Continental Insurance Co. v. Dawson

273 F. Supp. 3d 688
CourtDistrict Court, N.D. Texas
DecidedMarch 31, 2017
DocketNo. 3:13-cv-04150-M
StatusPublished
Cited by1 cases

This text of 273 F. Supp. 3d 688 (Continental Insurance Co. v. Dawson) is published on Counsel Stack Legal Research, covering District Court, N.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Continental Insurance Co. v. Dawson, 273 F. Supp. 3d 688 (N.D. Tex. 2017).

Opinion

MEMORANDUM OPINION AND ORDER

BARBARA M. G. LYNN, CHIEF JUDGE

Before the Court are the following Motions filed by Plaintiff: a Motion for Leave to File a Second Amended Complaint [690]*690(ECF No. 71), a Motion for Partial Summary Judgment (ECF No. 75), and a Motion to Dismiss Defendant’s Counterclaims (ECF No. 83), which, having given, notice pursuant to Fed. R. Civ. P. 12(d), the Court is treating as a motion for summary judgment (ECF No. 143). For the reasons stated below, the Motions for Summary Judgment are GRANTED and the Motion for Leave to File a Second Amended Complaint is DENIED.

I. Factual and Procedural Background

On November 16, 2007, Defendant David Dawson was severely burned while working for Hill International, Inc. in Baghdad, Iraq. Fluor Intercontinental, Inc. managed Dawson’s living quarters in Iraq. Hill had an employee benefit plan (the “Plan”) which is governed by the Employee Retirement Income Security Act (“ERISA”) and is fully insured by Aetna Life Insurance Company of Hartford, Connecticut. Plaintiff Continental Insurance Company was Hill’s workers’ compensation carrier, and thus was required to pay for Dawson’s medical expenses under the Longshore and Harbor Workers’ Compensation Act (“LHWCA”).1 Aetna was the company that provided Dawson’s group health insurance through Hill, Between November 18, 2007, and January 24, 2008, Aetna paid $282,774.51 in medical expenses incurred overseas on Dawson’s behalf. Continental paid Dawson’s subsequent medical expenses of $388,457.67. The Plan states Aet-na has the right to be repaid for all benefits provided by the Plan on behalf of the covered person for injuries caused by a third party.2

In 2009, Dawson filed suit against Fluor in the 134th Judicial District Court of Dallas County, Texas. Both Continental and Aetna intervened in the state lawsuit, asserting liens against any settlement or judgment Dawson obtained against Fluor. In April 2010, Continental' and Dawson executed a settlement agreement pursuant to § 8(i) of the LHWCA. Continental paid Dawson $260,759.68 in exchange for a complete discharge of its liability for compensation and past medical care ¿rising out of the injury. The agreement further provided that Continental could recover from Dawson the full amount of its asserted lien of $388,457.67, if Dawson was awarded more than $2 million in the state case against Fluor. On May 24, 2010, the Department of Labor’s Office of Workers’ Compensation Programs (“OWCP”) approved the settlement between Continental and Dawson. Dawson subsequently won a $20 million jury verdict and judgment, but Dawson entered into a confidential settlement with Fluor. At the request of the parties, the court of appeals entered a judgment setting aside the trial court’s judgment and instead entered a take nothing judgment. Fluor Intercontinental, Inc. v. Dawson, 05-13-00209-CV, 2014 WL 6466946 (Tex. App.—Dallas Nov. 19, 2014, no pet.).3 Dawson has since stipulated that the settlement exceeded $2 million.

In 2012, Dawson executed an agreed judgment regarding Continental’s asserted lien rights for medical benefits it paid on his behalf. He then satisfied the balance of Continental’s $388,457.67 lien. On May 9, 2012, Aetna filed with the OWCP a claim against Continental, seeking reimburse[691]*691ment under § 8(i) for expenses it paid for Dawson’s overseas medical care. The parties refer to this action as the San Francisco Longshore Proceeding (“SFLP”). Aetna and Continental eventually settled that dispute. Aetna agreed to assign the full válue of its $282,774.51 lien against Dawson to Continental, and agreed to assist Continental in enforcing the Plan’s subrogation and reimbursement provisions. In exchange, Continental paid Aetna $219,000. On April 23, 2013, OWCP approved the § 8(i) settlement between Aetna and Continental. Continental requested Dawson to stipulate that Aetna’s subrogation interest had been properly assigned to Continental, but Dawson refused.

On October 14, 2013, Continental filed suit against Dawson in this Court, alleging claims under ERISA as a derivative fiduciary of the Plan, seeking to enforce, as an assignee, Aetna’s subrogation and reimbursement rights. Continental also sought a declaratory judgment that it has an equitable lien on Dawson’s recovery in the Fluor suit, and a permanent .injunction prohibiting Dawson from retaining any recovery, from the Fluor settlement without first reimbursing Continental. Dawson maintained that Continental could not recover as Aetna’s assignee because Continental and Dawson’s 2010 agreement discharged him of any further liability to Continental.

.On March 31, 2015, this'Court granted Dawson summary judgment on the ground that the 2010 agreement precluded Continental from recovering as Aetna’s assign-ee. On April 6, 2016, the United States Court of Appeals for the. Fifth Circuit reversed, and held that Continental could recover for subrogation, and reimbursement rights assigned to it by Aetna.

DawSon then answered and counterclaimed, alleging that Continental breached its fiduciary duty under ERISA, by intentionally misrepresenting to Dawson that he owes Continental $282,774.51. Dawson also alleges Continental aided and abetted a breach of fiduciary duty by Aet-na. On-April 13, 2016, Continental filed a Motion • for Leave to File its Second Amended Complaint, seeking to add claims for breach of contract and a claim alleging failure to reimburse it under the LHWCA (ECF No. 71), On April 22, 2016, Continental filed a Motion for Partial Summary judgment on its declaratory judgment claim to recover its first-money lien (ECF No. 75). On May 11,2016, Continental filed a Motion to Dismiss Dawson’s Counterclaims (ECF No. 83). On September 1, 2016, the Court held a Rule 16 conference, and directed Dawson to file a proffer to explain what he hoped to prove in his counterclaims. On September 8, 2016, Dawson filed a Proffer of Proof, to which Continental responded (ECF Nos. 137, 138,139). Because the Court is now considering the Proffer of Proof, and all other evidence in the record, the Court gave notice and converted Continental’s Motion to Dismiss into a Motion for Summary Judgment (ECF No. 143).

II. Legal Standard

A. Summary Judgment

Under Fed. R. Civ. P. 56, summary judgment is proper'“if the movant shows that there is no genuine dispute as to any ■ material fact and the movant is entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(a). A factual issue is material “if its resolution could affect the outcome of the action.” Weeks Marine, Inc. v. Fireman’s Fund Ins. Co., 340 F.3d 233, 235 (5th Cir. 2003). A factual dispute is “‘genuine,’ if the evidence is such that- a reasonable [trier of fact] could return a verdict for the non-moving party.” Crowe v. Henry, 115 F.3d 294, 296 (5th Cir. 1997). If the moving party seeks summary judgment as to his opponent’s claims or defenses, “[t]he moving party bears the initial burden of identi[692]

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Bluebook (online)
273 F. Supp. 3d 688, Counsel Stack Legal Research, https://law.counselstack.com/opinion/continental-insurance-co-v-dawson-txnd-2017.