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KILMER v. CENTRAL CTYS. BANK

December 9, 1985

MICHAEL L. KILMER and MARK A. KILMER, Plaintiffs,
v.
CENTRAL COUNTIES BANK, individually and t/d/b/a CCB GROUP MEDICAL PLAN, Defendant



The opinion of the court was delivered by: COHILL

 Presently before the court are the Plaintiffs' and Defendant's motions for summary judgment. This action was initially commenced in the Court of Common Pleas of Blair County, Pennsylvania then removed by Defendant to this court. The issues before us are: 1) whether this action was properly removed from state to federal court, and 2) whether Plaintiffs' claim under state law is preempted by the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. §§ 1001-1461 (1982).

 Facts

 On July 31, 1982, Plaintiff, Mark A. Kilmer, the son of Plaintiff, Michael L. Kilmer, was seriously injured in a vehicular collision on Route 220, Snyder Township, Blair County, Pennsylvania. At the time of the accident, Mr. Kilmer maintained medical coverage with Donegal Mutual Insurance Company, his no-fault carrier. In addition, Mr. Kilmer maintained medical coverage with the CCB Group Medical Plan, an employee benefit plan which was provided by his employer, Central Counties Bank. Since the commencement of this action, Central Counties Bank has been acquired by Mellon Bank, N.A.

 On January 1, 1982, Central Counties Bank altered its health care coverage from a plan insured by an outside company, Blue Cross/Blue Shield, to its current self-insured coverage. As such, the bank relied on its general assets as a basis for coverage instead of purchasing insurance.

 Pursuant to this change in coverage, the CCB Group Medical Plan no longer provided primary insurance and would only pay claims which were not covered by another insurer. The Plan's "Coordination of Benefits" section provides for the reduction of a participant's benefits in proportion to any additional coverage which is similar to those benefits provided under the plan. Specifically, Article VI, para. 6.8(a) provides:

 
6.8 If a person who is covered for any benefits under this Plan (to which this provision applies) is covered simultaneously under any other plan, which provides health benefits similar to those provided under this Plan, payment of benefits for that person under this Plan shall be resolved in accordance with the following order of benefit determination:
 
a. If any other plan does not contain provisions which would coordinate its benefits or reduce its benefits by any benefits paid or payable under this Plan, benefits of the other plan shall be determined prior to determination of the benefits of this Plan.

 Stipulation of Facts, at Exhibit 2. Furthermore, the "General Exclusions" section of the CCB Group Medical Plan does not cover claims due to injury or sickness "to the extent that payment is made or required to be made under the terms of any 'No-Fault' type of automobile provision." Article X, para. 10.13. In response to these amendments, the monthly premium for adding a family member to coverage under the CCB Group Medical Plan was reduced from $8.00 to $5.00.

 On November 23, 1982, Johnson Administrators, who were responsible for managing the CCB Group Medical Plan, received a claim for the medical benefits which had already been reimbursed by Mr. Kilmer's no-fault carrier. On January 13, 1983, Johnson Administrators rejected the claim for the reason that the CCB Group Medical Plan was self-funded and therefore governed by ERISA, which preempted the Pennsylvania No-Fault Motor Vehicle Insurance Act, 40 P.S. §§ 1009.101-1009.701, repealed and superseded by the Motor Vehicle Financial Responsibility Law, 75 Pa. C.S.A. §§ 1701-1798, as amended (effective October 1, 1984).

 On March 2, 1983, Plaintiffs filed a complaint in assumpsit in the Court of Common Pleas of Blair County, Pennsylvania. Plaintiffs have based their claim for the recovery of medical expenses upon § 203 of the No-fault Act, 40 P.S. § 1009.203, which has been interpreted by Pennsylvania courts to allow double recovery under limited circumstances. See, e.g., Steppling v. Pennsylvania Manufacturers' Ass'n Insurance Co., 328 Pa.Super. 419, 477 A.2d 515 (1984) (§ 203 of No-fault Act, when read in conjunction with § 106, permits double recovery from no-fault carrier where medical expenses have already been reimbursed by Blue Cross).

 On April 28, 1983, Defendant filed a petition to remove the present action to this court pursuant to 28 U.S.C. § 1441, which confers federal removal jurisdiction over any civil action over which the district courts would have had jurisdiction had the case been brought there originally.

 In its petition, the Defendant asserts that this court has original jurisdiction under § 502(e)(1) of ERISA, 29 U.S.C. § 1132(e)(1), and that Plaintiffs' claim may be removed to this court pursuant to 28 U.S.C. § 1441. Specifically, § 502(e)(1) provides as follows:

 
(e) Jurisdiction
 
(1) Except for actions under subsection (a)(1)(B) of this section, the district courts of the United States shall have exclusive jurisdiction of civil actions under this subchapter brought by the Secretary or by a participant, beneficiary, or fiduciary. State courts of competent jurisdiction and district courts of the United States shall have concurrent jurisdiction of actions under subsection (a)(1)(B) of this section.

 29 U.S.C. § 1132(e)(1). Section 502 (a)(1)(B) provides:

 
(a) Persons empowered to bring a civil action
 
A civil action may be brought --
 
(1) by a participant or beneficiary --
 
(B) to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan;

 29 U.S.C. § 1132(a)(1)(B). Alternatively, the Defendant contends that this court has original jurisdiction pursuant to 28 U.S.C. 1331 since Plaintiffs' claim arises under the laws of the United States (i.e., ERISA) and a federal question is presented.

 Subsequently, the Plaintiffs filed an answer to Defendant's petition for removal on May 4, 1983. On May 31, 1983, Defendants filed their answer to Plaintiffs' complaint. A stipulation of facts was agreed upon, and both parties then filed their respective motions for summary judgment. Before the court can address the merits of the ...


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