OpenJurist

917 F2d 28 Lorenzana v. Inter-American Insurance Company of Illinois

917 F.2d 28

Unpublished Disposition

NOTICE: Ninth Circuit Rule 36-3 provides that dispositions other than opinions or orders designated for publication are not precedential and should not be cited except when relevant under the doctrines of law of the case, res judicata, or collateral estoppel.

Charles LORENZANA, individually, and as Administrator of the
Estate of Patricia Lorenzana, Plaintiff-Appellee,
v.
INTER-AMERICAN INSURANCE COMPANY OF ILLINOIS,
Defendant-Cross-complainant-Appellant,
v.
CENTURY NATIONAL INSURANCE COMPANY, A DIVISION OF
KRAMER-WILSON COMPANY INSURANCE SERVICES, aka
Kramer-Wilson Company, Inc., Defendant-Appellee.
Charles LORENZANA, individually, and as Administrator of the
Estate of Patricia Lorenzana, Plaintiff-Appellant,
v.
INTER-AMERICAN INSURANCE COMPANY OF ILLINOIS, Defendant,
and
Century National Insurance Company, a division of
Kramer-Wilson Company Insurance Services aka
Kramer-Wilson Company, Inc., Defendant-Appellee.

Nos. 89-15580, 89-16052 and 89-16042.

United States Court of Appeals, Ninth Circuit.

Argued and Submitted Oct. 4, 1990.
Decided Oct. 23, 1990.

Before GOODWIN, Chief Judge, JAMES R. BROWNING and RYMER, Circuit Judges.

1

Inter-American Insurance Company appeals the district court's grant of summary judgment and attorney's fees in favor of plaintiff Charles Lorenzana in Lorenzana's action to collect life insurance benefits of $25,000 allegedly due him on account of his deceased wife's participation in an ERISA employee benefit plan. His wife Patricia had enrolled in the Inter-American program on the assumption that it was "guaranteed issue" and without having been told that coverage was subject to the condition that she be "actively at work" on the effective date. The district court, applying principles of estoppel, held that Inter-American's denial of benefits on the basis of the "actively at work" requirement constituted arbitrary and capricious action. Lorenzana also appeals the district court's dismissal of Kramer-Wilson, his wife's employer, on the basis that Kramer-Wilson was not a "fiduciary" under the benefit plan. We reverse.

2

Material issues of fact which preclude summary judgment exist with respect to whether an ERISA "employee benefit welfare plan" was established or maintained by the employer,1 and if so, of what the plan consists. Lorenzana argues that there was a "plan," albeit unintegrated, comprised of oral communications and representations of the employers' insurance broker, an Inter-American brochure, and the enrollment card. Inter-American, on the other hand, urges that the plan consists of a written master group policy and individual certificates of insurance.

3

The parties likewise dispute the effective date of coverage, as well as the exact nature of the coverage afforded. Lorenzana understood the insurance offered to be "guaranteed issue" and contends that "guaranteed issue" connotes that the requirement of being "actively at work" on the effective date of coverage did not apply to his wife. Inter-American argues otherwise. The record permits no conclusion as a matter of law either way.

4

Moreover, without a clear record of whether there was a "plan," and if so what its terms are, the respective responsibilities and obligations of Kramer-Wilson and Inter-American cannot be determined as a matter of law. While there is no evidence in the record that Kramer-Wilson had discretionary functions to perform, there is also no evidence identifying the plan administrator.2 Accordingly, the judgment of the district court is

5

REVERSED.

*

This disposition is not approriate for publication and may not be cited to ro by the courts of this circuit except as provided by 9th Cir.R. 36-3

1

Consequently, because the extent to which the employer "merely advertised" rather than "endorsed" the plan is unclear from the record, the existence of federal subject matter jurisdiction is not free from doubt. See Kanne v. Connecticut General Life Ins. Co., 867 F.2d 489, 492 (9th Cir.1988) (per curiam), cert. denied, 109 S.Ct. 3216 (1989); see also Donovan v. Dillingham, 688 F.2d 1367, 1375 (11th Cir.1982) (en banc) (existence of ERISA employee welfare benefit plan conferred subject matter jurisdiction on district court)

2

We note that under 29 U.S.C. Sec. 1002(16)(A), the plan administrator is the person designated by the terms of the instrument under which the plan is operated, and if not so designated, the plan sponsor. The plan sponsor, under 29 U.S.C. Sec. 1002(16)(B), is the employer in the case of an employee benefit plan established or maintained by a single employer