Pilot Life Insurance Company, Petitioner v. Everate W. DEDEAUX
Pilot Life Insurance Company, Petitioner v. Everate W. DEDEAUX
Pilot Life Insurance Company, Petitioner v. Everate W. DEDEAUX
41
107 S.Ct. 1549
95 L.Ed.2d 39
Syllabus
The "pre-emption clause" ( 514(a)) of the Employee Retirement Income
Security Act of 1974 (ERISA) provides that ERISA supersedes all state
laws insofar as they "relate to any employee benefit plan," but ERISA's
"saving clause" ( 514(b)(2)(A)) excepts from the pre-emption clause any
state law that "regulates insurance." ERISA's "deemer clause" ( 514(b)(2)
(B)) provides that no employee benefit plan shall be deemed to be an
insurance company for purposes of any state law "purporting to regulate
insurance." On the basis of a work-related injury occurring in Mississippi
in 1975, respondent began receiving permanent disability benefits under
his employer's ERISA-regulated welfare benefit plan, under which claims
were handled by petitioner, the employer's insurer. However, after two
years petitioner terminated respondent's benefits, and during the following
three years his benefits were reinstated and terminated by petitioner
several times. Respondent ultimately instituted a diversity action against
petitioner in Federal District Court, alleging tort and breach of contract
claims under Mississippi common law for petitioner's failure to pay
benefits under the insurance policy. The court granted summary judgment
for petitioner, finding that respondent's common law claims were preempted by ERISA. The Court of Appeals reversed.
Held: ERISA pre-empts respondent's suit under state common law for
alleged improper processing of his claim for benefits under the ERISAregulated benefit plan. Pp. 44-57.
(a) The common law causes of action asserted in respondent's complaint,
This case presents the question whether the Employee Retirement Income
Security Act of 1974 (ERISA), 88 Stat. 829, as amended, 29 U.S.C. 1001 et
seq., pre-empts state common law tort and contract actions asserting improper
processing of a claim for benefits under an insured employee benefit plan.
In 1980, Dedeaux instituted a diversity action against Pilot Life in the United
States District Court for the Southern District of Mississippi. Dedeaux's
complaint contained three counts: "Tortious Breach of Contract"; "Breach of
Fiduciary Duties"; and "Fraud in the Inducement." App. 18-23. Dedeaux sought
"[d]amages for failure to provide benefits under the insurance policy in a sum
to be determined at the time of trial," "[g]eneral damages for mental and
emotional distress and other incidental damages in the sum of $250,000.00,"
and "[p]unitive and exemplary damages in the sum of $500,000.00." Id., at 2324. Dedeaux did not assert any of the several causes of action available to him
under ERISA, see infra, at ----.
At the close of discovery, Pilot Life moved for summary judgment, arguing
At the close of discovery, Pilot Life moved for summary judgment, arguing
that ERISA pre-empted Dedeaux's common law claim for failure to pay
benefits on the group insurance policy. The District Court granted Pilot Life
summary judgment, finding all Dedeaux's claims pre-empted. App. to Pet. Cert.
16a.
The Court of Appeals for the Fifth Circuit reversed, primarily on the basis of
this Court's decision in Metropolitan Life Ins. Co. v. Massachusetts, 471 U.S.
724, 105 S.Ct. 2380, 85 L.Ed.2d 728 (1985). See 770 F.2d 1311 (1985). We
granted certiorari, 478 U.S. 1004, 106 S.Ct. 3293, 92 L.Ed.2d 708 (1986), and
now reverse.
II
In ERISA, Congress set out to
6
Congress capped off the massive undertaking of ERISA with three provisions
relating to the pre-emptive effect of the federal legislation:
"Except as provided in subsection (b) of this section [the saving clause], the
provisions of this subchapter and subchapter III of this chapter shall supersede
any and all State laws insofar as they may now or hereafter relate to any
employee benefit plan. . . ." 514(a), as set forth in 29 U.S.C. 1144(a) (preemption clause).
10
11
"Neither an employee benefit plan . . . nor any trust established under such a
plan, shall be deemed to be an insurance company or other insurer, bank, trust
company, or investment company or to be engaged in the business of insurance
or banking for purposes of any law of any State purporting to regulate insurance
companies, insurance contracts, banks, trust companies, or investment
companies." 514(b)(2)(B), 29 U.S.C. 1144(b)(2)(B) (deemer clause).
12
To summarize the pure mechanics of the provisions quoted above: If a state law
"relate[s] to . . . employee benefit plan[s]," it is pre-empted. 514(a). The
saving clause excepts from the pre-emption clause laws that "regulat[e]
insurance." 514(b)(2)(A). The deemer clause makes clear that a state law that
"purport[s] to regulate insurance" cannot deem an employee benefit plan to be
an insurance company. 514(b)(2)(B).
13
14
"The bill that became ERISA originally contained a limited pre-emption clause,
applicable only to state laws relating to the specific subjects covered by ERISA.
The Conference Committee rejected those provisions in favor of the present
language, and indicated that section's pre-emptive scope was as broad as its
language. See H.R.Conf.Rep. No. 93-1280, p. 383 (1974); S.Conf.Rep. No. 931090, p. 383 (1974)."
15
The House and Senate sponsors emphasized both the breadth and importance of
the pre-emption provisions. Representative Dent described the "reservation to
Federal authority [of] the sole power to regulate the field of employee benefit
plans" as ERISA's "crowning achievement." 120 Cong.Rec. 29197 (1974).
Senator Williams said:
16
"It should be stressed that with the narrow exceptions specified in the bill, the
See also Shaw v. Delta Air Lines, Inc., supra, at 99-100, n. 20, 103 S.Ct., at
2901, n. 20 (describing remarks of Sen. Javits).
18
In Metropolitan Life, this Court, noting that the pre-emption and saving clauses
"perhaps are not a model of legislative drafting," 471 U.S., at 739, 105 S.Ct., at
2389, interpreted these clauses in relation to a Massachusetts statute that
required minimum mental health care benefits to be provided Massachusetts
residents covered by general health insurance policies. The appellants in
Metropolitan Life argued that the state statute, as applied to insurance policies
purchased by employee health care plans regulated by ERISA, was pre-empted.
19
The Court concluded, first, that the Massachusetts statute did "relate to . . .
employee benefit plan[s]," thus placing the state statute within the broad sweep
of the pre-emption clause, 514(a). Metropolitan Life, supra, at 739, 105 S.Ct.,
at 2389. However, the Court held that, because the state statute was one that
"regulate[d] insurance," the saving clause prevented the state law from being
pre-empted. In determining whether the Massachusetts statute regulated
insurance, the Court was guided by case law interpreting the phrase "business
of insurance" in the McCarran-Ferguson Act, 59 Stat. 33, as amended, 15
U.S.C. 1011 et seq.
20
III
21
There is no dispute that the common law causes of action asserted in Dedeaux's
complaint "relate to" an employee benefit plan and therefore fall under ERISA's
express pre-emption clause, 514(a). In both Metropolitan Life, supra, and
Shaw v. Delta Air Lines, Inc., supra, 463 U.S., at 96-100, 103 S.Ct., at 28992901, we noted the expansive sweep of the pre-emption clause. In both cases "
[t]he phrase 'relate to' was given its broad common-sense meaning, such that a
state law 'relate[s] to' a benefit plan 'in the normal sense of the phrase, if it has a
connection with or reference to such a plan.' " Metropolitan Life, supra, 471
U.S., at 739, 105 S.Ct., at 2389, quoting Shaw v. Delta Air Lines, supra, 463
U.S., at 97, 103 S.Ct., at 2900. In particular we have emphasized that the preemption clause is not limited to "state laws specifically designed to affect
employee benefit plans." Shaw v. Delta Air Lines, supra, at 98, 103 S.Ct., at
2900. The common law causes of action raised in Dedeaux's complaint, each
based on alleged improper processing of a claim for benefits under an employee
benefit plan, undoubtedly meet the criteria for pre-emption under 514(a).
22
Unless these common law causes of action fall under an exception to 514(a),
therefore, they are expressly pre-empted. Although Dedeaux's complaint
pleaded several state common law causes of action, before this Court Dedeaux
has described only one of the three countscalled "tortious breach of contract"
in the complaint, and "the Mississippi law of bad faith" in respondent's brief
as protected from the pre-emptive effect of 514(a). The Mississippi law of
bad faith, Dedeaux argues, is a law "which regulates insurance," and thus is
saved from pre-emption by 514(b)(2)(A).1
23
24
25
26
As early as 1915 the Mississippi Supreme Court had recognized that punitive
contract, and not merely breach of an insurance contract, may lead to liability
for punitive damages under Mississippi law.
28
29
Neither do the McCarran-Ferguson Act factors support the assertion that the
Mississippi law of bad faith "regulates insurance." Unlike the mandatedbenefits law at issue in Metropolitan Life, the Mississippi common law of bad
faith does not effect a spreading of policyholder risk. The state common law of
bad faith may be said to concern "the policy relationship between the insurer
and the insured." The connection to the insurer-insured relationship is
attenuated at best, however. In contrast to the mandated-benefits law in
Metropolitan Life, the common law of bad faith does not define the terms of the
relationship between the insurer and the insured; it declares only that, whatever
terms have been agreed upon in the insurance contract, a breach of that contract
may in certain circumstances allow the policyholder to obtain punitive
damages. The state common law of bad faith is therefore no more "integral" to
the insurer-insured relationship than any State's general contract law is integral
to a contract made in that State. Finally, as we have just noted, Mississippi's law
of bad faith, even if associated with the insurance industry, has developed from
general principles of tort and contract law available in any Mississippi breach of
contract case. Cf. Hart v. Orion Ins. Co., 453 F.2d 1358 (CA10 1971) (general
state arbitration statutes do not regulate the business of insurance under the
McCarran-Ferguson Act); Hamilton Life Ins. Co. v. Republic National Life Ins.
Co., 408 F.2d 606 (CA2 1969) (same). Accordingly, the Mississippi common
law of bad faith at most meets one of the three criteria used to identify the
"business of insurance" under the McCarran-Ferguson Act, and used in
Metropolitan Life to identify laws that "regulat[e] insurance" under the saving
clause.
In the present case, moreover, we are obliged in interpreting the saving clause
to consider not only the factors by which we were guided in Metropolitan Life,
but also the role of the saving clause in ERISA as a whole. On numerous
occasions we have noted that " ' " '[i]n expounding a statute, we must not be
guided by a single sentence or member of a sentence, but look to the provisions
of the whole law, and to its object and policy.' " ' " Kelly v. Robinson, 479 U.S.
36, 43, 107 S.Ct. 353, 358, 93 L.Ed.2d 216 (1986), quoting Offshore Logistics,
Inc. v. Tallentire, 477 U.S. 207, 221, 106 S.Ct. 2485, 2493, 91 L.Ed.2d 174
(1986) (quoting Mastro Plastics Corp. v. NLRB, 350 U.S. 270, 285, 76 S.Ct.
349, 359, 100 L.Ed. 309 (1956) (in turn quoting United States v. Heirs of
Boisdore, 8 How. 113, 122, 12 L.Ed. 1009 (1849))). Because in this case, the
state cause of action seeks remedies for the improper processing of a claim for
benefits under an ERISA-regulated plan, our understanding of the saving clause
must be informed by the legislative intent concerning the civil enforcement
The Solicitor General, for the United States as amicus curiae, argues that
Congress clearly expressed an intent that the civil enforcement provisions of
ERISA 502(a) be the exclusive vehicle for actions by ERISA-plan
participants and beneficiaries asserting improper processing of a claim for
benefits, and that varying state causes of action for claims within the scope of
502(a) would pose an obstacle to the purposes and objectives of Congress.
Brief for United States as Amicus Curiae 18-19. We agree. The conclusion that
502(a) was intended to be exclusive is supported, first, by the language and
structure of the civil enforcement provisions, and second, by legislative history
in which Congress declared that the pre-emptive force of 502(a) was modeled
on the exclusive remedy provided by 301 of the Labor Management Relations
Act, 1947 (LMRA), 61 Stat. 156, 29 U.S.C. 185.
31
The civil enforcement scheme of 502(a) is one of the essential tools for
accomplishing the stated purposes of ERISA.3 The civil enforcement scheme is
sandwiched between two other ERISA provisions relevant to enforcement of
ERISA and to the processing of a claim for benefits under an employee benefit
plan. Section 501, 29 U.S.C. 1131, authorizes criminal penalties for
violations of the reporting and disclosure provisions of ERISA. Section 503, 29
U.S.C. 1133, requires every employee benefit plan to comply with
Department of Labor regulations on giving notice to any participant or
beneficiary whose claim for benefits has been denied, and affording a
reasonable opportunity for review of the decision denying the claim. Under the
civil enforcement provisions of 502(a), a plan participant or beneficiary may
sue to recover benefits due under the plan, to enforce the participant's rights
under the plan, or to clarify rights to future benefits. Relief may take the form
of accrued benefits due, a declaratory judgment on entitlement to benefits, or an
injunction against a plan administrator's improper refusal to pay benefits. A
participant or beneficiary may also bring a cause of action for breach of
fiduciary duty, and under this cause of action may seek removal of the
fiduciary. 502(a)(2), 409. In an action under these civil enforcement
provisions, the court in its discretion may allow an award of attorney's fees to
either party. 502(g). See Massachusetts Mutual Life Ins. Co. v. Russell, 473
U.S. 134, 147, 105 S.Ct. 3085, 3092-3093, 87 L.Ed.2d 96 (1985). In Russell,
we concluded that ERISA's breach of fiduciary duty provision, 409(a), 29
U.S.C. 1109(a), provided no express authority for an award of punitive
damages to a beneficiary. Moreover, we declined to find an implied cause of
action for punitive damages in that section, noting that " '[t]he presumption that
a remedy was deliberately omitted from a statute is strongest when Congress
has enacted a comprehensive legislative scheme including an integrated system
of procedures for enforcement.' " Russell, supra, at 147, 105 S.Ct., at 3093,
quoting Northwest Airlines, Inc. v. Transport Workers, 451 U.S. 77, 97, 101
S.Ct. 1571, 1583, 67 L.Ed.2d 750 (1981). Our examination of these provisions
made us "reluctant to tamper with an enforcement scheme crafted with such
evident care as the one in ERISA." Russell, supra, 473 U.S., at 147, 105 S.Ct.,
at 3093.
32
33
The deliberate care with which ERISA's civil enforcement remedies were
drafted and the balancing of policies embodied in its choice of remedies argue
strongly for the conclusion that ERISA's civil enforcement remedies were
intended to be exclusive. This conclusion is fully confirmed by the legislative
history of the civil enforcement provision. The legislative history demonstrates
that the pre-emptive force of 502(a) was modeled after 301 of the LMRA.
34
35
36
Congress was well aware that the powerful pre-emptive force of 301 of the
LMRA displaced all state actions for violation of contracts between an
employer and a labor organization, even when the state action purported to
authorize a remedy unavailable under the federal provision. Section 301 preempts any "state-law claim [whose resolution] is substantially dependent upon
the analysis of the terms of an agreement made between the parties in a labor
contract." Allis-Chalmers Corp. v. Lueck, 471 U.S., at 220, 105 S.Ct., at 1916.
As we observed in Allis-Chalmers, the broad pre-emptive effect of 301 was
first analyzed in Teamsters v. Lucas Flour Co., 369 U.S. 95, 82 S.Ct. 571, 7
L.Ed.2d 593 (1962). In Lucas Flour the Court found that "[t]he dimensions of
301 require the conclusion that substantive principles of federal labor law must
be paramount in the area covered by the statute." Id., at 103, 82 S.Ct., at 576. "
[I]n enacting 301 Congress intended doctrines of federal labor law uniformly
to prevail over inconsistent local rules." Id., at 104, 82 S.Ct., at 577. Indeed, for
purposes of determining federal jurisdiction, this Court has singled out 301 of
the LMRA as having "pre-emptive force . . . so powerful as to displace entirely
any state cause of action 'for violation of contracts between an employer and a
labor organization.' Any such suit is purely a creature of federal law. . . ."
Franchise Tax Board of Cal. v. Construction Laborers Vacation Trust for
Southern Cal., 463 U.S. 1, 23, 103 S.Ct. 2841, 2853, 77 L.Ed.2d 420 (1983),
referring to Avco Corp. v. Machinists, 390 U.S. 557, 88 S.Ct. 1235, 20 L.Ed.2d
126 (1968).
37
In Metropolitan Life Ins. Co. v. Massachusetts, 471 U.S., at 746, 105 S.Ct., at
2393, this Court rejected an interpretation of the saving clause of ERISA's
express pre-emption provisions, 514(b)(2)(A), 29 U.S.C. 1144(b)(2)(A),
that saved from preemption "only state regulations unrelated to the substantive
provisions of ERISA," finding that "[n]othing in the language, structure, or
legislative history of the Act" supported this reading of the saving clause.
Metropolitan Life, however, did not involve a state law that conflicted with a
substantive provision of ERISA. Therefore the Court's general observation
that state laws related to ERISA may also fall under the saving clausewas not
focused on any particular relationship or conflict between a substantive
provision of ERISA and a state law. In particular, the Court had no occasion to
consider in Metropolitan Life the question raised in the present case: whether
Congress might clearly express, through the structure and legislative history of
a particular substantive provision of ERISA, an intention that the federal
remedy provided by that provision displace state causes of action. Our
resolution of this different question does not conflict with the Court's earlier
general observations in Metropolitan Life.
39
40
Reversed.
Decisional law that "regulates insurance" may fall under the saving clause. The
saving clause, 514(b)(2)(A), covers "any law of any State." For purposes of
514, "[t]he term 'State law' includes all laws, decisions, rules, regulations, or
other State action having the effect of law, of any State." 29 U.S.C. 1144(c)
(1) and (2).
U.S.C. 1012(a).
3
Because we conclude that Dedeaux's state common law claims fall under the
ERISA pre-emption clause and are not rescued by the saving clause, we need
not reach petitioner's argument that when an insurance company is engaged in
the processing and review of claims for benefits under an employee benefit
plan, it is acting in place of the plan's trustees and should be protected from
direct state regulation by the deemer clause.