Sanders v. Scheideler

816 F. Supp. 1338, 1993 U.S. Dist. LEXIS 3634, 1993 WL 85691
CourtDistrict Court, W.D. Wisconsin
DecidedMarch 23, 1993
Docket92-C-0477-C
StatusPublished
Cited by30 cases

This text of 816 F. Supp. 1338 (Sanders v. Scheideler) is published on Counsel Stack Legal Research, covering District Court, W.D. Wisconsin primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Sanders v. Scheideler, 816 F. Supp. 1338, 1993 U.S. Dist. LEXIS 3634, 1993 WL 85691 (W.D. Wis. 1993).

Opinion

OPINION and ORDER

CRABB, Chief Judge.

This is a civil action for a declaration of rights to the proceeds of an insurance policy. The parties asserting rights are defendants Joshua, Andrea, Dustin and Daniel Scheide-ler, all minors, and defendant NEPCO EMBA, a self-insured employee benefit plan established under 29 U.S.C. § 1102. The dispute concerns defendant NEPCO EMBA’s entitlement to reimbursement for medical payments made on behalf of the Seheidelers.

Before the court are cross-motions for summary judgment by the Scheideler children and NEPCO EMBA. NEPCO EMBA contends that it is subrogated to the rights of the Scheideler children to the full extent of the insurance proceeds. The Scheideler children maintain that NEPCO EMBA’s subro-gation rights are limited to third party payments that duplicate medical benefits paid by the fund and that their interest in the proceeds concerns losses other than medical costs. Because the Plan fails to grant priority to either of the defendants, I will adopt as federal common law the “make-whole” doctrine as a default priority rule. The parties’ motions for summary judgment will be denied and a hearing will be set to determine the amount of the Scheideler children’s damages.

To succeed on a motion for summary judgment, the moving party must show that there is no genuine issue of material fact and that the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c); Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 2552, 91 L.Ed.2d 265 (1986); Indiana Grocery Inc. v. Super Valu Stores, Inc., 864 F.2d 1409, 1412 (7th Cir.1989). When the moving party succeeds in showing the absence of a genuine issue as to any material fact, the opposing party must set forth specific facts showing that there is a genuine issue for trial. Fed.R.Civ.P. 56(e); Matsushita Electric Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586, 106 S.Ct. 1348, 1355, 89 L.Ed.2d 538 (1986); Bank Leumi Le-Israel, B.M. v. Lee, 928 F.2d 232, 236 (7th Cir.1991). The opposing party cannot rest on the pleadings alone, but must designate *1341 specific facts in affidavits, depositions, answers to interrogatories or admissions that establish that there is a genuine issue for trial. Celotex, 477 U.S. at 324, 106 S.Ct. at 2553. Also, if a party fails to make a showing sufficient to establish the existence of an essential element on which that party will bear the burden of proof at trial, summary judgment for the opposing party is proper. Id. at 322, 106 S.Ct. at 2552.

The relevant facts derive from the parties’ proposed findings of fact'and from copies of NEPCO EMBA’s Articles of Association and other documents related to its plan. For the purpose only of deciding the parties’ cross-motions for summary judgment, I find the following facts to be undisputed.

FACTS

Plaintiff Marcus J. Sanders is an adult resident of New Mexico. He was insured' against liability for automobile accidents for up to $50,000 by plaintiff Dairyland Insurance Company, a Wisconsin corporation with its main office in Stevens Point, Wisconsin. Defendants Rebecca J. Scheideler and Daniel G.. Scheideler reside in Nekoosa, Wisconsin. Their children are defendants Jason B. Scheideler, Joshua D. Scheideler, Andrea J. Scheideler and Dustin G. Scheideler, all of whom are minors.

Defendant NEPCO EMBA is a self-funded “employee welfare benefit plan” within the meaning of § 3(1) of ERISA, 29 U.S.C. § 1002(1). The plan is a voluntary health care plan available to eligible employees of the Georgia-Pacific Corporation (formerly Nekoosa Papers, Inc.).

NEPCO EMBA’s Articles of Association authorize a board of directors to govern the plan’s affairs (Art. Ill, § 1). The board is granted the power to terminate the plan (Art. XII, § 1), to amend by majority vote the terms, conditions and limitations governing benefits (Art. II, § 2), and to make final decisions with respect to proposed settlements of claims by the executive committee (Art. IX, § 8). The articles authorize an executive committee to “pass upon all claims by a member against the association” (Art. Ill, § 12) and “to authorize payment of benefits; accept or reject all applications for members ... and perform such other duties as may be required by the Board of Directors.” (Art. Ill, § 10).

At all times relevant to this action, defendant Daniel Scheideler was an eligible employee and a participant in the NEPCO EMBA. His wife and children were eligible for benefits under the NEPCO EMBA group medical plan as his dependents.

On March 3,1992, an automobile driven by defendant Rebecca J. Scheideler collided with a vehicle driven by plaintiff Sanders. Defendants Rebecca, Jason, Joshua, Andrea and Dustin Scheideler sustained injuries requiring medical treatment. The negligence of plaintiff Sanders was a substantial factor and proximate cause of the accident and injuries sustained by the Scheideler family.

As of July 1, 1992, NEPCO EMBA has paid $156,680.70 in benefits to Daniel- Schei-deler for treatment of the injuries sustained by his wife and children in the March 3 accident. The payments have been disbursed as follows:

Rebecca J. Scheideler $ 28,664.46

Jason B. Scheideler $ 21,500.17

Joshua D. Scheideler Dustin Scheideler ... $100,657.13 $ 1,839.46

Andrea Scheideler .. $ 4,007.55

The NEPCO EMBA Articles of' Association contain a subrogation clause that provides as follows:

Section 2. Third Party Liability

If the employee is reimbursed for medical expenses incurred as the result of an injury by either the person causing such injury or that person’s insurance, such payments that duplicate benefits paid by NEMBA *1342 will be refunded to NEMBA by the employee.

The Articles of Association also contain the following “Coordination of Benefits” provision:

This plan has been designed to help the employee meet the cost of disease or injury. Since it is not intended that he receive greater benefits than the actual medical expenses incurred, any coverage he has under other “plans” will be taken into account in determining the amount of benefit payable under this plan; that is, the benefits of this plan will be coordinated with the benefits of the other plans.

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Cite This Page — Counsel Stack

Bluebook (online)
816 F. Supp. 1338, 1993 U.S. Dist. LEXIS 3634, 1993 WL 85691, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sanders-v-scheideler-wiwd-1993.