Primax Recoveries, Inc. v. Lee

260 F. Supp. 2d 43, 30 Employee Benefits Cas. (BNA) 1971, 2003 U.S. Dist. LEXIS 6992, 2003 WL 1961349
CourtDistrict Court, District of Columbia
DecidedApril 15, 2003
DocketCIV.A. 99-2020(PLF)
StatusPublished
Cited by57 cases

This text of 260 F. Supp. 2d 43 (Primax Recoveries, Inc. v. Lee) is published on Counsel Stack Legal Research, covering District Court, District of Columbia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Primax Recoveries, Inc. v. Lee, 260 F. Supp. 2d 43, 30 Employee Benefits Cas. (BNA) 1971, 2003 U.S. Dist. LEXIS 6992, 2003 WL 1961349 (D.D.C. 2003).

Opinion

OPINION

PAUL L. FRIEDMAN, District Judge.

The Court has before it defendant Anna-bell Lee’s motion to dismiss the complaint against her, plaintiffs opposition and defendant’s reply, as well as supplemental briefs concerning the impact of the recent opinion of the Supreme Court in Great-West Life & Annuity Ins. Co. v. Knudson, 534 U.S. 204, 122 S.Ct. 708, 151 L.Ed.2d 635 (2002). After considering the complaint in the light most favorable to plaintiff, the Court concludes that defendant’s motion to dismiss for lack of subject matter jurisdiction, failure to state a claim, failure to join an indispensable party, and failure to sue the real party in interest must be denied.

I. FACTUAL BACKGROUND

Defendant Annabell Lee suffered personal injuries in an automobile accident on January 17, 1992. See Complaint U11; Motion to Dismiss at 1. Her injuries required hospitalization, with medical treatment continuing for two and a half years at a total cost of $89,843.17 to defendant’s health insurer, The George Washington University Health Plan (“the Plan”). See Complaint II12. Following her accident, defendant filed a civil action against a third-party tortfeasor, who she alleged was responsible for the accident and her injuries. A settlement was reached between defendant and the third party, and defendant received what she characterizes as a non-differentiated, lump sum settlement of $450,000. See Motion to Dismiss at 2. It is from this recovery that plaintiff seeks reimbursement.

Plaintiff brought this action pursuant to Section 1132(a)(3) of the Employee Retirement Income Security Act of 1974 (“ERISA”), claiming that as an assignee for purposes of collection and as a fiduciary of the George Washington University Health Plan, it is entitled to reimbursement from defendant for medical expenses based on the reimbursement clause contained in defendant’s health plan. In relevant part, that provision states: “If a Member is injured or suffers illness as a *46 result of an act caused by or involving a third party, the Health Plan shall be reimbursed for Covered Services it provides or pays that are recovered or may be recoverable from the third party .... ” Complaint, Exhibit 1, The George Washington University Health Plan, Inc., District of Columbia Standard Option Plan at 22, Art. 10(A). Plaintiff contends that the benefits defendant received from the Plan were subject to and conditioned upon the Plan’s right of reimbursement, and that defendant’s refusal to reimburse the Plan out of the settlement proceeds violated her contractual obligation under the policy. See Complaint HIT 15, 21.

The Plan is a health care plan sponsored by The George Washington University. See Complaint 112. 1 The University established and maintains the Plan for the purpose of providing its employees and their eligible dependents with medical, surgical and/or hospital care. See id. Plaintiff asserts, and defendant does not contest, that the Plan therefore is an “employee welfare benefit plan” within the meaning of ERISA. See id.;. 29 U.S.C. § 1002(1)..

Seeking to assert its rights under the Plan and to obtain equitable and “restitutionary relief’ under ERISA in an amount equivalent to the benefits it has paid for medical expenses incurred by defendant, plaintiff filed suit against defendant on July 28, 1999. See Complaint 11115, 19, 22. Plaintiff asserts that it has standing to bring this suit as the assignee and fiduciary of the Plan pursuant to 29 U.S.C. § 1132(a)(3), which provides that a civil action may be brought under ERISA

by a participant, beneficiary, or fiduciary (A) to enjoin any act or practice which violates any provision of this subchapter or the terms of the plan, or (B) to obtain other appropriate equitable relief (i) to redress such violations or (ii) to enforce any provisions of this subchapter or the terms of the plan.

According to plaintiff, the Plan duly appointed and authorized plaintiff to administer and prosecute all of the Plan’s rights and claims to reimbursement and subrogation, making plaintiff an assignee for purposes of collection and a fiduciary under ERISA. Id. 1T1Í 3, 6. 2 Plaintiff bases its claim of fiduciary status on its assertion that it has discretionary authority in the settlement and prosecution of claims for reimbursement and subrogation, as well as in the collection, management, investment and disbursement of Plan assets. Id. 116.

II. DISCUSSION

Defendant moves to dismiss plaintiffs complaint on the grounds that: (1) this Court lacks subject matter jurisdiction; (2) plaintiff has failed to state a claim upon which relief can be granted; (3) plaintiff has failed to join an indispensable party, namely the Plan; and (4) plaintiff must sue the real party in interest, the Plan, rather *47 than defendant. The Court will address each of these arguments in turn.

A. Subject Matter Jurisdiction

Defendant contends that the Court does not have subject matter jurisdiction over this matter because plaintiff’s cause of action is not a genuine ERISA claim. Defendant bases this claim on two separate theories: (1) that plaintiff is not a fiduciary, and (2) that plaintiffs claim is legal, rather than equitable in nature.

1. Plaintiff’s Status as “Fiduciary”

First, defendant argues that plaintiff is not a fiduciary within the meaning of ERISA and thus is not empowered to bring suit under 29 U.S.C. § 1132(a)(3). Defendant alleges that plaintiffs assertion of fiduciary status was made only to enable it to bring this action in federal court and that plaintiff has provided no evidence of an assignment of rights or of its status as a fiduciary. Defendant notes that a federal court may dismiss an asserted ERISA claim for lack of subject matter jurisdiction if the claim is made solely for the purpose of obtaining jurisdiction or is wholly insubstantial and frivolous. See Blue Cross & Blue Shield v. Sanders, 138 F.3d 1347, 1352 (11th Cir.1998) (citing Bell v. Hood, 327 U.S. 678, 682-83, 66 S.Ct. 773, 90 L.Ed. 939 (1946)).

On a Rule 12(b)(1) motion to dismiss for lack of subject matter jurisdiction, the Court must accept as true all factual allegations set forth in the complaint and must draw all reasonable inferences from those allegations in favor of the non-moving party. See Artis v. Greenspan,

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Bluebook (online)
260 F. Supp. 2d 43, 30 Employee Benefits Cas. (BNA) 1971, 2003 U.S. Dist. LEXIS 6992, 2003 WL 1961349, Counsel Stack Legal Research, https://law.counselstack.com/opinion/primax-recoveries-inc-v-lee-dcd-2003.