Seneca Wire & Manufacturing Co. v. Aetna Life Insurance

8 F. Supp. 2d 670, 1997 U.S. Dist. LEXIS 23276, 1997 WL 909474
CourtDistrict Court, N.D. Ohio
DecidedMay 7, 1997
Docket3:95 CV 7601
StatusPublished

This text of 8 F. Supp. 2d 670 (Seneca Wire & Manufacturing Co. v. Aetna Life Insurance) is published on Counsel Stack Legal Research, covering District Court, N.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Seneca Wire & Manufacturing Co. v. Aetna Life Insurance, 8 F. Supp. 2d 670, 1997 U.S. Dist. LEXIS 23276, 1997 WL 909474 (N.D. Ohio 1997).

Opinion

MEMORANDUM OPINION

KATZ, District Judge.

This matter is before the Court on multiple motions for summary judgment. The relevant facts are not in dispute. For the follow *671 ing reasons, Plaintiff Seneca Wire & Manufacturing Company’s motion for summary judgment against Defendant/Third-Party Plaintiff Aetna Life Insurance Company will be denied. Defendant/Third Party-Plaintiff Aetna Life Insurance Company’s motion for summary judgment against Plaintiff Seneca Wire & Manufacturing Company will be granted. Defendant/Third-Party Plaintiff Aetna Life Insurance Company’s motion for summary judgment against Third-Party Defendant First Allmerica Financial Life Insurance Company will be denied as moot. Third-Party Defendant First Allmerica Financial Life Insurance Company’s motion for summary judgment against Defendant/Third-Party Plaintiff Aetna Life Insurance Company will be denied as moot.

I. Background

From March 1, 1984 to April 30, 1993, Plaintiff Seneca Wire & Manufacturing Company (“Seneca”) and Defendant/Third-Party Plaintiff Aetna Life Insurance Company (“Aetna”) were parties to a split-funded agreement concerning the provision and financing of health insurance benefits for Seneca’s employees and their dependents (the “Agreement”). Under the Agreement, Seneca self-insured all medical claims up to a liability limit of $100,000 per covered individual per year. Aetna processed the claims for Seneca and was then reimbursed for those 'payments through bank transfers. Aetna also funded all claims above the first $100,000 of claims per person in a single year.

On March 17, 1993, Seneca notified Aetna it was terminating the Agreement effective May 1, 1993. Seneca then entered into similar stop-loss and claims processing arrangements with State Mutual Life Assurance Company of America (“State Mutual”), predecessor in interest to Third-Party Defendant First Allmerica Financial Life Insurance Company, and McDonough Caperton Benefit Services, Inc., which is not a party to this action. By letter dated April 22, 1993, Seneca notified Aetna that McDonough would be responsible for the processing of all “run-out” claims — claims incurred before the May 1, 1993 termination but not processed until after that date.

On April 3, 1993, the wife of a covered Seneca employee gave birth to premature twins, who incurred significant medical expenses. During April, 1993, Nicolas • Long incurred medical expenses in the amount of $130,168 and Mitchell Long incurred medical expenses of $149,012, for a total of $279,180. From May to August, 1993, Nicholas Long incurred medical expenses in the amount of $155,311 and Mitchell Long incurred medical expenses of $193,144, for a total of $348,455. All of the medical bills were submitted for processing after May 1,1993.

Aetna forwarded the Long twins’ medical bills to McDonough for processing, but Mc-Donough refused to process or pay the Long twins’ bills. On September 16, 1993, Aetna processed and paid $604,609 on the Long-twins’ claims and then reimbursed itself in that amount from-a Seneca bank account.

Subsequently, State Mutual paid $263,-368.28 to Seneca conditioned on Seneca pursuing its claim against Aetna and agreeing to a formula allocating Seneca’s- and State Mutual’s participation in any recovery from Aet-na.

Seneca then brought the instant action against Aetna for the Long twins’ medical expenses, less the $100,000 liability limit for each twin. Seneca alleges that Aetna is responsible under the Agreement for the expenses incurred before May 1, 1993 because those expenses were incurred while the Agreement was still in full force. Seneca alleges that Aetna is responsible for the expenses incurred on and after May 1, 1993 because the plan booklet given to employees to explain their rights under the insurance plan guarantees employees basic medical expenses to a participant who is totally disabled for three months after the termination of coverage, and the twins were totally disabled.

Aetna brought a third-party complaint against State Mutual for indemnity. State Mutual has filed a counterclaim against Aet-na for reimbursement of the $263,368.28 it paid to Seneca.

The matter is now before the Court on two sets of cross motions for summary judgment. Seneca and Aetna have each moved for summary judgment on the issue of Aetna’s liabili *672 ty for the twins’ medical bills. Aetna and State Mutual have each moved for summary judgment on the issue of Aetna’s right to indemnity. The Court discusses the parties’ contentions below.

II. Summary Judgment Standard

As an initial matter, the Court sets forth the relative burdens of the parties once a motion for summary judgment is made. Summary judgment must be entered “against a party who fails to make a showing sufficient to establish the existence of an element essential to that party’s case, and on which that party will bear the burden of proof at trial.” Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). Of course, the moving party always bears the initial responsibility of informing the district court of the basis for its motion, and identifying those portions of “the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any,” which it believes demonstrate the absence of a genuine issue of material fact. 477 U.S. at 323, 106 S.Ct. 2548. The burden then shifts to the nonmov-ing party who “must set forth specific facts showing that there is a genuine issue for trial.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 250, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986) (quoting Fed.R.Civ.P. 56(e)).

Once the burden of production has so shifted, the party opposing summary judgment cannot rest on its pleadings or merely reassert its previous allegations. It is not sufficient to “simply show that there is some metaphysical doubt as to the material facts.” Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986). Rather, Rule 56(e) “requires the nonmoving party to go beyond the [unverified] pleadings” and present some type of evidentiary material in support of its position. Celotex Corp., 477 U.S. at 324, 106 S.Ct. 2548. Summary judgment shall be rendered if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c).

III. Motions Regarding Aetna’s Liability

Seneca and Aetna each have moved for summary judgment on the issue of Aetna’s liability.

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Anderson v. Liberty Lobby, Inc.
477 U.S. 242 (Supreme Court, 1986)
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Bluebook (online)
8 F. Supp. 2d 670, 1997 U.S. Dist. LEXIS 23276, 1997 WL 909474, Counsel Stack Legal Research, https://law.counselstack.com/opinion/seneca-wire-manufacturing-co-v-aetna-life-insurance-ohnd-1997.