National Benefit Administrators, Inc. Ex Rel. National Business Ass'n Trust v. Mississippi Methodist Hospital & Rehabilitation Center, Inc.

748 F. Supp. 459, 12 Employee Benefits Cas. (BNA) 2633, 1990 U.S. Dist. LEXIS 13166, 1990 WL 144285
CourtDistrict Court, S.D. Mississippi
DecidedJuly 26, 1990
DocketCiv. A. J89-0532(L)
StatusPublished
Cited by12 cases

This text of 748 F. Supp. 459 (National Benefit Administrators, Inc. Ex Rel. National Business Ass'n Trust v. Mississippi Methodist Hospital & Rehabilitation Center, Inc.) is published on Counsel Stack Legal Research, covering District Court, S.D. Mississippi primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
National Benefit Administrators, Inc. Ex Rel. National Business Ass'n Trust v. Mississippi Methodist Hospital & Rehabilitation Center, Inc., 748 F. Supp. 459, 12 Employee Benefits Cas. (BNA) 2633, 1990 U.S. Dist. LEXIS 13166, 1990 WL 144285 (S.D. Miss. 1990).

Opinion

MEMORANDUM OPINION AND ORDER

TOM S. LEE, District Judge.

This is an action brought by National Benefit Administrators, Inc., on behalf of National Business Association Trust (NBAT), the administrator of an employee health benefits plan, seeking recovery of payments made to defendant, Mississippi Methodist Hospital and Rehabilitation Center (MMHRC), for the account of third-party defendant Derron Johnson. Jurisdiction is based upon both federal question and diversity. Defendant has asserted a counterclaim for the recovery of remaining amounts due on the account. Presently before the court are plaintiff’s motion for summary judgment and defendant’s motion for partial summary judgment. Each party has responded to the motion of the opposing party, and the court has considered *461 the memoranda with attachments submitted by the parties in ruling on the motions.

Parties and Facts

The facts in this ease, for purposes of the present motions, are essentially undisputed. On May 21, 1988, Derron Johnson was injured in an accident. He was hospitalized at the Mississippi Baptist Medical Center (not a party to this suit) for approximately one month. At the time of the accident, Derron Johnson’s father, Samuel Johnson, was covered under an employee health benefit plan with his employer, Laurel Coca-Cola Bottling Company. This plan provided that coverage would include dependents of Samuel Johnson who were eighteen years of age or younger, and those dependents over the age of eighteen but less than twenty-five years of age who were full-time students. In July of 1988 Samuel Johnson submitted to plaintiff a claim for Derron’s hospitalization expenses at Mississippi Baptist Medical Center. On this form, he stated that Derron’s date of birth was June 26, 1969 and that Derron was a student. He made this same representation approximately two weeks later when he signed a new enrollment card for the plan. This date of birth indicated that Der-ron qualified for health benefits under the terms of the plan. Subsequently, Derron was hospitalized at MMHRC for additional treatment. Before defendant admitted Derron, one of its employees contacted the plan coordinator at Laurel Coca-Cola, who verified that Derron was a qualified dependent. During and after Derron’s treatment at MMHRC, several claims were filed with NBAT for his treatment there. Based upon Samuel Johnson’s representation on the initial claim form, which indicated that Derron was a qualified dependent, NBAT paid approximately $65,000 in claims to MMHRC, the assignee of benefits due Der-ron Johnson. Subsequently, plaintiff learned that Derron’s correct date of birth was June 26, 1968 and that he had not been a student at the time of the accident. Thus, he was not a qualified dependent under the terms of the policy. After attempting unsuccessfully to obtain repayment from MMHRC of the amounts paid to Derron’s account, plaintiff brought the present action for recovery of the payments. Defendant has asserted a counterclaim for recovery of remaining amounts due on Derron Johnson’s account.

In its complaint, NBAT seeks a declaratory judgment that, pursuant to the terms of the plan and under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. §§ 1001 et seq. (1985 & Supp.1990), MMHRC is not entitled to retain payments and judgment for the amount of the payments (count I). NBAT also seeks recovery based on the state common law causes of action for money had and received (count II) and conversion (count III). Defendant’s counterclaim is for recovery of additional amounts from plaintiff; although the counterclaim does not specify a theory of recovery, defendant’s memoranda suggest that this is a state law claim for breach of an implied contract. By its motion, plaintiff seeks summary judgment on counts I and II of its complaint and on defendant’s counterclaim. The relief sought by defendant in its motion for partial summary judgment is not entirely clear; when considered along with statements and arguments contained in defendant’s memoranda, it appears to be a request for summary judgment on plaintiff’s ERISA claim (count I) and the state law conversion claim (count III), and the court will consider it as such. 1

Does a Cause of Action Exist under ERISA?

The initial question to be resolved is whether ERISA provides a basis for recov *462 ery. Both parties have moved for summary judgment on this claim. It is helpful, initially, to clarify the manner in which a claim may arise under the Act. Both plaintiff and defendant refer in their briefs to ERISA causes of action which arise under “federal common law,” apparently being under the impression that there exist two kinds of ERISA causes of action: those which arise under its express civil enforcement provisions, 29 U.S.C. § 1132, and those which arise under the general federal common law of ERISA. In the court’s opinion, this view is incorrect. While Congress did intend that the courts develop federal common law to be applied in ERISA cases when issues not specifically addressed in the Act arise, Degan v. Ford Motor Co., 869 F.2d 889, 895 (5th Cir.1989); Hayden v. Texas-U.S. Chemical Co., 681 F.2d 1053, 1058 (5th Cir.1982), Congress did not authorize the courts to develop or allow causes of action or remedies not expressly provided for in section 1132, Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 54, 107 S.Ct. 1549, 1556, 95 L.Ed.2d 39 (“The six carefully integrated civil enforcement provisions found in [section 1132(a) ] ... provide strong evidence that Congress did not intend to authorize other remedies that it simply forgot to incorporate expressly.”) Either plaintiffs ERISA claim arises under the express provisions of the Act, or it does not exist. Cf. Amos v. Blue Cross-Blue Shield of Alabama, 868 F.2d 430, 432 (11th Cir.) (indicating that effect of ERISA preemption is to leave remaining only those causes of action expressly provided for in section 1132), cert. denied, — U.S. -, 110 S.Ct. 158, 107 L.Ed.2d 116 (1989).

The only portion of section 1132 which addresses the type of claim which may be brought by an administrator of a plan is section 1132(a)(3), which provides that a civil action may be brought by a fiduciary to obtain appropriate equitable relief to redress violations of the statute or terms of the plan or to enforce any of their provisions. 2 The question of whether a plan administrator may bring an action under section 1132(a)(3) to recover payments made in error has been addressed in only a few cases. In Northern California Food Employers & Retail Clerks Unions Benefit Fund v. Dianda’s Italian-American Pastry Co., 645 F.Supp.

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Bluebook (online)
748 F. Supp. 459, 12 Employee Benefits Cas. (BNA) 2633, 1990 U.S. Dist. LEXIS 13166, 1990 WL 144285, Counsel Stack Legal Research, https://law.counselstack.com/opinion/national-benefit-administrators-inc-ex-rel-national-business-assn-trust-mssd-1990.