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Enenstein v. Eagle Insurance Agency

August 23, 2007

LOUIS ENENSTEIN, PLAINTIFF,
v.
EAGLE INSURANCE AGENCY, INC., ET AL., DEFENDANTS.



The opinion of the court was delivered by: Samuel Der-yeghiayan, District Judge

MEMORANDUM OPINION

This matter is before the court on Defendant/Third-Party Plaintiff Eagle Insurance Agency, Inc.'s ("Eagle") and Defendant/Third-Party Plaintiff Robert Gainsberg's ("Gainsberg") (collectively referred to as "Defendants") motion for summary judgment and on Third-Party Defendant Humana Insurance Company's ("Humana") motion for summary judgment. For the reasons stated below, we deny the motions for summary judgment in their entirety.

BACKGROUND

Plaintiff Louis Enenstein ("Enenstein") alleges that from September 2003 to January 2004, he was employed as an accountant for Eagle. Eagle allegedly provides its employees with the Eagle Insurance Agency Group Health Plan ("Plan"), which is provided through Humana and, according to Enenstein, was administered by Gainsberg. Enenstein asserts that after his employment with Eagle ended, Eagle and Gainsberg failed to notify Enenstein that he was qualified for continued insurance coverage under the Consolidated Omnibus Budget Reconciliation Act ("COBRA"), 29 U.S.C. § 1161 et seq. Enenstein also alleges that Eagle and Gainsberg falsely notified Third-Party Defendant Humana, Inc. and Humana that Enenstein was not eligible for COBRA benefits.

According to Enenstein, after his termination he complained to the "Illinois Division of Insurance" ("Division"), which investigated his complaint and documented the alleged false statements that Eagle and Gainsberg made to Humana concerning Enenstein's right to continued insurance coverage. (Compl. Par. 9). Enenstein states that after the Division's investigation, Eagle and Gainsberg agreed to represent to Humana that Enenstein was entitled to continued insurance coverage. Enenstein contends that Eagle and Gainsberg were required to have informed Humana of Enenstein's correct insurance status a year earlier than when they chose to do so. Enenstein brought the instant action and included in his complaint claims alleging that Eagle and Gainsberg violated the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1132 et seq., and COBRA.

On June 7, 2006, we denied Defendants' motion to dismiss and on June 27, 2006, Defendants and the Plan filed a third-party complaint against Humana and Humana, Inc. Defendants contend that errors made by Humana employees were responsible for the alleged violations of ERISA and COBRA that are the basis of the instant action. Third-Party Plaintiffs allege that, pursuant to an agreement between Eagle and Humana, Humana acted as the fiduciary for ERISA claims review purposes and had the exclusive discretionary authority to make interpretations concerning the provisions of the Plan and resolve eligibility and coverage issues. Third-Party Plaintiffs claim that Enenstein completed an application for health benefits on December 30, 2003, and Eagle sent the application to Humana. According to Third-Party Plaintiffs, Eagle terminated Enenstein's employment before receiving a response from Humana concerning Enenstein's Plan coverage. Gainsberg contends that he then spoke with Tom McNeely ("McNeely"), an employee of Humana, who informed him that Enenstein was not entitled to coverage under the Plan or under COBRA. Third-Party Plaintiffs claim that Eagle refrained from sending a COBRA notification to Enenstein in January or February of 2004 because of McNeely's representations. According to Third-Party Plaintiffs, in January 2005, Humana changed its position and informed Eagle that Enenstein was actually eligible for Plan coverage and instructed Eagle to provide COBRA notifications and Plan coverage to Enenstein. Eagle allegedly then provided Enenstein with notification and benefits. The third-party complaint includes an ERISA breach of fiduciary duty claim (Count I), and an indemnification claim (Count II). On November 8, 2005, we granted Humana, Inc.'s motion to dismiss the breach of fiduciary duty claim brought against it.

Defendants moves for summary judgment on the claims brought against them by Enenstein and on the claims they have brought against Humana. Humana moves for summary judgment on the claims brought against it by Defendants and the Plan.

LEGAL STANDARD

Summary judgment is appropriate when the record, viewed in the light most favorable to the non-moving party, reveals that there is no genuine issue as to any material fact and the moving party is entitled to judgment as a matter of law. Fed. R. Civ. P. 56(c). In seeking a grant of summary judgment the moving party must identify "those portions of 'the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any,' which it believes demonstrate the absence of a genuine issue of material fact." Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986) (quoting Fed. R. Civ. P. 56(c)). This initial burden may be satisfied by presenting specific evidence on a particular issue or by pointing out "an absence of evidence to support the non-moving party's case." Id. at 325. Once the movant has met this burden, the non-moving party cannot simply rest on the allegations in the pleadings, but, "by affidavits or as otherwise provided for in [Rule 56], must set forth specific facts showing that there is a genuine issue for trial." Fed. R. Civ. P. 56(e). A "genuine issue" in the context of a motion for summary judgment is not simply a "metaphysical doubt as to the material facts." Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 586 (1986). Rather, a genuine issue of material fact exists when "the evidence is such that a reasonable jury could return a verdict for the nonmoving party." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986); Insolia v. Philip Morris, Inc., 216 F.3d 596, 599 (7th Cir. 2000). The court must consider the record as a whole, in a light most favorable to the non-moving party, and draw all reasonable inferences that favor the non-moving party. Anderson, 477 U.S. at 255; Bay v. Cassens Transport Co., 212 F.3d 969, 972 (7th Cir. 2000). When there are cross motions for summary judgment, the court should "construe the evidence and all reasonable inferences in favor of the party against whom the motion under consideration is made." Premcor USA, Inc. v. Am. Home Assur. Co., 400 F.3d 523, 526-27 (7th Cir. 2005).

DISCUSSION

I. Claims Brought By Enenstein Against Defendants

Defendants argue that Gainsberg cannot be sued since he is not the administrator of the Plan ("Administrator"). Defendants also argue that Enenstein lacks standing to bring the instant action against Defendants.

A. Claims Brought Against Gainsberg

Defendants argue that Gainsberg is not a proper defendant since he was not the Administrator. An ERISA plan administrator is required to provide plan beneficiaries and participants with certain documents upon request within a certain time frame. 29 U.S.C. ยง 1024(b)(4). Under ERISA, an administrator is deemed to be: "(i) the person specifically so designated by the terms of the instrument under which the plan is operated; (ii) if an administrator is not so designated, the plan sponsor; or (iii) in the case of a plan for which an administrator is not designated and a plan sponsor cannot be identified, such other person as the Secretary ...


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