AirTran Airways, Inc. v. Elem

771 F. Supp. 2d 1344, 2011 U.S. Dist. LEXIS 35470, 2011 WL 1045583
CourtDistrict Court, N.D. Georgia
DecidedMarch 8, 2011
DocketCivil Action 1:10-CV-3673-ODE
StatusPublished
Cited by2 cases

This text of 771 F. Supp. 2d 1344 (AirTran Airways, Inc. v. Elem) is published on Counsel Stack Legal Research, covering District Court, N.D. Georgia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
AirTran Airways, Inc. v. Elem, 771 F. Supp. 2d 1344, 2011 U.S. Dist. LEXIS 35470, 2011 WL 1045583 (N.D. Ga. 2011).

Opinion

ORDER

ORINDA D. EVANS, District Judge.

This claim for reimbursement under an employee welfare benefit plan subject to the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), 29 U.S.C. §§ 1101 et seq., is before the Court on a motion to dismiss pursuant to Federal Rule of Civil Procedure 12(b)(6) filed by Defendants Mark D. Link and Link & Smith, P.C. (together, the “Link Defendants”) [Doc. 5]. Plaintiff AirTran Airways, Inc. (“AirTran”) filed a response in opposition to the motion to dismiss [Doc. 6], to which the Link Defendants replied [Doc. 10]. For the reasons set forth below, the Link Defendants’ motion to dismiss [Doc. 5] is DENIED.

I. Background

The facts that follow are set forth in AirTran’s complaint. AirTran funded and sponsored an employee welfare benefit plan (the “Plan”), in which Defendant Brenda Elem (“Defendant Elem”) participated [Doc. 1 at 2-3]. The Plan was administered by Aetna Life Insurance Company (“Aetna”) on behalf of AirTran [Id. at 2]. On or about March 10, 2007, Defendant Elem was involved in a car accident [Id. at 3]. The Plan provided $131,704.28 in medical benefits to Defendant Elem as a result of her injuries [Id.}.

The Plan Documents/which set forth the terms by which the Plan benefits are provided, require Defendant Elem to reimburse the Plan for the amount of medical benefits provided on her behalf when Elem recovers these benefits from a third party source [Id. at 4]. The Plan Documents provide:

Subrogation
Immediately upon paying or providing any benefit under this Plan, the Plan shall be subrogated to (stand in the *1347 place of) all rights of recovery a Covered Person has against any Responsible Party with respect to any payment made by the Responsible Party to a Covered Person due to a Covered Person’s injury ... to the full extent of benefits provided or to be provided by the Plan.
Reimbursement
In addition, if a Covered Person receives any payment from any Responsible Party or Insurance Coverage as a result of an injury ... the Plan has the right to recover from, and be reimbursed by, the Covered Person for all amounts this Plan has paid and will pay as a result of that injury ... up to and including the full amount the Covered Person receives from any Responsible Party.
Constructive Trust
By accepting benefits ... from the Plan, the Covered Person agrees that if he or she receives any payment from any Responsible Party as a result of injury ... he or she will serve as a constructive trustee over the funds that constitute such payment....
Lien Rights
Further, the Plan will automatically have a lien to the extent of benefits paid by the Plan for treatment of the ... injury ... for which the Responsible Party is liable. The lien shall be imposed upon any recovery whether by settlement, judgment, or otherwise related to treatment for any illness, injury, or condition for which the Plan paid benefits....
First-Priority Claim
By accepting benefits ... from the Plan, the Covered Person acknowledges that this Plan’s recovery rights are a first priority claim against all Responsible Parties and are to be paid to the Plan before any other claim for the Covered Person’s damages. This Plan shall be entitled to full reimbursement on a first-dollar basis from any Responsible Party’s payments, even if such payment to the Plan will result in a recovery to the Covered Person which is insufficient to make the Covered Person whole or to compensate the Covered Person in part or in whole for the damages sustained. The Plan is not required to participate in or pay court costs or attorney fees to any attorney hired by the Covered Person to pursue the Covered Person’s damage claim.
Applicability to All Settlements and Judgments
The terms of this entire subrogation and right of recovery provision shall apply and the Plan is entitled to full recovery regardless of whether any liability for payment is admitted by any Responsible Party and regardless of whether the settlement or judgment received by the Covered Person identifies the medical benefits the Plan provided or purports to allocate any portion of such settlement or judgment to payment of expenses other than medical expenses. The Plan is entitled to recover from any and all settlements or judgments, even those designated as pain and suffering, non-economic damages, and/or general damages only.

[Doc. 1-2, Ex. 2 at 2-3].

Following the car accident, Defendant Elem retained the Link Defendants as counsel and filed suit against the third party responsible for the accident, Miguel A. Rizoiglesias, in the State Court of Cherokee County, Georgia (the “civil action”) [Doc. 1 at 5]. On July 13, 2007, counsel for Aetna (the Plan administrator) wrote a letter to Defendant Elem regarding the civil action against Mr. Rizoiglesias and advised Defendant Elem of the reimbursement and subrogation provisions contained in the Plan [Id. at 5-6; Doc. 1-3, Ex. 3 at 2], The letter also requested that Defendant Elem contact Aetna “prior to settle *1348 ment to obtain the final amount due” under the Plan’s reimbursement provision [Doc. 1-3, Ex. 3 at 2],

On July 24, 2007, Aetna sent to Mr. Rizoiglesias’ insurer, AIG Insurance d/b/a American International South Insurance Company (“AIG”) a Notice of Lien/Claim Pertaining to Self-Funded, ERISA-Qualified Plan Which Preempts State Law (“Notice of Lien”) [Doc. 1 at 6; Doc. 1-4, Ex. 4 at 2]. The Notice of Lien informed AIG of the Plan’s subrogation and reimbursement rights against Defendant Elem and advised AIG of the Plan’s automatic lien on any “judgment, settlement, or compromise” between the parties to the civil action [Doc. 1-4, Ex. 4 at 2],

On September 21, 2007, AIG received a demand letter in which Defendant Elem advised AIG of: (1) her willingness to settle her claim within AIG’s policy limits of $25,000 within 30 days of the demand letter; (2) her claim that Aetna did not have an automatic lien on any settlement funds obtained in the civil action; and (3) her intention to pursue the full amount of her claim against Mr. Rizoiglesias if AIG declined to pay her $25,000 within 30 days [Doc. 1-5, Ex. 5 at 2],

On December 6, 2007, Aetna provided the Link Defendants with a Notice of Lien, which informed the Link Defendants of the Plan’s subrogation and reimbursement rights, as well as the Plan’s automatic lien against any “judgment, settlement, or compromise” between Defendant Elem and Mr. Rizoiglesias [Doc. 1-6, Ex. 6 at 2].

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Cite This Page — Counsel Stack

Bluebook (online)
771 F. Supp. 2d 1344, 2011 U.S. Dist. LEXIS 35470, 2011 WL 1045583, Counsel Stack Legal Research, https://law.counselstack.com/opinion/airtran-airways-inc-v-elem-gand-2011.