Fairfield Manufacturing Co. v. Hartman

132 F. Supp. 2d 1142, 26 Employee Benefits Cas. (BNA) 1471, 2001 U.S. Dist. LEXIS 2967, 2001 WL 245146
CourtDistrict Court, N.D. Indiana
DecidedFebruary 23, 2001
DocketCIV. 4:00cv0027AS
StatusPublished
Cited by1 cases

This text of 132 F. Supp. 2d 1142 (Fairfield Manufacturing Co. v. Hartman) is published on Counsel Stack Legal Research, covering District Court, N.D. Indiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Fairfield Manufacturing Co. v. Hartman, 132 F. Supp. 2d 1142, 26 Employee Benefits Cas. (BNA) 1471, 2001 U.S. Dist. LEXIS 2967, 2001 WL 245146 (N.D. Ind. 2001).

Opinion

MEMORANDUM AND ORDER

ALLEN SHARP, District Judge.

This matter is before the Court on Plaintiffs’, Fairfield Manufacturing Company, Inc. (“Fairfield”), as Plan Administrator of the Fairfield Manufacturing Company, Inc. Health Care Plan (“Plan”), and the Plan, motion for summary judgment pursuant to Rule 56 of the Federal Rules of Civil Procedure. The Plaintiffs’ are seeking full reimbursement from the Defendants’ Robert and Aaron Hartman for certain medical expenses paid by the Plan as a result of the injuries sustained by Aaron Hartman. The Defendants’ (“Hart-mans”) while not specifically fifing a cross motion for summary judgment ask that the Court enter summary judgment in their favor, requiring Fairfield to pay a proportionate share of attorney fees and expenses incurred in recovering the benefits that are to be used in reimbursing the plan.

7. BACKGROUND

Both Fairfield and the Hartmans are in agreement as to the material facts in this matter. For all times relevant to this case, Robert Hartman was employed by Fairfield. Fairfield provided health care and medical benefits to its employees by way of an employee benefit plan. The plan is a self-funded “employee welfare benefit plan” created under the Employee Retirement Income Security Act of 1974 (“ERISA”). Fairfield serves as the administrator and fiduciary of the Plan.

Robert Hartman and his dependent Aaron Hartman were covered under the terms of the Plan. On November 6, 2000, Aaron Hartman was injured in an accident which involved the alleged liability of various third parties. As a result of Aaron’s injuries, the Hartmans submitted medical claims to the plan which totaled approximately $320,000 at the time of the fifing in this case. The Hartmans’ filed a civil lawsuit against the alleged tortfeasors. As a result of the lawsuit, the Hartmans entered into a settlement agreement with four of the alleged tortfeasors and have dismissed the fifth tortfeasor. The Hart-mans’ claim was settled for $3,550,000. The attorneys’ fees totaled some $1,185,000 in addition to litigation expenses in the amount of $24,845.

Fairfield contends that pursuant to the language in the governing documents it' has a right to subrogation and 100% reimbursement of the medical benefits it has paid on behalf of Aaron Hartman for his injuries. The reimbursement provisions contain the following language:

The Plan has the right to full subrogation and reimbursement of any and all amounts paid by the Plan, to or on behalf of, a Covered Person, if the Covered Person receives any sum of money from any third party in connection with *1144 any accident ... The Covered Person shall be responsible for all expenses of recovery from such third parties, including but not limited to, all attorneys’ fees,., which fees and expenses shall not reduce the amount of reimbursement to the Plan required of the covered person. (Article XIV; Subrogation Rights)
The Plan’s right to reimbursement as set forth herein shall be payable first from sums received from third parties and such reimbursement shall continue until the Covered Person’s obligations hereunder to the Plan are fully discharged, even though the Covered Person does not receive full compensation or recovery for his/her injuries damages, loss or debt. This right to subrogation pro tanto shall exist in all cases. (Article XIV; Subrogation Rights)

Furthermore, Fairfield points to the language in the Summary Plan Description which states in pertinent part:

The Plan reserves the right to subrogation and recovery of amounts paid.... By participating in the Plan, you and your Dependents are agreeing that the Plan is subrogated to all rights of you and your Dependents and acknowledge that the Plan will have a lien against any sum of money received from a third party ... The covered person is responsible for all expenses of recovery from third parties including attorney fees, which amounts will not reduce the amount of reimbursement payable to the plan. (Exhibit B; SPD).

The Plan also provides specific language with respect to the duties and authority conferred upon the Plan Administrator. Article XII of the Plan provides the following discretion granted to the Administrator:

full, discretionary authority to enable it to carry out its duties under the plan, including but not limited to, the authority to determine eligibility under the Plan and to construe and interpret the terms of the Plan and to determine all questions of factor law arising hereunder and to authorize coverage in a manner which is cost effective under the Plan. All such determinations and interpretations shall be final, conclusive, and binding on all persons affected thereby. The Plan Administrator or its designee shall have full, discretionary authority to correct any defect, supply any omission or reconcile any inconsistency and resolve ambiguities in the Plan in such a manner and to such extent as it may deem expedient, and subject to Article XII, the Plan Administrator or its desig-nee shall be the sole and final judge of expediency.

(Section 12.03 of the Plan)

II. SUMMARY JUDGMENT STANDARD

Summary judgment is to be granted “forthwith” when, after an adequate period for discovery one party is unable to show a genuine issue as to a material fact on which that party will bear the burden of proof at trial, so long as judgment against that party is appropriate as a matter of law. Department of Commerce v. U.S. House of Representatives, 525 U.S. 316, 327, 119 S.Ct. 765, 142 L.Ed.2d 797 (1999); Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). When there are no genuine issues of material fact, contract interpretation is particularly well-suited for summary judgment. Anstett v. Eagle-Picher Industries, 203 F.3d 501 (7th Cir.2000).

III. STANDARD OF REVIEW

In Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989) the Supreme Court set out the applicable standard of review for a decision made by a plan administrator in an ERISA case. A de novo standard of review is not applied in cases where a benefit plan gives the administrator or fiduciary discretionary authority to construe the terms of the plan. Id. at 115, 109 S.Ct. 948. In situations where the administrator is given discretionary authority courts ap *1145 ply an arbitrary or capricious standard in reviewing the administrator’s decision. Russo v. Health, Welfare & Pension Fund,

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Bluebook (online)
132 F. Supp. 2d 1142, 26 Employee Benefits Cas. (BNA) 1471, 2001 U.S. Dist. LEXIS 2967, 2001 WL 245146, Counsel Stack Legal Research, https://law.counselstack.com/opinion/fairfield-manufacturing-co-v-hartman-innd-2001.