## Facts

- John P. O’Neil, Commissioner of the Essex County Department of Social Services (the Commissioner), sued regarding health coverage for W.P.L., a child whose support rights had been assigned to the Commissioner by the child’s mother, Betsy Lord.
- Aimee Vradenburg, a Wal-Mart employee and the child-support obligor, participated in the Wal-Mart Stores, Inc. Associates’ Health and Welfare Plan (the Plan), a group health plan governed by ERISA.
- A New York Family Court issued a medical support order directing that health insurance be provided for W.P.L. through available employer-sponsored coverage.
- The Commissioner submitted the order to the Plan and contended it was a qualified medical child support order (QMCSO) under 29 U.S.C. § 1169 and was also supported by New York Insurance Law § 2608–a.
- The Plan denied coverage, arguing (1) the order did not satisfy ERISA’s QMCSO requirements, (2) ERISA preempted New York Insurance Law § 2608–a, and (3) W.P.L., as a stepson, did not meet the Plan’s eligibility rules and the order could not override those rules.
- The parties filed cross-motions for summary judgment, asserting there were no disputed material facts and that the dispute turned on legal questions about QMCSO validity, eligibility, and preemption.

## Issues

1. Whether the Family Court medical support order qualified as a QMCSO under ERISA, 29 U.S.C. § 1169, such that the Plan had to provide coverage to W.P.L.
2. Whether the Plan could deny coverage by relying on its own dependent-eligibility terms, including arguments based on W.P.L.’s status as a stepchild.
3. Whether ERISA preempted reliance on New York Insurance Law § 2608–a in seeking enforcement of the medical support order.

## Decision

- The court granted summary judgment for the Commissioner and denied the Plan’s cross-motion.
- The court held the Family Court order was a valid QMCSO under 29 U.S.C. § 1169.
- The court rejected the Plan’s argument that a stepchild is outside ERISA’s QMCSO protection, reasoning that the statute focuses on whether the child is a “dependent child,” not on birth parentage.
- The court concluded the Plan could not use plan eligibility guidelines to defeat obligations triggered by a valid QMCSO.
- The court rejected the Plan’s ERISA preemption defense as applied to the Commissioner’s reliance on New York Insurance Law § 2608–a in this setting and required the Plan to provide coverage consistent with the QMCSO.

## Legal Principles

- ERISA requires a group health plan to provide benefits in accordance with the requirements of a QMCSO. See 29 U.S.C. § 1169.
- A medical child support order is “qualified” when it meets ERISA’s content and administration requirements and does not demand a type or form of benefit not otherwise offered by the plan.
- For QMCSO purposes, “dependent child” is not limited to biological or adopted children; a stepchild may qualify when the child is a dependent of the participant within the meaning of the statute.
- A plan administrator may not reject an order that meets ERISA’s QMCSO requirements by relying on narrow readings of plan eligibility terms where the order triggers ERISA’s duty to provide coverage.
- ERISA’s preemption provision does not allow a plan to avoid QMCSO-based obligations, and state insurance requirements directed at enforcing medical support for dependent children may operate consistently with ERISA’s QMCSO scheme.

## Conclusion

The court held that the New York Family Court medical support order qualified as a QMCSO under ERISA and required the Wal-Mart plan to provide health coverage for the employee’s dependent stepchild, rejecting both the Plan’s eligibility-based defenses and its claim that ERISA preempted enforcement supported by New York Insurance Law § 2608–a.


O'Neil v. Wal-Mart, 502 Fed. Supp. 2d 318 (2007)