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Board of Trustees of National Elevator Industry Health Benefit Plan v. McLaughlin

United States District Court, Third Circuit

January 24, 2014

Board of Trustees of the National Elevator Industry Health Benefit Plan, Plaintiff,
v.
Bernard McLaughlin, Defendant.

OPINION

ANNE E. THOMPSON, District Judge.

This matter comes before the Court on Plaintiff Board of Trustees of the National Elevator Industry Health Benefit Plan's motion for summary judgment, (Doc. No. 20), and Defendant Bernard McLaughlin's counterclaim and motion for summary judgment, (Doc. No. 22). The Court has issued the Opinion below based upon the written submissions of the parties and without oral argument pursuant to Federal Rule of Civil Procedure 78(b). For the reasons stated herein, the Court grants Plaintiff's motion for summary judgment and denies Defendant's motion.

DISCUSSION

Defendant's ERISA Plan seeks reimbursement for money paid toward Defendant's medical expenses. (Doc. No. 1, 1). Plaintiff is the named fiduciary and administrator of the National Elevator Industry Health Benefit Plan (the "Plan"), as defined in sections 402(a) and 3(16)(A) of the Employee Retirement Income Security Act of 1974 (ERISA) (29 U.S.C. § 1102(a) and § 1002(16)(A). Defendant was a participant in the Plan. (Doc. No. 1, 2).

On January 10, 2009, Defendant was injured in a motor vehicle accident. (Doc. No. 1, 1). Defendant asserted a liability claim against a third party for his injuries. (Doc. No. 1, 2). The third party settled with Defendant. (Doc. No. 1, 2).

A portion of Defendant's medical bills were paid by the Plan. (Doc. No. 1, 2). The Plan required Defendant to reimburse the Plan if Defendant received money from any proceeding related to the injury, "regardless of how the proceeds are characterized." (Doc. No. 1). The Plan states:

[a]cceptance of benefits from the Plan for an injury or illness by a covered person [...] constitutes an agreement that any amounts recovered from another party by award, judgment, settlement or otherwise, and regardless of how the proceeds are characterized, will promptly be applied first to reimburse the Plan in full for benefits advanced by the Plan due to the injury or illness and without reduction for attorney's fees, costs, expenses or damages claimed by the covered person, and regardless of whether the covered person is made whole or recovers only parts of his/her damages.

(Doc. No. 1). Based on this language, Plaintiff contends that Defendant must reimburse Plaintiff for the money advanced for medical bills from the settlement proceeds. (Doc. No. 1). However, Defendant claims that he did not ask for or receive money for medical bills in the settlement and, therefore, is under no obligation to reimburse Plaintiff. (Doc. No. 22, 8).

Defendant has also counterclaimed pursuant to 29 U.S.C. § 1132 ((a)(1)(B)) for a declaration that his right to benefits is unaffected by this failure to reimburse the Plan and has moved for summary judgment on that count. (Doc. No. 22).

1. Legal Standard

"The court shall grant summary judgment if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(c)(2). The Court must construe all facts and inferences in the light most favorable to the nonmoving party. Boyle v. City of Allegheny Pennsylvania, 139 F.3d 386, 393 (3d Cir. 1998). The nonmoving party must come forward with specific facts showing a genuine issue for trial. Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 586-87 (1986) (citations omitted). "A factual dispute is genuine' and... warrants trial if the evidence is such that a reasonable jury could return a verdict for the nonmoving party.'" Brightwell v. Lehman, 637 F.3d 187, 194 (3d Cir. 2011) (citations omitted).

"Credibility determinations, the weighing of the evidence, and the drawing of legitimate inferences from the facts are jury functions, not those of a judge." Anderson v. Liberty Lobby, 477 U.S. 242, 255 (1986). If a civil defendant moves for summary judgment on the basis that plaintiff has failed to establish a material fact, the judge must inquire not as to "whether [s]he thinks the evidence unmistakably favors one side or the other but[, ] whether a fair-minded jury could return a verdict for the plaintiff on the evidence presented." Id. at 252. A mere "scintilla of evidence in support of the plaintiff's position will be insufficient; there must be evidence on which the jury could reasonably find for the plaintiff." Id.

2. Analysis

The Court must determine three main issues: 1) whether Plaintiff may bring the present action; 2) whether the Court should enforce the terms of the Other Party Liability Claims provision of the Plan; and 3) ...


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