BlueCross BlueShield of South Carolina v. Carillo

372 F. Supp. 2d 628, 2005 WL 1350048
CourtDistrict Court, N.D. Georgia
DecidedMay 25, 2005
DocketCIV.A.4:05 CV 0044 H
StatusPublished
Cited by7 cases

This text of 372 F. Supp. 2d 628 (BlueCross BlueShield of South Carolina v. Carillo) 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
BlueCross BlueShield of South Carolina v. Carillo, 372 F. Supp. 2d 628, 2005 WL 1350048 (N.D. Ga. 2005).

Opinion

ORDER

DAVID L. MURPHY, District Judge.

This is a case filed under the Employee Retirement Income Security Act (“ERISA”). The case is before the Court on Plaintiffs Motion for a Preliminary Injunction [4], Defendants’ Motion to Dismiss [16], and Plaintiffs Motion for Summary Judgment [17].

I. Procedural Background

On February 23, 2005, Plaintiff filed this lawsuit. Plaintiff asserts claims under 29 U.S.C.A. § 1132(a)(3) of ERISA. Plaintiff seeks to require Defendants to reimburse Plaintiff from funds that Defendants received in a settlement for medical costs that Plaintiff paid on behalf of Defendants under the terms of an ERISA employee *631 benefit plan. Plaintiff requested that the Court enter a temporary restraining order and a preliminary injunction preventing Defendants and their counsel, Richard Yancey, from dissipating the settlement funds.

On February 25, 2005, the Court held a hearing with respect to Plaintiffs Motion for Temporary Restraining Order. On that same day, the Court approved an ex parte Temporary Restraining Order presented by Plaintiff preventing Defendants and Attorney Yancey from dissipating the settlement funds. (Order of Feb. 25, 2005.)

The Court scheduled a hearing on Plaintiffs Motion for Preliminary Injunction for March 7, 2005. Attorney Yancey and Defendants, however, were unable to attend the March 7, 2005, hearing. The Court consequently entered an Order extending the Temporary Restraining Order for ten days or until the Court could hold a hearing on the Motion for Preliminary Injunction, whichever was earlier. (Order of Mar. 7, 2005.)

On March 14, 2005, the Court held a hearing on Plaintiffs Motion for Preliminary Injunction. During the March 14, 2005, hearing, the Court heard evidence and counsel for the parties presented oral argument. On that same day, the Court entered an Order deferring ruling on the Motion for Preliminary Injunction to allow counsel time to file additional briefs. (Order of Mar. 14, 2005.) The Court also extended the Temporary Restraining Order as to the following: (1) $61,120.17 of settlement proceeds deposited in Defendant Josué Carillo’s account at Dalton Whitfield Bank, located at 401 South Thornton Avenue in Dalton, Georgia; (2) $32,000 of settlement proceeds remaining in Defendant Vincente Carillo’s account at Dalton Whitfield Bank, located at 401 South Thornton Avenue in Dalton, Georgia; and (3) a 2000 F-150 Ford truck purchased by Defendant Vincente Carillo with a portion of the settlement proceeds. (Id.) The March 14, 2005, Order provided that the Temporary Restraining Order would remain in place until the Court issued a decision on Plaintiffs Motion for Preliminary Injunction. (Id.) The Court’s March 14, 2005, Order also appointed a guardian ad litem for Defendant Josué Carillo. (Id.)

On March 21, 2005, Defendants responded to Plaintiffs Motion for Preliminary Injunction with a Motion to Dismiss. On April 4, 2005, Plaintiff responded to Defendant’s Motion to Dismiss by filing a Motion for Summary Judgment. The briefing process for Plaintiffs Motion for Preliminary Injunction, Defendants’ Motion to Dismiss, and Plaintiffs Motion for Summary Judgment is complete, and the matters are ripe for resolution by the Court.

II. Defendant’s Motion to Dismiss

A. Allegations of Plaintiffs Verified Complaint

Plaintiffs Verified Complaint states, in relevant part: “This action is to enforce the terms of the Mohawk Carpet Corporation Health and Welfare Benefits Plan (the ‘Plan’) ... and for equitable relief arising under” ERISA. (Verified Compl. ¶ 1.) Plaintiff is a fiduciary of the Plan. (Id. ¶ 2.)

Defendant Josué Carillo and Defendant Vincente Carillo reside in Chatsworth, Georgia. (Verified Compl. ¶¶3-4.) Defendants were covered persons under the terms of the Plan, which is self-funded. (Id. ¶¶ 1, 7.) The Plan is covered by ERISA. (Id. ¶ 1.)

On or about June 17, 2002, Defendants sustained injuries in an accident. (Verified Compl. ¶ 8.) The Plan paid medical benefits of $122,393.64 on behalf of Defendant Josué Carillo as a result of the June 17, *632 2002, accident. (Id. ¶ 9.) The Plan paid medical benefits of $3,971.09 on behalf of Defendant Vincente Carillo as a result of the June 17, 2002, accident. (Id. ¶ 10.)

The Plan contains a Subrogation/Right of Reimbursement provision, which states: ARTICLE XI-SUBROGATION RIGHT OF REIMBURSEMENT

In the event benefits are provided to or on behalf of a Covered Person under the terms of this Plan, the Covered Person agrees, as a condition of receiving benefits under the Plan, to transfer to the Plan all rights to recover damages in full for such benefits when the injury or illness occurs through the act or omission of another person, firm, corporation, or organization.
If, however, the Covered Person receives a settlement, judgment, or other payment relating to the accidental injury or illness from another person, firm, corporation, organization, or business entity paid by, or on behalf of, the person or entity who allegedly caused the injury or illness, the Covered Person agrees to reimburse the Plan in full, and in first priority, for any medical expenses paid by the Plan relating to the injury or illness. The Plan’s right of recovery applies regardless of whether such payments are designated as payment for, but not limited to, pain and suffering, medical benefits, lost wages, other specified damages, or whether the Covered Person has been made whole or fully compensated for his/her injuries.
The [Plan’s] right of full recovery may be from the third-party, any liability or other insurance covering the third-party, the insured’s own uninsured motorist insurance, underinsured motorist insurance, any medical payments (Med-Pay), no fault, personal injury protection (PIP), malpractice, or other insurance coverages which are paid or payable. In the event benefits are provided to or on behalf of a Covered Person under the terms of this Plan, the Plan shall be subrogated, at its expense, to the rights of recovery of such Covered Person against any person, firm, corporation, organization, and/or any insurance coverages to which the Covered Person may be entitled.
The Plan will not pay attorney’s fees, costs, or other expenses associated with a claim or lawsuit without the expressed written authorization of the Plan.
The Covered Person shall not do anything to hinder the Plan’s right of subro-gation and/or reimbursement. The Covered Person shall cooperate with the Plan and execute all instruments and do all things necessary to protect and secure the Plan’s right of subrogation and/or reimbursement, including assert a claim or lawsuit against the third-party or any insurance coverages to which the Covered Person may be entitled. Failure to cooperate with the Plan will entitle the Plan to withhold benefits due the Covered Person under the Plan Document.

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Cite This Page — Counsel Stack

Bluebook (online)
372 F. Supp. 2d 628, 2005 WL 1350048, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bluecross-blueshield-of-south-carolina-v-carillo-gand-2005.