Allison v. Wellmark, Inc.

153 F. Supp. 2d 1023, 26 Employee Benefits Cas. (BNA) 2199, 2001 U.S. Dist. LEXIS 10872, 2001 WL 867392
CourtDistrict Court, N.D. Iowa
DecidedJuly 30, 2001
DocketC00-3015-MWB
StatusPublished
Cited by3 cases

This text of 153 F. Supp. 2d 1023 (Allison v. Wellmark, Inc.) is published on Counsel Stack Legal Research, covering District Court, N.D. Iowa primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Allison v. Wellmark, Inc., 153 F. Supp. 2d 1023, 26 Employee Benefits Cas. (BNA) 2199, 2001 U.S. Dist. LEXIS 10872, 2001 WL 867392 (N.D. Iowa 2001).

Opinion

MEMORANDUM OPINION AND ORDER REGARDING MOTIONS FOR SUMMARY JUDGMENT

BENNETT, Chief Judge.

TABLE OF CONTENTS

J. INTRODUCTION AND BACKGROUND .1025

A. Procedural Background.1025

*1025 B. Factual Background.1025

II. LEGAL ANALYSIS.1027

A. Standards For Summary Judgment.1027

B. Standard Of Review.1028

C. Wellmark’s Interpretation Of The Plan.1029

D. Analysis of Shell Factors.1030

1. Interpretation consistent with clear language of the Plan.1030

2. Interpretation renders plan language internally inconsistent.1031

3. Interpretation consistent with earlier interpretations.1032

4. Interpretation of the Plan consistent with its goals.1032

5. Interpretation of the Plan consistent with ERISA .1032

III. CONCLUSION.1034

I. INTRODUCTION AND BACKGROUND

A. Procedural Background

On February 3, 2000, plaintiff Paul J. Allison filed a petition for declaratory judgment in the Iowa District Court In And For Franklin County seeking a declaration that defendant Wellmark, Inc. d/b/a Blue Cross and Blue Shield of Iowa (“Wellmark”) had no right of subrogation to the proceeds of plaintiff Allison’s under-insured motorist coverage. Defendant Wellmark removed this case to this court on February 18, 2000, pursuant to 28 U.S.C. § 1441. On February 28, 2001, defendant Wellmark filed its answer and prayed for a declaration from the court that Wellmark’s subrogation rights extend to plaintiff Allison’s underinsured motorist coverage. On April 12, 2001, plaintiff Allison filed his Motion For Summary Judgment (# 10) and defendant Wellmark filed its Motion For Partial Summary Judgment (# 16). The parties’ cross-motions for summary judgment center on the nub of this case, whether defendant Wellmark is entitled to subrogation of plaintiff Allison’s right to recovery of underinsured motorist coverage proceeds.

The court heard telephonic oral arguments on the parties’ respective motions for summary judgment on July 26, 2001. At the oral arguments, plaintiff Allison was represented by counsel Raymond P. Drew of Drew & Miller, P.C., Hampton, Iowa. Defendant Wellmark was represented by counsel David Swinton of Ahlers, Cooney, Dorweiler, Haynie, Smith & Allbee, P.C., Des Moines, Iowa. The court turns first to a discussion of the undisputed facts as shown by the record and the parties’ submissions, then to consideration of the standards applicable to motions for summary judgment, and, finally, to the legal analysis of whether either party is entitled to summary judgment.

B. Factual Background

The record reveals that the following facts are undisputed. Plaintiff Paul J. Allison was an employee of the Curries Company on June 3, 1990. As an employee of the Curries Company, Allison had health care benefits through the Curries Company health benefits plan (“The Plan”). The Plan is self-funded by the Curries Company and is maintained pursuant to an Alliance Select Benefit Certificate. Defendant Wellmark provides certain administrative services and stop-loss coverage to the Curries Company with respect to the Plan pursuant to an Administrative Services and Financial Agreement. The Plan is an employee welfare benefit plan governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. (“ERISA”). Plaintiff Allison was furnished with a copy of the Plan.

*1026 On June 3, 1999, plaintiff Allison was severely injured in an automobile accident. Plaintiff Allison was a passenger in the automobile at the time of the accident. The accident was caused by the driver of the automobile in which Allison was a passenger. The driver of the automobile carried automobile insurance with the Hartford Insurance Company with a liability limit of $10,000. Plaintiff had automobile insurance with the Prudential Insurance Company which provided underinsured motorist coverage in the amount of $100,000.

As a result of the injuries sustained in the accident, plaintiff Allison incurred medical expenses in excess of $135,000. Plaintiff Allison’s total damages for injuries sustained in the accident exceed the amount of automobile insurance coverage available to him. Following the accident, Allison made a demand on the Prudential Insurance Company for the limits of his underinsured motorist coverage. The Prudential Insurance Company subsequently paid to Allison underinsured motorist benefits in the amount of $100,000.

Defendant Wellmark has paid $126,067.17 in benefits for the medical expenses incurred by Allison as a result of the accident. The Plan contains the following provision with respect to subrogation:

□ SUBROGATION
Once you receive benefits under this certificate arising from an illness or injury, we will assume any legal right you have to collect compensation, damages, or any other payment related to the illness or injury, including benefits from any of the following:
□ The responsible person’s insurer.
□ Uninsured motorist coverage.
□ Underinsured motorist coverage
□ Other insurance coverage.
You and your family agree to all of the following:
□ You will let us know about any potential claims or rights of recovery related to the illness or injury.
□ You will furnish any information and assistance we determine we will need to enforce our rights under this certificate.
□ You will do nothing to prejudice our rights and interests.
□ You will not compromise, settle, surrender, or release any claim or right of recovery described above, without getting our written permission.
□ You must reimburse us to the extent of benefit payments made under this certificate if payment is received from the other party or parties.
You and your covered family member(s) must notify us if you have the potential right to receive payment from someone else. You must cooperate with us to ensure that our rights to subrogation are protected.
We reserve the right to offset any amounts owed to us against any future claim settlement amounts.

Curries Company Alliance Select Health Benefits Certificate, Def.’s Ex.

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Cite This Page — Counsel Stack

Bluebook (online)
153 F. Supp. 2d 1023, 26 Employee Benefits Cas. (BNA) 2199, 2001 U.S. Dist. LEXIS 10872, 2001 WL 867392, Counsel Stack Legal Research, https://law.counselstack.com/opinion/allison-v-wellmark-inc-iand-2001.