Humana Health Plan, Inc. v. Nguyen

17 F. Supp. 3d 638, 58 Employee Benefits Cas. (BNA) 1434, 2014 WL 1775551, 2014 U.S. Dist. LEXIS 61239
CourtDistrict Court, S.D. Texas
DecidedMay 2, 2014
DocketCivil Action No. H-13-1793
StatusPublished

This text of 17 F. Supp. 3d 638 (Humana Health Plan, Inc. v. Nguyen) is published on Counsel Stack Legal Research, covering District Court, S.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Humana Health Plan, Inc. v. Nguyen, 17 F. Supp. 3d 638, 58 Employee Benefits Cas. (BNA) 1434, 2014 WL 1775551, 2014 U.S. Dist. LEXIS 61239 (S.D. Tex. 2014).

Opinion

MEMORANDUM OPINION AND ORDER

SIM LAKE, District Judge.

Plaintiff, Humana Health Plan, Inc. (“Humana”), filed this action asserting claims against defendants, Patrick Nguyen (“Nguyen”), David Abney (“Abney”), and Crady, Jewett, & McCulley, LLP (“Cra-dy”), to enforce the terms of the API Employee Benefits Plan (“Plan”), and for equitable relief pursuant to the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. §§ 1001 et. seq. Pending before the court are Plaintiff Hu-mana Health Plan, Inc.’s Motion for Summary Judgment (Docket Entry No. 41), and Defendant Patrick Nguyen’s Response to Motion for Summary Judgment and Cross Motion for Summary Judgment (Docket Entry No. 44). Also pending are Nguyen’s objections to Humana’s evidence and request for a continuance to conduct discovery. For the reasons stated below, Humana’s motion for summary judgment will be granted, Nguyen’s objections to Humana’s evidence will be overruled, Nguyen’s cross motion for summary judgment and request for a continuance will be denied, and the court will enter a final judgment ordering the Clerk to disperse settlement funds in the registry of the court to Humana, and ordering Nguyen to remit to Humana any additional funds recovered in connection with his accident on April 14, 2012, up to $274,607.84.

I. Standard of Review

Summary judgment is authorized if the movant establishes that there is no genuine dispute about any material fact and the law entitles it to judgment. Fed.R.Civ.P. 56(c). Disputes about material facts are “genuine” if the evidence is such that a reasonable jury could return a verdict for the nonmoving party. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 106 S.Ct. 2505, 2511, 91 L.Ed.2d 202 (1986). The Supreme Court has interpreted the plain language of Rule 56(c) to mandate the entry of summary judgment “after adequate time for discovery and upon motion, against a party who fails to make a showing sufficient to establish the existence of an element essential to that party’s case, and on which that party will bear the burden of proof at trial.” Celotex Corp. v. Catrett, 477 U.S. 317, 106 S.Ct. 2548, 2552, 91 L.Ed.2d 265 (1986). A party moving for summary judgment “must ‘demonstrate the absence of a genuine issue of material fact.’ ” Little v. Liquid Air Corp., 37 F.3d 1069, 1075 (5th Cir.1994) (en banc). If the moving party meets this burden, Rule 56(c) requires the nonmovant to present admissible evidence creating genuine issues of material fact for trial. Id.

II. Undisputed Facts

Nguyen is a participant in the API Employee Benefits Plan (“Plan”). The Plan is governed by ERISA, 29 U.S.C. § 1001 et seq. On July 13, 2009, API and Humana executed a Plan Management Agreement (“PMA”) pursuant to which Humana is the Plan Manager and API is the Plan Administrator with discretion to interpret the terms of the Plan.1

[642]*642In April of 2012 Nguyen was injured in an automobile accident (“accident”). From April 14, 2012 to April 5, 2013, the Plan paid $274,607.84 in medical expenses for Nguyen arising from the accident.2 Nguyen recovered from a third party settlement funds of $255,000.00 for damages sustained in the accident. Humana asked Nguyen to reimburse the Plan for benefits paid on his behalf. Nguyen refused Hu-mana’s request, and this action ensued.3

III. Procedural Background

On June 16, 2013, Humana filed a Verified Complaint (Docket Entry No. 1) seeking to enforce the terms of the Plan, and to receive equitable relief in the form of the settlement funds that Nguyen received from a third party under 29 U.S.C. § 1132(a)(3). On June 20, 2013, the court entered a Temporary Restraining Order (Docket Entry No. 6), restraining defendants and others acting in concert with them from disposing of any of the settlement funds. On July 2, 2013, the court signed an Agreed Preliminary Injunction (Docket Entry No. 13) pursuant to which the settlement funds were deposited into the registry of the court. On July 3, 2013, Humana filed a Notice of Voluntary Dismissal of David Abney and Crady, Jewett & McCulley, LLP (Docket Entry No. 18), and the court signed an Order (Docket Entry No. 19) dismissing the claims asserted against those defendants with prejudice. Nguyen is the only remaining defendant.

On July 18, 2013, Nguyen filed a Counterclaim (Docket Entry No. 21) against Humana for breach of fiduciary duty.

On October 15, 2013, Humana filed Plaintiff Humana Health Plan, Inc.’s Motion for Summary Judgment (Docket Entry No. 41), and Memorandum in Support of Plaintiff Humana Health Plan, Inc.’s Motion for Summary Judgment (Docket Entry No. 42). On November 12, 2013, Nguyen filed Defendant Patrick Nguyen’s Response to Motion for Summary Judgment and Cross Motion for Summary Judgment (Docket Entry No. 44), and on November 22, 2013, Humana filed Plaintiff Humana Health Plan, Inc.’s Reply in Support of Motion for Summary Judgment and Response in Opposition to Defendant’s Cross Motion for Summary Judgment (“Humana’s Reply,” Docket Entry No. 45).

IV. Analysis

Humana argues that it is entitled to summary judgment on its claims to enforce the terms of the Plan and for equitable relief because the 2009 Summary Plan Description (“SPD”) and the 2012 SPD both clearly state that the Plan is entitled to reimbursement.4 Humana argues that Nguyen’s breach of fiduciary duty counterclaim should be dismissed “because [Nguyen] does not deny that he has adequate relief through a claim for benefits,”5 and [643]*643because Nguyen “has not — and cannot— prove either that Humana would be unjustly enriched or that [Nguyen] has been harmed.”6 Nguyen argues that he is entitled to summary judgment on Humana’s claims because Humana lacks necessary authority from the Plan to seek recovery,7 and because Humana is trying to enforce the wrong Plan document.8 Alternatively, Nguyen argues that Humana has breached its fiduciary duty by pursuing claims that the Plan Administrator does not wish to pursue.9

A. Applicable Law

Federal common law governs the construction of ERISA plan provisions. Todd v. AIG Life Ins. Co., 47 F.3d 1448, 1452 n. 1 (5th Cir.1995); Jones v. Georgia Pacific Corp., 90 F.3d 114, 116 (5th Cir.1996). In construing an ERISA plan, courts give Plan language its ordinary and generally accepted meaning. Provident Life & Accident Insurance Co. v. Sharpless,

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Related

Little v. Liquid Air Corp.
37 F.3d 1069 (Fifth Circuit, 1994)
Jones v. Georgia Pacific Corp.
90 F.3d 114 (Fifth Circuit, 1996)
Wegner v. Standard Insurance
129 F.3d 814 (Fifth Circuit, 1997)
Rhorer v. Raytheon Engineers & Constructors, Inc.
181 F.3d 634 (Fifth Circuit, 1999)
McCall v. Burlington Northern/Santa Fe Co.
237 F.3d 506 (Fifth Circuit, 2000)
Gosselink v. American Telephone & Telegraph, Inc.
272 F.3d 722 (Fifth Circuit, 2001)
Provident Life & Accident Insurance v. Sharpless
364 F.3d 634 (Fifth Circuit, 2004)
Amschwand v. Spherion Corp.
505 F.3d 342 (Fifth Circuit, 2007)
Anderson v. Liberty Lobby, Inc.
477 U.S. 242 (Supreme Court, 1986)
Firestone Tire & Rubber Co. v. Bruch
489 U.S. 101 (Supreme Court, 1989)
Mertens v. Hewitt Associates
508 U.S. 248 (Supreme Court, 1993)
Metropolitan Life Insurance v. Glenn
554 U.S. 105 (Supreme Court, 2008)
CIGNA Corp. v. Amara
131 S. Ct. 1866 (Supreme Court, 2011)
Kenneth E. Wildbur, Sr. v. Arco Chemical Co.
974 F.2d 631 (Fifth Circuit, 1992)
Clifford Duhon v. Texaco, Inc.
15 F.3d 1302 (Fifth Circuit, 1994)
Todd v. AIG Life Ins. Co.
47 F.3d 1448 (Fifth Circuit, 1995)

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Bluebook (online)
17 F. Supp. 3d 638, 58 Employee Benefits Cas. (BNA) 1434, 2014 WL 1775551, 2014 U.S. Dist. LEXIS 61239, Counsel Stack Legal Research, https://law.counselstack.com/opinion/humana-health-plan-inc-v-nguyen-txsd-2014.