These provisions in the 1993 Plan and the 1994 Plan indicate that Met Life did not contravene the plain language of those plans in ceasing to make payments to Meadow View on behalf of McCall. Meadow View has not presented any language or provisions in the plans that would contradict such a conclusion.
Turning to the first three Moench factors, Meadow View has not pointed to any Plan policy that conflicts with Met Life's administration of the Plan, any language in the Plan rendered meaningless by Met Life's interpretation, any pertinent conflicts in the language of the Plan, or any provisions of the ERISA statute that conflict with Met Life's administration of the Plan. None of these factors suggest that Met Life's interpretation of the Plan's terms has been arbitrary or capricious.
Although Meadow View does not make the point
, one could argue that the fourth Moench factor -- whether the plan administrator interpreted the provision in question consistently -- weakens Met Life's argument that it has interpreted the Plan reasonably. Met Life employees allegedly represented initially that McCall would be covered for the vast majority of treatment received at Meadow View, then coverage was limited to 100 days of treatment for each year, and now Met Life contends that McCall was not covered for any expenses incurred at Meadow View since the adoption of the 1994 Plan.
In any event, the remaining Moench factors, which favor a finding a reasonableness, mandate that Met Life's motion for summary judgment should be granted as to plaintiffs' claims brought pursuant to 29 U.S.C. § 1132(a)(1)(B) of ERISA. When scrutiny is confined to the provisions of the Plan, as required in this ERISA cause of action, no reasonable fact-finder could conclude that Met Life's denial of further benefits to McCall under the unambiguous terms of the Plan was arbitrary and capricious. See Firestone, 489 U.S. at 115; Abnathya, 2 F.3d at 45. There are no material facts in dispute in this area, and it is apparent that Met Life is entitled to judgment as a matter of law on this point. That conclusion is supported by the fact that the most important Moench factor, the plain language of the plan, points unequivocally to a finding of reasonableness in this case. See Lockhart v. United Mine Workers, 5 F.3d 74 at 78 ("The award of benefits under any ERISA plan is governed in the first instance by the language of the plan itself."); Callahan v. Rouge Steel Co., 941 F.2d 456, 460 (6th Cir. 1991); see also Lickteig v. Business Men's Assurance Co. of Am., 61 F.3d 579, 585 (8th Cir. 1995) (according "significant weight" to unambiguous plan language). Meadow View has not met its summary judgment burden. See Celotex, 477 U.S. at 322-325.
2. Equitable Estoppel Under ERISA
In addition to the cause of action set forth in 29 U.S.C. § 1132(a)(1)(B), discussed supra, ERISA also provides to ERISA "participants" and "beneficiaries" the right to "obtain other appropriate equitable relief." 29 U.S.C. § 1132(a)(3)(B). Meadow View may not bring an action under 29 U.S.C. § 1132(a)(3)(B) in its own name because it is not a "participant" or "beneficiary" as defined by ERISA. See 29 U.S.C. § 1002(7),(8); Cameron Manor, Inc. v. United Mine Workers of Am., 575 F. Supp. 1243, 1245-46 (W.D. Pa. 1983) (holding that nursing home was not ERISA participant or beneficiary). However, McCall's complaint contained a count that could be read as invoking 29 U.S.C. § 1132(a)(3)(B). Specifically, McCall sought to have Chevron, Met Life and Healthmarc "estopped . . . from disclaiming coverage for [McCall's] reasonable medical care and treatment." (McCall Compl. P 25). McCall subsequently assigned that claim to Meadow View. (Meadow View Amend. Compl., Count VII P 2).
Plaintiffs' estoppel claim fails, however, because a plaintiff may not bring an equitable estoppel claim under ERISA in an attempt to circumvent the ERISA provisions precluding oral or informal amendments to ERISA plans. See Curcio v. John Hancock Mut. Life Ins. Co., 33 F.3d 226, 236 n.17 (3d Cir. 1994). Such circumvention is exactly what plaintiffs are attempting in this case, as they have supported their estoppel claim by pointing to oral statements made by Met Life employees and the letter signed by Reichert, who was without authority to amend the Plan. ERISA's ban on oral amendments and amendments not made in accordance with the amendment provisions set forth in the plan itself is intended to ensure that the terms of an ERISA plan are the sole determinant of whether a beneficiary is entitled to benefits under the plan. See Frank v. Colt Indus., Inc., 910 F.2d 90, 97 (3d Cir. 1990) (citing ERISA's legislative history). Plaintiffs may not subvert that aim by cloaking their cause of action in the language of equitable estoppel. See Coleman v. Nationwide Life Ins. Co., 969 F.2d 54, 58-59 (4th Cir. 1992), cert. denied, 506 U.S. 1081, 122 L. Ed. 2d 359, 113 S. Ct. 1051 (1993); see also Kane v. Aetna Life Ins., 893 F.2d 1283, 1285 n.3 (11th Cir.) (noting that estoppel may not be invoked to enlarge or extend the coverage specified in a contract), cert. denied, 498 U.S. 890, 112 L. Ed. 2d 192, 111 S. Ct. 232 (1990). Met Life and Healthmarc are therefore entitled to summary judgment on plaintiffs' equitable estoppel claims.
C. Plaintiffs' State Law Claims
1. Whether Plaintiffs' State Law Causes of Action Are Preempted by ERISA
As noted, plaintiffs' complaints raise claims of breach of contract and negligent misrepresentation under the law of the State of New Jersey. Met Life and Healthmarc contend that these claims are preempted by ERISA.
The relevant ERISA provision states: "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 described in section 1003(a) of this title and not exempt under section 1003(b) of this title." 29 U.S.C. § 1144. In accordance with this "deliberately expansive" language, Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 46, 95 L. Ed. 2d 39, 107 S. Ct. 1549 (1987), ERISA has been construed to preempt a broad range of state law claims. See, e.g., Pane v. RCA Corp., 868 F.2d 631 (3d Cir. 1989) (holding that state law claims of breach of contract, breach of covenants of good faith and fair dealing, and intentional infliction of emotional distress were preempted by ERISA); Cote v. Durham Life Ins. Co., 754 F. Supp. 18 (D. Conn. 1991) (holding that ERISA preempted state law claims of breach of contract, bad faith, unfair insurance practices, and intentional infliction of emotional distress).
The ERISA preemption clause aims to establish employee-benefit-plan regulation "'as exclusively a federal concern.'" Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 46, 95 L. Ed. 2d 39, 107 S. Ct. 1549 (1987) (quoting Alessi v. Raybestos-Manhattan, Inc., 451 U.S. 504, 523, 68 L. Ed. 2d 402, 101 S. Ct. 1895 (1981)). Thus, the phrase "relate to" in 29 U.S.C. § 1144 "has been given the broadest common sense meaning, such that a state law 'relates to' a benefit plan if it has a connection with or reference to such a plan." Shiffler v. Equitable Life Assurance Soc'y, 838 F.2d 78, 81 (3d Cir. 1988). A state law may be found to "relate to" a benefit plan "even if the law was not specifically designed to affect such plans, or the effect is only indirect." Ingersoll-Rand Co. v. McClendon, 498 U.S. 133, 139, 112 L. Ed. 2d 474, 111 S. Ct. 478 (1990). As the Supreme Court has explained,
The detailed provisions of [ERISA] set forth a comprehensive civil enforcement scheme that represents a careful balancing of the need for prompt and fair claims settlement procedures against the public interest in encouraging the formulation of employee benefit plans. The policy choices reflected in the inclusion of certain remedies and the exclusion of others under the federal scheme would be completely undermined if ERISA-plan participants and beneficiaries were free to obtain remedies under state law that Congress rejected in ERISA.