Electro-Mechanical Corp. v. Ogan

9 F.3d 445, 1993 WL 442013
Court of Appeals for the Sixth Circuit·Decided November 3, 1993·No. No. 92-6256·Published·Cited by 39 cases

Opinion

ECHOLS, District Judge.

In this appeal, Defendants-Appellants, Douglas L. and Karen E. Ogan (“the Ogans”), individually and as next friends of their son, Nathan Douglas Ogan, and Hamilton Bank of Upper East Tennessee (“Hamilton Bank”), challenge the district court’s grant of summary judgment in favor of the Plaintiff-Appellee, Electro-Mechanical Corporation (“Electro-Mechanical”), 820 F.Supp. 346, the Plan Administrator for the employee benefit plan of Line Power Manufacturing Corporation. By granting Electro-Mechanical’s Motion for Summary Judgment, the district court declared that Electro-Mechanical was entitled to recoup the full amount of its subrogation claim against the settlement pro[447] ceeds of the medical malpractice action brought by the Ogans on behalf of their son, Nathan Ogan, as well as any future medical expenses it will pay on Nathan’s behalf. For the reasons more fully outlined herein, we affirm the district court’s decision.

Douglas L. Ogan has been an employee of Line Power Manufacturing Company (“Line Power”) for seyenteen years, the last twelve years of which he has served in the position of a supervisor. He is a participant in Line Power’s employee health benefit plan (“the plan”) which covers both employees and then-dependents. It is undisputed that the plan is governed by the Employee Retirement Income Security Act, 29 U.S.C. § 1002(1) (1988) (“ERISA”).

Prior to August 1987, the plan was funded by insurance purchased from various outside providers. During this time, the plan did not contain a subrogation provision. On August 22,1988, Line Power created a new employee benefit plan which was self-funded and which included a subrogation clause which read as follows:

If any payment is made under this Plan, the Plan Administrator will be subrogated to all the rights of recovery of the covered person to whom or for whose benefit the payment was made, to the extent of the amount paid. The covered person will execute and deliver instruments and papers and do whatever else is necessary to secure these rights and will do nothing to prejudice such rights.

On January 1, 1992, this new plan was further amended to clarify the language of the subrogation clause as follows:

If any payment is made under this Plan, the Plan Administrator will be subrogated to all the rights of recovery of the covered person for whom benefits are paid.
If you or your Dependents recover damages from a third party(ies) which related to a condition for which the Plan incurred expenses, the Plan shall be entitled to reimbursement to the extent of any such expenses incurred. You and your dependents must notify the Plan of this possibility and must cooperate fully with the Plan in this regard and must do nothing that may prejudice the Plan’s rights.

This amendment was retroactively effective to October 1, 1991.

On July 23, 1986, Nathan Ogan was born with severe neurological damage which resulted in serious and permanent disabilities. His medical expenses were covered by Line Power’s employee health benefit plan. In August 1987, the Ogans filed a medical malpractice action on behalf of Nathan against certain medical professionals involved with his birth. The Ogans settled their medical malpractice action for a total of $1,100,000.00 on May 11,1990. This settlement was divided as follows: 1) $200,000.00 was paid directly to Douglas L. Ogan and Karen E. Ogan; 2) $321,789.77 was approved and allocated for costs and attorneys’ fees; and 3) the balance of $578,210.23 was paid to the Sullivan County Court for the benefit of the minor, Nathan Ogan.1

After receiving notice of this settlement, Electro-Mechanical notified the Ogans that, under the plan’s subrogation provision, they were required to reimburse the plan for the costs of the medical expenses which the plan had paid on Nathan’s behalf.2 When the Ogans failed to reimburse the plan, ElectroMechanical instituted this action, seeking a declaratory judgment as to the validity of its subrogation rights, and requesting full enforcement of those rights against the Ogans. Shortly thereafter, both parties filed Cross-Motions for Summary Judgment. The district court granted Electro-Mechanical’s Motion for Summary Judgment and denied the Ogans’ Motion for Summary Judgment.

The parties have presented two issues on appeal. The first issue is whether the district court erred in finding that the Tennessee Medical Malpractice statute is preempted [448] by ERISA and, therefore, inapplicable to the issues raised in this action. The second issue is whether the district court erred in finding that Electro-Mechanical did not breach its fiduciary duty by failing to provide the Ogans with an explanation of the subrogation clause contained within the new plan, as well as the clause’s effect upon any recovery the Ogans might obtain from a third party tortfeasor.

Free access — add to your briefcase to read the full text and ask questions with AI

Electro-Mechanical Corp. v. Ogan, 9 F.3d 445, 1993 WL 442013 (6th Cir. 1993).

9 F.3d 445 (Electro-Mechanical Corp. v. Ogan) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

Neaves v. Hampton
E.D. Kentucky, 2024
Woodhead v. Ridener
E.D. Kentucky, 2022
Cheryl Wallace v. Oakwood Hosp.
954 F.3d 879 (Sixth Circuit, 2020)
Rahman v. Sessions
Second Circuit, 2018
Echague v. Metropolitan Life Insurance
43 F. Supp. 3d 994 (N.D. California, 2014)
Bell v. Pfizer, Inc.
626 F.3d 66 (Second Circuit, 2010)
Zamora v. Jacobs (In Re Jacobs)
403 B.R. 565 (N.D. Illinois, 2009)
Anderson v. BOARD OF TRUSTEES OF NORTHWEST OHIO
567 F. Supp. 2d 991 (N.D. Ohio, 2008)
Jones v. Johanns
264 F. App'x 463 (Sixth Circuit, 2007)
Garst v. Wal-Mart Stores, Inc.
30 F. App'x 585 (Sixth Circuit, 2002)
Qualchoice, Inc. v. Williams
14 F. App'x 417 (Sixth Circuit, 2001)
Estate of Dermady v. Eastman Kodak Co.
136 F. Supp. 2d 181 (W.D. New York, 2001)
Griggs v. E I DuPont
Fourth Circuit, 2001
Margaret Krohn v. Huron Memorial Hospital
173 F.3d 542 (Sixth Circuit, 1999)
Engle v. Wal-Mart Associates Health & Welfare Plan
48 F. Supp. 2d 1114 (N.D. Indiana, 1999)