CopyPublished | District Court, S.D. Florida | 1994 U.S. Dist. LEXIS 561, 1994 WL 22553
...Accordingly, the Defendant, *524 PALIC provided coverage in the amount of $1,500 pursuant to the terms and conditions of the plan. The Plaintiff, however, believes that she is entitled to a larger payment from the Defendant. According to the Plaintiff, under Florida Statute 627.666 relating to insurance, the Defendant is obligated to pay benefits equal to the lesser of the benefits which would have been payable for the medical treatment under the Plaintiff's prior insurance plan, or the coverage which would be available under the subsequent PALIC plan, were it not for the pre-existing condition limitation. The Plaintiff also makes this contention by way of traditional tort and contract claims. Relying upon Florida Statute 627.666, the Plaintiff further contends that her case is not preempted by the Employee Retirement Income Security Act of 1974, 29 U.S.C....
...subject to federal preemption under the ERISA. As tort and contract actions, the Plaintiff's claims are void. See Title 29 U.S.C. § 1144. Likewise, the Plaintiff's state statutory argument is unavailing. According to the Defendant, Florida Statute
627.666 does not create a private cause of action, nor does it not apply to the insurance policy at issue. Under Florida Statute
627.6515, the Defendant argues, its insurance policy meets the test for exclusion from the requirements of Florida Statute
627.666, because the policy is allegedly in compliance with the three elements of Section
627.6515(2)....
...Consequently, the Defendant contends that this Court should grant summary judgment in its favor, because the Plaintiff has already admitted that the Defendant processed the insurance claim in accordance with the original terms of the plan. DISCUSSION The Plaintiff's central argument rests on Florida Statute 627.666....
...This statute defines the liability of a succeeding insurer upon the replacement of a group, blanket, or franchise health insurance policy. However, based upon the record presented before this Court, this Court finds that the provisions of Florida Statute 627.666 have no effect upon the outcome of this case....
...n Florida.' ... and c) The policy provides the benefits specified in sections
627.419,
627.6574,
627.6575,
627.6579,
627.6613,
627.667, and
627.6675. *525 This provision apparently exempts out-of-state groups from the requirements of Florida Statute
627.666 when the health policy at issue meets the conditions set forth in subsections (a), (b), and (c) of section
627.6515(2)....
...In response, the Plaintiff has offered only argument by counsel that the Defendant has failed to meet its burden of showing that they have met the conditions of section
627.6515(2). Given the possible application of Florida Statute
627.6515(2), the relevancy of section
627.666 remains tenuous. More importantly, however, even if this Court were to find that section
627.666 applies to the Defendant, the Plaintiff's reliance upon Florida Statute
627.666 would still fail to protect this case from federal preemption under ERISA. In particular, the Plaintiff's reliance is misplaced because Florida Statute
627.666 neither creates an express private right of action, nor is it an essential element of the Plaintiff's tort and contract claims....
...Generally, the federal courts are "reluctant to read private rights of action in state laws where state courts and state legislatures have not done so." Farlow v. Union Cent. Life Ins. Co.,
874 F.2d 791, 795 (11th Cir.1989). In this case, nothing in the text or history of Florida Statute
627.666 suggests that the section carries a private cause of action, thus this Court declines to read one into the statute....
...y be the substitution of their pleasure to that of the legislative body. The Federalist No. 78, at 396 (A. Hamilton) (Bantam Classic Edition 1982). Ultimately, the state statute through which the Plaintiff hopes to escape ERISA is irrelevant because section 627.666 does not delineate an independent cause of action....
