Providence Health System-Washington v. Bush

461 F. Supp. 2d 1226, 39 Employee Benefits Cas. (BNA) 2540, 2006 U.S. Dist. LEXIS 81912, 2006 WL 3249199
CourtDistrict Court, W.D. Washington
DecidedNovember 8, 2006
DocketC06-5268 RBL
StatusPublished
Cited by2 cases

This text of 461 F. Supp. 2d 1226 (Providence Health System-Washington v. Bush) is published on Counsel Stack Legal Research, covering District Court, W.D. Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Providence Health System-Washington v. Bush, 461 F. Supp. 2d 1226, 39 Employee Benefits Cas. (BNA) 2540, 2006 U.S. Dist. LEXIS 81912, 2006 WL 3249199 (W.D. Wash. 2006).

Opinion

ORDER

LEIGHTON, District Judge.

This matter comes before the Court on competing motions to dismiss pursuant to Fed. R Civ. P. 12(b)(6), and motions for summary judgment. [Dkt. # s. 10, 12, 16 and 34], The material facts are not in dispute and having reviewed the written and oral presentations of the parties, the Court hereby renders the following decision.

FACTUAL AND PROCEDURAL BACKGROUND

On or about September 12, 2005, defendant Terri Block’s daughter, Sarah Block, was seriously injured in an automobile accident in Pierce County, Washington. Complaint ¶ 8 [Dkt. # 1]. Defendant Block is an employee of Providence and at all relevant times has been a participant in an employee welfare benefit plan for health coverage maintained by Providence under ERISA. Id. at ¶ 2. As a result of the injuries sustained by Block in the accident, and as required by the Plan, Providence has paid $801,664.72. This amount is projected eventually to equal $1 million. Id. at ¶ 8. 1

*1230 The Plan constitutes a contract between Providence and Terri Block. It includes the following provision.

Third-Party Liability — If someone else is legally responsible or agrees to compensate you for injuries suffered by you or a family member, you will need to reimburse the plan for up to 100% of any benefits the plan paid in connection with those injuries. This reimbursement may be reduced in the same proportion by which the settlement, judgment or other recovery is reduced for payment of costs and attorneys’ fees reasonably incurred in obtaining that recovery.

Plan at page 5-5, Ex. 1 to Complaint. Under the terms of this provision of the Plan, Providence argues that defendant Block is obligated to repay it for any recovery from any insurance company, in an amount equal to the full value of the benefits provided, less a proportionate share of reasonable attorneys’ fees. Id.; Complaint ¶ 10.

Several months after the accident, Farmer’s Insurance Company agreed to settle Sarah Block’s underinsured motorist claims for $2,100,000 (“the Settlement Funds”). Complaint ¶ 9. Due to Sarah Block’s incapacity, defendant Block was appointed guardian in a state proceeding entitled In re the Guardianship of Sarah Block, an Alleged Incapacitated Person, Pierce County (Washington) Case No. 05-4-01531-7 (“the Guardianship Proceeding”). Id.

On March 23, 2006, defendant Block moved in the Guardianship Proceeding for an order creating a “Special Needs Trust,” which by its terms contains a “spendthrift” clause purporting to bar Providence from making a claim against the settlement funds. Id. at ¶ 11. Providence intervened in the Guardianship Proceeding to protect its interest in the Settlement Funds, but a court commissioner on March 31, 2006 entered an order approving the creation of the Special Needs Trust. Id. On Providence’s motion for revision and over Providence’s objections that its claim must first be determined before placing the settlement funds beyond its reach, the Superior Court confirmed creation of the Special Needs Trust on April 21, 2006. Id. That order was timely appealed by Providence to the Washington Court of Appeals. Id.

Pursuant to the March 31, 2006 order of the Pierce County Superior Court, defendant Bush was appointed trustee of the Special Needs Trust. He therefore has possession and control of the Settlement Funds, minus certain sums paid to Block’s attorneys pursuant to that same court order. Complaint ¶ 12.

In this action, Providence seeks to establish a constructive trust or equitable lien over the funds contained within the special needs trust. Providence relies on the terms and conditions of its plan, provisions of the Employee Retirement Income Security Act of 1974 (ERISA), specifically, § 502(a)(3), (29 U.S.C.A. § 1132(a)(3)); and recent case law handed down by the United States Supreme Court and lower federal courts. Defendants challenge the Court’s jurisdiction and, alternatively, urge the Court to interpret language of the plan in such a way that allows, under various theories, the special needs trust to keep the funds intact.

SUMMARY JUDGMENT STANDARD

Summary judgment is appropriate when, viewing the facts in the light most favorable to the nonmoving party, there is no genuine issue of material fact which would preclude summary judgment as a matter of law. Once the moving party has satisfied its burden, it is entitled to summary judgment if the non-moving party fails to present, by affidavits, depositions, answers to interrogatories, or admissions *1231 on file, “specific facts showing that there is a genuine issue for trial.” Celotex Corp. v. Catrett, 477 U.S. 317, 324, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). “The mere existence of a scintilla of evidence in support of the non-moving party’s position is not sufficient.” Triton Energy Corp. v. Square D Co., 68 F.3d 1216, 1221 (9th Cir.1995). Factual disputes whose resolution would not affect the outcome of the suit are irrelevant to the consideration of a motion for summary judgment. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). In other words, “summary judgment should be granted where the nonmoving party fails to offer evidence from which a reasonable [fact finder] could return a [decision] in its favor.” Triton Energy, 68 F.3d at 1220.

RULE 12(b)(6) STANDARD

Under FRCP 12(b)(6), a complaint may be dismissed for failure to state a claim upon which relief can be granted for one of two reasons: (1) lack of cognizable legal theory or (2) insufficient facts under a cognizable legal theory. Conley v. Gibson, 355 U.S. 41, 45-46, 78 S.Ct. 99, 2 L.Ed.2d 80 (1957); accord, Balistreri v. Pacifica Police Dep’t, 901 F.2d 696, 699 (9th Cir.1988). For purposes of a motion to dismiss, all allegations of material fact in the complaint are taken as true and construed in the light most favorable to the nonmoving party. NOW v. Scheidler, 510 U.S. 249, 256, 114 S.Ct. 798, 127 L.Ed.2d 99 (1994); Clegg v. Cult Aivareness Network, 18 F.3d 752, 754 (9th Cir.1994).

I. Subject Matter Jurisdiction

Defendants 2

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461 F. Supp. 2d 1226, 39 Employee Benefits Cas. (BNA) 2540, 2006 U.S. Dist. LEXIS 81912, 2006 WL 3249199, Counsel Stack Legal Research, https://law.counselstack.com/opinion/providence-health-system-washington-v-bush-wawd-2006.