Auto-Owners Insurance v. Edward D. Jones & Co. Employee Health & Welfare Program

759 F. Supp. 2d 895, 2010 U.S. Dist. LEXIS 100712, 2010 WL 3810214
CourtDistrict Court, W.D. Michigan
DecidedSeptember 23, 2010
DocketCase 1:09-CV-938
StatusPublished

This text of 759 F. Supp. 2d 895 (Auto-Owners Insurance v. Edward D. Jones & Co. Employee Health & Welfare Program) is published on Counsel Stack Legal Research, covering District Court, W.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Auto-Owners Insurance v. Edward D. Jones & Co. Employee Health & Welfare Program, 759 F. Supp. 2d 895, 2010 U.S. Dist. LEXIS 100712, 2010 WL 3810214 (W.D. Mich. 2010).

Opinion

OPINION

ROBERT HOLMES BELL, District Judge.

Before the Court is Defendant’s motion to dismiss Plaintiffs complaint (Dkt. No. 1) pursuant to Rule 12(b)(6) of the Federal Rules of Civil Procedure. (Dkt. No. 11.) For the reasons given herein, the motion will be granted.

I. Background

Andrew Cove was injured in an automobile accident on July 28, 2003. At the time of the accident, Mr. Cove was an employee of Edward D. Jones & Co. and a participant in the Edward Jones & Co. Employee Health and Welfare Program (“Plan”), a self-funded ERISA plan. He was also insured for no-fault automobile insurance by Auto-Owners.

Mr. Cove incurred medical expenses as a result of the accident. (Dkt. No. 1, Exhibit B, 3.) Although the Plan paid Mr. Cove’s earliest bills after the accident, it began refusing to make payments on August 20, 2003. Since that date, the Plan has refused to pay any of Mr. Cove’s medical expenses related to the accident, asserting that it is secondary to Mr. Cove’s auto insurance, Auto-Owners. 1 It does not appear from the record that Mr. Cove submitted any expenses to the Plan after that date. On October 24, 2003, the Plan demanded reimbursement from Auto-Owners in the amount of $10,553.52 for its early payments and provided Auto-Owners with the relevant plan language to substantiate its claim that the Plan should be secondary. (Dkt. No. 18, Exhibit 1, #5.) Auto-Owners responded by sending the Plan a check for $9,577.03 and noted that Auto-Owners had already reimbursed the Plan for previous payments the Plan *899 had made on behalf of Mr. Cove. (Id. at # 6.) Mr. Cove’s coverage under the Plan ended in 2005. (Dkt. No. 1, Complaint, ¶¶ 11,18.)

On October 13, 2009, Auto-Owners filed the present suit. Auto-Owners alleges that it paid $195,299.88 on behalf of Mr. Cove between July 28, 2003, and the end of his coverage under the Plan in 2005. (Dkt. No. 1, Complaint, ¶¶ 11, 18.) Auto-Owners further alleges that these payments were made out of priority; that is, that they should have been paid by the Plan. (Id.) The Plan filed a motion to dismiss on January 25, 2010, alleging that Auto-Owners relies on preempted Michigan state law which does not apply to the Plan, that the complaint is untimely, and that Auto-Owners is primary in any case. It is that motion that is before the Court today.

II. Legal Standards

The parties disagree as to whether the Court should treat the Plan’s motion as a motion to dismiss under Rule 12(b)(6) or a motion for summary judgment under Rule 56 of the Federal Rules of Civil Procedure. In reviewing a motion to dismiss under Federal Rule of Civil Procedure 12(b)(6), the Court must accept all well-pleaded allegations of the complaint as true and construe them in the light most favorable to the plaintiff. Scheuer v. Rhodes, 416 U.S. 232, 236, 94 S.Ct. 1683, 40 L.Ed.2d 90 (1974). A statute of limitations defense “may be raised on a motion to dismiss under Rule 12(b)(6) when it is apparent from the face of the complaint that the time limit for bringing the claim has passed.” Hoover v. Langston Equip. Assocs., 958 F.2d 742, 744 (6th Cir.1992). In such cases, “the plaintiff may come forward with allegations explaining why the statute of limitations should be tolled.” Id.

In evaluating a motion for summary judgment under Rule 56, on the other hand, the Court must look beyond the pleadings and assess the proof. Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986). Summary judgment is proper where there is no genuine issue as to any material fact and the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c)(2). In considering a motion for summary judgment, the Court must construe the evidence and draw all reasonable inferences in favor of the nonmoving party. Minges Creek, L.L.C. v. Royal Ins. Co. of Am., 442 F.3d 953, 955-56 (6th Cir.2006) (citing Matsushita, 475 U.S. at 587, 106 S.Ct. 1348). Nevertheless, the mere existence of a scintilla of evidence in support of the nonmoving party’s position is not sufficient to create a genuine issue of material fact. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 252, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). The proper inquiry is whether the evidence is such that a reasonable jury could return a verdict for the nonmoving party. Id.; see generally, Street v. J.C. Bradford & Co., 886 F.2d 1472, 1476-80 (6th Cir.1989).

III. Analysis

A.) Timeliness

Were this a primacy dispute between two insurers, Michigan law would provide a cause of action for payments made out of priority. See Mich. Comp. Laws § 500.3109a; Citizens Ins. Co. v. MidMichigan Health Plan, 449 F.3d 688, 694 (6th Cir.2006). Here, however, neither party disputes that Defendant is a self-funded ERISA plan, and that the Michigan law has been preempted. See Auto Club Ins. Ass’n v. Health & Welfare Plans, Inc., 961 F.2d 588, 593 (6th Cir.1992). In such cases, it is federal common law which provides the cause of action. See Auto Owners Ins. Co. v. Thorn Apple Valley, 31 F.3d 371 (6th Cir.1994); MidMichigan Health Plan, 449 F.3d at 690 (“[A] priority dispute *900 arising between an ERISA plan and a no-fault policy is resolved pursuant to federal common law.”).

Although ERISA preempts the state law in this case, ERISA does not contain an applicable statute of limitations provision. This is not surprising given that “ERISA contains no provision specifically according [Plaintiff] the right to bring a cause of action” — as noted above, that development has been one of federal common law. Thorn Apple Valley, 31 F.3d at 374. “[I]n the absence of a federally mandated statute of limitations, the court should apply the most analogous state law statute of limitations.” Redmon v. Sud-Chemie Inc. Ret. Plan for Union Emps.,

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Bluebook (online)
759 F. Supp. 2d 895, 2010 U.S. Dist. LEXIS 100712, 2010 WL 3810214, Counsel Stack Legal Research, https://law.counselstack.com/opinion/auto-owners-insurance-v-edward-d-jones-co-employee-health-welfare-miwd-2010.