Mid Atlantic Medical Services, Inc. v. Sereboff

303 F. Supp. 2d 691, 32 Employee Benefits Cas. (BNA) 1829, 2004 U.S. Dist. LEXIS 2581, 2004 WL 324832
CourtDistrict Court, D. Maryland
DecidedJanuary 26, 2004
DocketCIV. AMD 03-2269
StatusPublished
Cited by3 cases

This text of 303 F. Supp. 2d 691 (Mid Atlantic Medical Services, Inc. v. Sereboff) is published on Counsel Stack Legal Research, covering District Court, D. Maryland primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mid Atlantic Medical Services, Inc. v. Sereboff, 303 F. Supp. 2d 691, 32 Employee Benefits Cas. (BNA) 1829, 2004 U.S. Dist. LEXIS 2581, 2004 WL 324832 (D. Md. 2004).

Opinion

MEMORANDUM OPINION

DAVIS, District Judge.

Defendants Joel and Marlene Sereboff, residents of Maryland, were injured in a motor vehicle accident while visiting California. In consequence of their injuries, the ERISA-covered health insurance plan of which they were participants through Mrs. Sereboffs employer provided benefits in the amount of $74,869.37. ’ In due course, the Sereboffs successfully prosecuted a civil action in California state court against the parties responsible for their injuries. Ultimately, they settled their claims for $750,000. Thereafter, upon the refusal by the Sereboffs- to pay over a portion of their recovery to the health, insurance plan in reimbursement for the benefits that had been provided, plaintiff Mid Atlantic Medical Services, Inc., the plan fiduciary, instituted this action against them pursuant to § 502(a)(3) the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1132(a)(3). * .Now pending are (1) the motion to dismiss for failure to state a claim filed by defendants and (2) the motion for summary judgment filed by plaintiff. The issues have been fully briefed and no hearing is necessary. For the reasons stated below, the motion to dismiss shall be denied and the motion for summary judgment shall be granted in part and denied in part.

I.

The applicable standard for the review of a motion to dismiss for failure to state a claim under Fed.R.Civ.P. 12(b)(6) is well settled:

A Rule 12(b)(6) motion should only be granted if, after accepting all well-pleaded allegations in the plaintiffs complaint as true, it. appears certain that the.plaintiff cannot prove any set of facts in support of his claim entitling him to relief. See Edwards v. City of Goldsboro, 178 F.3d 231, 244 (4th Cir.1999). Furthermore, the “Federal Rules of Civil Procedure do not require a claimant to set out in detail the facts upon which he bases his claim.” Conley v. Gibson, 355 U.S. 41, 47, 78 S.Ct. 99, 2 L.Ed.2d 80 (1957). Rather, Rule 8(a)(2) requires only a “short and plain statement of the claim showing that the pleader -is entitled to relief.” Fed.R.Civ.P. 8(a)(2).

Migdal v. Rowe Price-Fleming Int’l, Inc., 248 F.3d 321, 325-26 (4th Cir.2001).

Pursuant ’ to Fed.R.Civ.P. 56(c), summary judgment is appropriate “if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). A fact is material for purposes of summary judgment, if when applied to the substantive law, it affects the outcome of the litigation. Id. at 248, 106 S.Ct. 2505. Summary judgment is also appropriate when a party “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 *694 proof at trial.” Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986).

A party opposing a properly supported motion for summary judgment bears the burden of establishing the existence of a genuine issue of material fact. Anderson, 477 U.S. at 248-49, 106 S.Ct. 2505. “When a motion for summary judgment is made and supported as provided in [Rule 56], an adverse party may not rest upon the mere allegations or denials of the adverse party’s pleading, but the adverse party’s response, by affidavit or as otherwise provided in [Rule 56] must set forth specific facts showing that there is a genuine issue for trial.” Fed.R.Civ.P. 56(e). See Celotex Corp., 477 U.S. at 324, 106 S.Ct. 2548; Anderson, 477 U.S. at 252, 106 S.Ct. 2505; Shealy v. Winston, 929 F.2d 1009, 1012 (4th Cir.1991). Of course, the facts, as well as the justifiable inferences to be drawn therefrom, must be viewed in the light most favorable to the nonmoving party. See Matsushita Elec. Indust. Co. v. Zenith Radio Corp., 475 U.S. 574, 587-88, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986). The court, however, has an affirmative obligation to prevent factually unsupported claims and defenses from proceeding to trial. See Felty v. Graves-Humphreys Co., 818 F.2d 1126, 1128 (4th Cir.1987).

II.

Helpfully, the parties have entered into a comprehensive stipulation of undisputed facts which, without the exhibits thereto, is attached to this Memorandum Opinion and is incorporated by reference herein.

At bottom, the dispute between the parties is narrow and highly focused, and may be set forth succinctly. In Great-West Life & Annuity Ins. Co. v. Knudson, 534 U.S. 204, 213-14, 122 S.Ct. 708, 151 L.Ed.2d 635 (2002), the Supreme Court affirmed a judgment of the Ninth Circuit that an ERISA fiduciary could not recover reimbursement in federal court against a beneficiary (who, like the Sereboffs, had suffered injuries in a motor vehicle accident) under ERISA § 502(a)(3) because the relief the fiduciary sought was not “other appropriate equitable relief’ within the contemplation of § 502(a)(3). The Court held on the facts presented that the ostensible claim for “restitution” sought by the ERISA fiduciary was actually a claim for compensatory damages relief. See id. at 213, 122 S.Ct. 708 (“[N]ot all relief falling under the rubric of restitution is available in equity.”).

In announcing its holding, Knudson provided some critical obiter dicta in delineating the circumstances under which an ERISA fiduciary’s claim falls on the “equity” or “law” side of the often fuzzy line separating the two forms of monetary relief encompassed by the term restitution:

In the days of the divided bench, restitution was available in certain cases at law, and in certain others in equity. See, e.g., 1 Dobbs §§ 1.2, at 11; id., §§ 4.1(1), at 556;

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Bluebook (online)
303 F. Supp. 2d 691, 32 Employee Benefits Cas. (BNA) 1829, 2004 U.S. Dist. LEXIS 2581, 2004 WL 324832, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mid-atlantic-medical-services-inc-v-sereboff-mdd-2004.