Rodriguez v. Tennessee Laborers Health & Welfare Fund

89 F. App'x 949
CourtCourt of Appeals for the Sixth Circuit
DecidedFebruary 6, 2004
DocketNo. 02-5601
StatusPublished
Cited by330 cases

This text of 89 F. App'x 949 (Rodriguez v. Tennessee Laborers Health & Welfare Fund) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Rodriguez v. Tennessee Laborers Health & Welfare Fund, 89 F. App'x 949 (6th Cir. 2004).

Opinion

[951]*951OPINION

GWIN, District Judge.

The Tennessee Laborers Health and Welfare Fund (“Fund”), an ERISA plan administrator, appeals from a district court decision that found it had no right to reimbursement from participant Elias Rodriguez after Rodriguez settled a claim against a third-party tortfeasor. The Fund contends that Rodriguez had no coverage under the ERISA plan and that it erred in paying benefits on his behalf. Moreover, the Fund argues that it has a right to reimbursement from the settlement proceeds that Rodriguez received.

With this appeal, we examine whether the district court: (1) erred when it determined that the Fund construed an ERISA plan provision in an arbitrary and capricious manner; (2) erred when it determined that the Fund was not entitled to reimbursement based on the federal common-law “make whole” rule; and (3) erred when it denied the Fund’s motion to alter, amend, or reconsider an interlocutory order.

For the following reasons, we AFFIRM the district court’s decisions on all issues the Fund raises in its appeal.

HISTORY

In July 1997, Rodriguez began work for Skilton Paving and Construction Company (“Skilton”). Skilton contributes to the Fund’s employee welfare benefit plan governed by the Employee Retirement Insurance Security Act (ERISA), 29 U.S.C. § 1001 et seq. In October 1997, Rodriguez sustained an on-the-job injury that left him unable to work for Skilton. Following this injury, Skilton continued to pay Rodriguez wages, to document Rodriguez as a full-time employee, and to submit contributions to the Fund on behalf of Rodriguez. At the time, the Fund was unaware that Rodriguez no longer worked for Skilton.

On April 4, 1999, Rodriguez suffered serious injuries in an automobile accident unrelated to his work. Before paying any medical benefits under the plan, the Fund required Rodriguez to sign a subrogation agreement. On June 8, 1999, Rodriguez’ wife signed this agreement on Rodriguez’ behalf.

Shortly thereafter, Rodriguez requested that the Fund waive any right to subrogation of any recovery he received from a third-party tortfeasor. Rodriguez argued that such limits to insurance coverage would result in his not being fully compensated for his injuries and damages. Rodriguez later informed the Fund’s Board of Trustees that he would recover approximately $116,666 through settlements of his claims.

As of November 30, 1999, the Fund had paid approximately $238,638.11 in medical expenses on behalf of Rodriguez. At a March 6, 2000, meeting of the Fund’s Board of Trustees, the Board reviewed Rodriquez’ request that it not seek reimbursement. The Board unanimously decided to reduce its reimbursement demand to $57,139.94.

Rodriguez requested the Board reconsider its decision. At its May 22, 2000, meeting, the Board again discussed Rodriguez’ request. For the first time, the Board considered whether Rodriguez had been entitled to receive any benefits for his injuries sustained in the April 4, 1999, accident. After this May 22, 2000, review, the Board determined that Rodriguez was not an employee covered under the Fund’s plan at the time of the April 4, 1999, automobile accident because he had not worked at Skilton since October 1997. [952]*952The Board interpreted the “CONTINUATION OF ELIGIBILITY” section of the benefits plan to require that an employee work 130 hours per month to maintain eligibility for benefits. Although the Board gave suggestions regarding how Rodriguez might purchase coverage under COBRA,1 the Board demanded subrogation of $57,139.94 that Rodriguez would receive from the third-party tortfeasor.

Rodriguez did not make the payments and instead brought suit under ERISA, 29 U.S.C. § 1132(a)(3), in the United States District Court for the Middle District of Tennessee. With his complaint, Rodriguez sought a declaration of his rights under the terms of the plan. Rodriguez asked the district court to find that he was eligible to receive benefits in April 1999 and to prevent the Fund from seeking reimbursement from the settlement recovery. After ordering the Fund to supplement the administrative record with plan documents and amendments in effect from October 1, 1997, through April 30, 1999, the district court entered an interlocutory order. With its order, the district court granted Rodriguez judgment regarding his eligibility for coverage under the plan and the applicability of the common law “make whole” rule to the plan. The Plan subsequently conceded that Rodriguez’ recovery had not made him whole, which was the only remaining issue in the case. The Fund moved for reconsideration of the order entering judgment for Rodriguez, and the district court denied that motion. The Fund then filed a timely notice of appeal.

STANDARD OF REVIEW

We review de novo a district court’s grant of judgment in an ERISA action. Wilkins v. Baptist Healthcare Sys., Inc. 150 F.3d 609 (6th Cir.1998). When an ERISA plan expressly grants a Fund discretionary authority to interpret plan provisions, we review the Fund’s interpretation of the provisions under the arbitrary and capricious standard of review. See Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989); Hunter v. Caliber Sys., Inc., 220 F.3d 702, 711 (6th Cir.2000); Yeager v. Reliance Standard Life Ins. Co., 88 F.3d 376, 380 (6th Cir.1996); Cooper Tire & Rubber Co. v. St. Paul Fire & Marine Ins. Co., 48 F.3d 365, 371 (8th Cir.1995) (applying arbitrary and capricious standard to a claim brought under 29 U.S.C. § 1132(a)(3)). Review under the arbitrary and capricious standard is the least demanding form of judicial review of an administrative action. Under this standard of review, “we must decide whether the plan administrator’s decision was ‘rational in light of the plan’s provisions.’ ” Smith v. Ameritech, 129 F.3d 857, 863 (6th Cir. 1997) (quoting Daniel v. Eaton Corp., 839 F.2d 263, 267 (6th Cir.1988)).

In contrast, this court reviews the district court’s denial of the Fund’s motion for reconsideration of an interlocutory order for abuse of discretion. District courts possess the authority and discretion to reconsider and modify interlocutory judgments any time before final judgment. See, e.g., Moses H. Cone Mem’l Hosp. v. Mercury Constr. Corp., 460 U.S. 1, 12, 103 S.Ct. 927, 74 L.Ed.2d 765 (1983) (noting that “every order short of a final decree is subject to reopening at the discretion of the district judge”); Mallory v. Eyrich,

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Bluebook (online)
89 F. App'x 949, Counsel Stack Legal Research, https://law.counselstack.com/opinion/rodriguez-v-tennessee-laborers-health-welfare-fund-ca6-2004.