Community Insurance v. Morgan

54 F. App'x 828
CourtCourt of Appeals for the Sixth Circuit
DecidedDecember 20, 2002
DocketNos. 99-6669, 00-5002
StatusPublished
Cited by5 cases

This text of 54 F. App'x 828 (Community Insurance v. Morgan) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Community Insurance v. Morgan, 54 F. App'x 828 (6th Cir. 2002).

Opinion

BATCHELDER, Circuit Judge.

Pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), and invoking the supplemental jurisdiction of the district court, Appellant. Community Insurance Co. (“Community”), filed suit against defendants Troy G. Morgan, Dorothy Wright and Morgan’s insurer Liberty Mutual Insurance Company (“Liberty”), seeking reimbursement pursuant to the terms of an ERISA plan for benefits paid by Community to Morgan to cover his medical expenses resulting from injuries he incurred as a result of a motor vehicle accident. The district court held that Community had failed to protect any rights it might have had against Wright or her insurer; that Community was entitled to judgment against Morgan to the extent of proceeds received by Morgan from Wright. Wright’s insurer, or Liberty, less his attorney’s fees and costs: and that Liberty was entitled to recover from Wright’s insurer the funds advanced to Morgan by Liberty in anticipation of recovery from Wright and her insurer. On the authority of Great-West Life & Annuity Insurance Co. v. Knudson, 534 U.S. 204, 122 S.Ct. 708, 151 L.Ed.2d 635 (2002), [830]*830we vacate the judgment and remand with instructions that this case be dismissed for lack of subject matter jurisdiction.

I.

On August 31, 1996, in Campbell County, Kentucky, defendant Troy Morgan was severely injured when the motorcycle he was driving was involved in a collision with a vehicle negligently driven by co-defendant Dorothy Wright. Morgan incurred some $116,000 in medical costs.

Morgan has health insurance through an ERISA plan offered by his employer and administered by Community Insurance Company. Pursuant to its coverage agreement, Community paid Morgan’s medical bills which totaled $116,529.83. The Plan Certificate of Insurance contains a subrogation proviso that states:

If we pay benefits under this Certificate, and you have a right to recover damages from another, we are subrogated to that right. You or your legal representative must do whatever is necessary to enable us to exercise our rights and do nothing to prejudice them.
We are subrogated to any right you may have to recover from another, his insurer, or under any “Uninsured Motorist.” “Underinsured Motorist,” “Medical Payments,” “No-fault” or other similar coverage provisions.”

The Certificate also spells out the plan’s right to reimbursement stating:

If you recover damages from any party or through any coverage named above, you must hold in trust for us the proceeds of the recovery and must reimburse us to the extent of payments made.

The plan explicitly provides that Community, as plan administrator,

shall have discretionary authority to determine an individual’s eligibility for benefits under the Group Contract and to construe the terms and conditions of this Certificate which describes [the Plan] benefits. Whenever we make a determination or construction which is not arbitrary and capricious, our determination will be final and conclusive.

Morgan timely sued Wright, the tortfeasor, in state court. Wright had $100,000 in liability coverage with State Farm. Morgan had liability insurance with Liberty Mutual Insurance Co., which included underinsured motorist coverage in the amount of $50,000. Realizing that because of the extent of Morgan’s injuries, it would have to pay under the underinsured motorist coverage, Liberty paid Morgan $50,000 on the underinsured motorist claim, and irrevocably advanced him $100,000 (the policy limits of Wright’s State Farm coverage) in order to preserve its subrogation rights against State Farm.1 When it advanced the money to Morgan, Liberty executed an agreement with Morgan whereby Morgan agreed that Liberty was entitled “to the first proceeds of any settlement or judgment which may result from the exercise of any rights of recovery by Troy Morgan against Dorothy Wright up to the $100,000 hereunder paid.”

Morgan’s state court action against Wright was eventually settled by means of a mediated agreement providing, inter alia, that State Farm would pay the $100,000 policy limits to Liberty (essentially reimbursing Liberty for the money advanced to Morgan) and Wright would pay $7,500 in cash to Morgan and would exe[831]*831cute a note payable to Morgan in the amount of $30,000, bearing interest at 6%, secured by a mortgage on real property owned by Wright.

Before State Farm had made its payment to Liberty, Community filed the instant action, claiming that it was entitled to the $100,000 coming from State Farm, on the theory that its subrogation rights are superior to Liberty’s. State Farm has not paid any proceeds to Liberty, and awaits the court’s resolution of this controversy. Similarly, no payments have yet been made pursuant to the terms of the mediated agreement because of the instant litigation.

II.

After we had heard oral argument in this case, the Supreme Court decided Knudson, 534 U.S. 204, 122 S.Ct. 708, 151 L.Ed.2d 635 (2002), in which it held that ERISA does not authorize an action for money damages brought by an ERISA plan fiduciary against a plan beneficiary to enforce a reimbursement provision in the plan. In that case, the Court held that, regardless of how the fiduciary framed the complaint, it sought to impose personal liability on the plan beneficiary for a contractual obligation to pay money. Such an action, the Court held, is not an action in equity, but an action at law, and 29 U.S.C. § 1132(a)(3) authorizes only actions seeking equitable relief. 122 S.Ct. at 712.

We hold that Knudson requires this case to be dismissed for lack of jurisdiction. The claim of Community Insurance against Morgan, the plan beneficiary, for reimbursement under the terms of the plan is squarely precluded by Knudson. The application of Knudson to Community’s claim against Liberty Mutual, however, requires a bit of explanation.

Community did not plead its claim against Liberty Mutual as a claim under ERISA, but as a state law claim for a judgment declaring, under the Kentucky law principles announced in Coots v. Allstate Ins. Co., 853 S.W.2d 895 (Ky.1993), the rights of the competing insurers to the State Farm policy limits of $100,000 that Liberty Mutual irrevocably advanced to Morgan. That this claim is pled as a state law claim, however, is not dispositive of the issue of jurisdiction; rather, it raises the question of whether this claim is preempted by ERISA. If it is, then Community’s only cause of action must be found in ERISA. We conclude that after Knudson, no such cause of action is available.

We turn first to the question of preemption. State laws that “relate to” an ERISA plan are preempted by ERISA. 29 U.S.C. § 1144(a). For purposes of preemption, “state law” includes not only statutes but state common law tort and contract actions. Pilot Life Ins. Co. v. Dedeaux,

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Bluebook (online)
54 F. App'x 828, Counsel Stack Legal Research, https://law.counselstack.com/opinion/community-insurance-v-morgan-ca6-2002.