April 18, 2018

Colorado Court of Appeals: Arbitration Clause in Health Insurance Contract Displaced by C.R.S. § 10-3-1116

The Colorado Court of Appeals issued its opinion in Meardon v. Freedom Life Insurance Co. of America on Thursday, March 8, 2018.

Health Insurance Policy—Mandatory Arbitration—Conformity Clause—Federal Arbitration Act—C.R.S. § 10-3-1116(3)—McCarran-Ferguson Act—Federal Supremacy—Preemption—Reverse Preemption.

Defendants Freedom Life Insurance Company of America and Robert J. Pavese (collectively, Freedom Life) denied health insurance benefits claimed by plaintiff  Meardon under a health insurance policy (policy) issued to her by Freedom Life. The policy contained a mandatory arbitration clause to resolve disputes. The policy also contained a “conformity clause” stating that a policy provision that conflicts with the laws of the policyholder’s state is amended to conform to the minimum requirements of such laws. Freedom Life moved to compel arbitration and to dismiss the case, relying on the mandatory arbitration clause. The trial court denied the motion, relying on C.R.S. § 10-3-1116(3), which allows denied claims to be contested in court before a jury.

On appeal, Freedom Life contended that (1) C.R.S. § 10-3-1116(3) cannot be applied because it is preempted by the Federal Arbitration Act (FAA); (2) even if the FAA does not preempt the statute, the arbitration clause remains in effect for those claims that fall outside the statute; and (3) Meardon must arbitrate her claims to “exhaust her administrative remedies” under C.R.S. § 10-3-1116(3). The plain words of the statute conflict with the mandatory arbitration clause. This conflict triggered the policy’s conformity clause, the application of which invalidated the arbitration clause for those claims covered by C.R.S. § 10-3-1116(3). Further, the FAA does not preempt C.R.S. § 10-3-1116(3) because the McCarran-Ferguson Act preempts the FAA under the doctrine of reverse-preemption.

Freedom Life alternatively contended that only those claims covered by C.R.S. § 10-3-116(3) are exempted from the arbitration clause and the remaining claims must be arbitrated. Because the parties did not seek a ruling from the trial court on this specific issue, the court of appeals was unable to determine which claims are subject to the arbitration clause.

The court’s order denying arbitration of those claims covered by C.R.S. § 10-3-1116(3) was affirmed. The case was remanded for the trial court to determine which claims are covered by C.R.S. § 10-3- 1116(3) and which are subject to the policy’s arbitration clause.

Summary provided courtesy of Colorado Lawyer.

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