 So. 2d at 921. To the latter, the insurance policy in gave the insurer the
right to cancel the policy at its election if it gave sufficient notice. 389 So. 2d at
321. The insurer used that right to cancel the policy when it found out about the
insured’s heart attack. at 921. The Mississippi Supreme Court found that to
be unconscionable because the insured had become uninsurable, and he could not
have obtained desirable insurance. at 922.
Guardian’s policy, however, only gave it the right to cancel if either (1) “less
than two employees [were] insured . . .; or” (2) “less than 75% of those employees
who are eligible for insurance . . . are insured.” [12-1] at 12. Consistent with that
4 For the same reasons, Edwards cannot rely on
, 50 F.3d 144, 151 (2d Cir. 1995) or ,
526 U.S. 358 (1999). [18] at 8–9. In , the Second Circuit expressly contrasted
the New York state statute at issue from laws that “provide general remedies for . . . breach
of contract.” 50 F.3d at 151. And although decided whether a California
common-law rule was a law regulating insurance, the claim giving rise to the case was a
claim for denial of disability benefits rather than for breach of contract. 526 U.S. at
22
right, Guardian canceled Allure’s policy because Allure fell below that required
participation level, not because Mrs. Edwards presumably “became uninsurable.”
[1-1]; [1-2]; , 389 So. 2d at 922. Edwards provides no evidence
that Guardian was even aware of Mrs. Edwards’s condition. And Guardian’s right to
cancel would not be unconscionable because, assuming Allure had the required
number of employees, it could obtain a similar employee-benefit plan.
The parties raise no other exception to ERISA. Because the
law-regulating-insurance exception does not apply to Allure’s insurance policy, it is
not excluded from ERISA’s preemption. Edwards does not show a genuine dispute
over whether ERISA preempts his state-law contract claim. For those reasons, the
Court dismisses that claim with prejudice, and only his claim for benefits under
ERISA will proceed.
IV. Conclusion
The Court has considered all arguments. Those not addressed would not have
changed the outcome. For the stated reasons, the Court GRANTS Defendant
Guardian Life Insurance of America’s [12] Motion for Partial Summary Judgment
and GRANTS IN PART AND DENIES IN PART its [23] Motion to Strike; and
DENIES Plaintiff James “Jimmy” Emmett Edwards’s [29] Motion for Leave to File
Surrebuttal Brief and [30] Motion to Take Depositions. Edwards’s claim for benefits
under ERISA will proceed against Guardian. The parties should contact the
363–64.
23
magistrate judges’ chambers within seven days to schedule the case management
conference.
SO ORDERED, this the 9th day of August, 2023.
s/
UNITED STATES DISTRICT JUDGE
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