Alves v. Silverado Foods, Inc.

6 F. App'x 694
CourtCourt of Appeals for the Tenth Circuit
DecidedMarch 9, 2001
Docket00-5011
StatusUnpublished
Cited by6 cases

This text of 6 F. App'x 694 (Alves v. Silverado Foods, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Tenth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Alves v. Silverado Foods, Inc., 6 F. App'x 694 (10th Cir. 2001).

Opinion

ORDER AND JUDGMENT **

BELOT, District Judge.

After examining the briefs and appellate record, this panel has determined unanimously to honor the parties’ request for a decision on the briefs without oral argument. See Fed.RApp.P. 34(f). The case is therefore submitted without oral argument.

INTRODUCTION

Joseph and Kristi Alves appeal the district court’s final order and judgment granting in part and denying in part their motion for summary judgment The Alves filed this ERISA enforcement action seeking declaratory and injunctive relief after their employee welfare benefit plan refused to pay medical benefits. On cross-motions for summary judgment, the district court found the plan’s refusal justified due to the Alves’ refusal to sign a reimbursement acknowledgment form. We exercise jurisdiction under 28 U.S.C. § 1291 and affirm.

BACKGROUND

Through his employer, Silverado Foods, Inc., Joseph Alves participated in the Silverado Foods Welfare Benefit Plan (“the Plan”), an “employee welfare benefit plan” governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq. (“ERISA”). Alves’ wife and minor son, Kristi and Braden Alves, were beneficiaries of the Plan and were thus “covered persons” under the terms of the Plan. Silverado Foods, Inc. is the Named Fiduciary of the Plan.

*697 Pursuant to 29 U.S.C. § 1021(a), the Plan distributed a Summary Plan Description (“SPD”) to its plan participants and beneficiaries. 1 Importantly, for purposes of this litigation, the SPD provided for the Plan’s subrogation rights in instances of third-party recovery situations. The SPD stated:

RIGHT OF SUBROGATION AND REFUND

When this provision applies. The Covered Person may incur medical or dental charges due to injuries which may be caused by the act or omission of a third party. In such circumstances, the Covered Person may have a claim against that third party, or insurer, for payment of the medical or dental charges. Accepting benefits under this Plan for those incurred medical or dental expenses automatically assigns to the Plan any rights the Covered Person may have to recover payments from any third party or insurer. This subrogation right allows the Plan to pursue any claim which the Covered Person has against any third party, or insurer, whether or not the Covered Person chooses to pursue that claim. The Plan may make a claim directly against the third party or insurer, but in any event, the Plan has a lien on any amount recovered by the Covered Person whether or not designated as payment for medical expenses. This lien shall remain in effect until the Plan is repaid in full.

The Covered Person:

• automatically assigns to the Plan his or her rights against any third party or insurer when this provision applies; and
• must repay to the Plan the benefits paid on his or her behalf out of the recovery made from the third party or insurer.
Amount subject to subrogation or refund. The Covered Person agrees to recognize the Plan’s right to subrogation and reimbursement. These rights provide the Plan with a priority over any funds paid by a third party to a Covered Person relative to the Injury or Sickness, including a priority over any claim for non-medical or dental charges, attorney fees, or other costs and expenses. Notwithstanding its priority to funds, the Plan’s subrogation and refund rights, as well as the rights assigned to it, are limited to the extent to which the Plan has made, or will make, payments for medical or dental charges as well as any costs and fees associated with the enforcement of its rights under the Plan. When a right or recovery exists, the Covered Person will execute and deliver all required instruments and papers as well as doing whatever else is needed to secure the Plan’s right of subrogation as a condition to having the Plan make payments. In addition, the Covered Person will do nothing to prejudice the right of the Plan to subrogate.
Defined terms: “Recovery” means monies paid to the Covered Person by way of judgment, settlement, or otherwise to compensate for all losses caused by the Injuries or Sickness whether or not said losses reflect medical or dental charges covered by the Plan.
“Subrogation” means the Plan’s right to pursue the Covered Person’s claims for medical or dental charges against the other person.
*698 “Refund” means repayment to the Plan for medical or dental benefits that it has paid toward care and treatment of the Injury or Sickness.

(Summary Plan Description at 34; Aplt. App., Tab 7 at 000194).

On March 3, 1997, Kristi and Braden Alves were involved in a catastrophic motor vehicle accident in which Kristi Alves suffered a permanent and irreversible brain injury. As a result of the injuries sustained from the accident, the Alves incurred medical expenses totaling $103,514.24. The Alves filed suit in Texas against the tortfeasor who tendered the limits of an available liability policy in the amount of $100,000. The Texas state court action has not been resolved, nor have the Alves accepted the $100,000 tendered.

The Alves submitted their medical bills to the Plan for processing and payment. The Plan, however, required the Alves to sign a standard reimbursement acknowledgment form before it would pay out any benefits. The acknowledgment form read:

In accordance with the Subrogation provision of the SILVERADO FOODS Employee Health Benefit Plan, the undersigned hereby agrees to reimburse and pay promptly to the SILVERADO FOODS Employee Health Benefit Plan an amount not exceeding the aggregate amount of benefits paid or to be paid to me or on my behalf under said Plan for charges incurred as a result of injury sustained or disease contracted on or about in County, State of out of recovery by settlement or judgment or otherwise, from any person’s or organization’s insurance.
The undersigned agrees to execute instruments and papers, furnish information and assistance, and to take other necessary and related actions that SILVERADO FOODS may require to facilitate its right of reimbursement under the Employee Health Benefit Plan.
The undersigned represents and warrants that no release or discharge has been given with respect to his (their) rights of recovery described herein and that the undersigned has done nothing to prejudice said rights.

The Alves refused to sign the acknowledgment form, believing the form granted the Plan additional rights and that their signing the form would waive their legal rights.

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Cite This Page — Counsel Stack

Bluebook (online)
6 F. App'x 694, Counsel Stack Legal Research, https://law.counselstack.com/opinion/alves-v-silverado-foods-inc-ca10-2001.