Serembus Ex Rel. UIU Health & Welfare Fund v. Mathwig

817 F. Supp. 1414, 16 Employee Benefits Cas. (BNA) 1493, 1992 U.S. Dist. LEXIS 20872, 1992 WL 466845
CourtDistrict Court, E.D. Wisconsin
DecidedOctober 13, 1992
Docket90-C-1038
StatusPublished
Cited by27 cases

This text of 817 F. Supp. 1414 (Serembus Ex Rel. UIU Health & Welfare Fund v. Mathwig) is published on Counsel Stack Legal Research, covering District Court, E.D. Wisconsin primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Serembus Ex Rel. UIU Health & Welfare Fund v. Mathwig, 817 F. Supp. 1414, 16 Employee Benefits Cas. (BNA) 1493, 1992 U.S. Dist. LEXIS 20872, 1992 WL 466845 (E.D. Wis. 1992).

Opinion

ORDER

STADTMUELLER, District Judge.

In this civil action, the plaintiff, as chairman on behalf of the Upholsters International Union (UIU) Health & Welfare Fund (hereinafter “UIU” or “Fund”) seeks reimbursement, for amounts it paid to defendant Kalana Mathwig (“Kalana”) for medical expenses she incurred from the settlement proceeds recovered by Kalana from third parties. Because this case involves the interpretation of an employee benefit plan regulated by the Employee Retirement Income Security Act (ERISA), jurisdiction exists pursuant to 29 U.S.C. § 1132. Presently before the court are the parties’ cross motions for summary judgment.

Plaintiff seeks summary judgment that the amounts it paid be reimbursed from the settlement proceeds held by Kalana, and declaratory judgment that the plaintiff does not have an obligation to pay any further medical bills or other claims. Defendant Kalana also seeks summary judgment that plaintiff has no contractual right of subrogation against her. Further, Kalana contends that even if the court finds plaintiff has a contractual right of subrogation, she has not been “made whole” as that term is defined by Wisconsin common law of subrogation, thereby precluding plaintiff from seeking reimbursement before Kalana is fully reimbursed for her injuries. These cross motions are fully briefed with additional authorities submitted by the parties at the court’s direction after a conference call on the motions.

I. Background

When the parties have both moved for summary judgment, the facts are usually undisputed, as is true in this case. The following serves as a summary of the court’s findings of fact. This case arises out of injuries suffered by Kalana Mathwig in an auto accident which occurred on June 13,1989. Kala-na, then age four, was a passenger in the back of a pick-up truck owned and operated by her grandfather, Douglas D. Meyer. Ka-lana’s mother, Sunday Dittmer, was also a passenger in the back of the truck. The Meyer truck was struck by a car operated by Timothy Beamon. Kalana and her mother Sunday were thrown from the truck. Kalana was severely injured and her mother was killed. Kalana was treated on an inpatient basis first at Children’s Hospital of Wisconsin in Milwaukee for about six weeks, then at Mercy Medical Center in Oshkosh, Wisconsin for about five weeks. Prior to the accident, Sunday Dittmer was married to James Ditt-mer and Kalana had been living with them. Kalana’s natural father is the defendant Derek Dahlke.

UIU Health & Welfare Fund is an employee welfare benefit plan which provides compensation for health expenses to its members. UIU is regulated by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1002 et seq. Plaintiff John H. Serembus is the chairman of UIU. UIU is self-funded, in that it pays benefits from its own funds rather than contracting with a third party insurance company to pay the benefits. Kalana’s stepfather, James Ditt-mer, was a member of the Fund at the time of the accident by virtue of his employment with Duo-Safety Ladder in Oshkosh, which participates in the Fund.

After the accident, a claim was made to the Fund for payment of Kalana’s medical expenses on the grounds that Kalana was a dependent stepdaughter of James Dittmer, and therefore, covered under the plan. Before benefits were paid, James Dittmer was required to sign an assignment and subrogation agreement pursuant to the Plan’s subro-gation provision. That assignment and' sub-rogation agreement contained the following language:

The trustees of the UIU Health and Welfare Fund have established the following subrogation policy:
If a covered member incurs any medical expense or loss time expense resulting *1417 from bodily injury or sickness for which he or she may have any right of recovery against a third party, other than an insurer of the covered member, any benefits paid by the fund for such expense shall be made on the condition that the fund will be reimbursed therefore by the covered member and his or her dependents to the extent of the amount received by the covered member from such third party by way of settlement or in satisfaction for any judgment. As security for the fund’s rights to such reimbursement, the fund shall be subro-gated to all rights of recovery of the covered member and his or her dependents against such third party to the extent of any benefit paid by the fund with respect to such expense. The covered member and his or her dependents shall do whatever is necessary fully to secure and to protect, and nothing to prejudice, the rights of the fund to such subrogation.
Assignment and Subrogation Agreement
Whereas, the undersigned (hereinafter called “claimant”) may be or has been furnished benefits in connection with the above claim under a benefit plan with the UIU Health and Welfare Fund (hereinafter called “the fund”) and the cost of such benefits may be recovered by the claimant from a party liable to claimant, other than an insurer of claimant.
Now therefore, claimant intending to be legally bound, agrees to assign and does hereby assign to the fund any amounts recovered from any party, other than an insurer of claimant, to the extent of the benefits furnished or to be furnished by the fund to or on behalf of claimant. Claimant also agrees that) when claimant shall have any rights to recover from any person or persons, other than an insurer of claimant, for benefits furnished under the agreement, the fund shall be subrogated to such rights to the extent of the benefits so furnished.
Claimant agrees to reimburse the UIU Health and Welfare Fund from any recovery he or she obtains from a third party to the extent of any benefits the fund pays on account of the accident giving rise to this claim. Claimant shall immediately inform the fund of any legal action or settlement which arises subsequent to the payment of benefits hereunder. In addition, claimant shall do nothing to prejudice such rights of the fund.
Claimant authorizes the fund to claim and receive any amounts hereby assigned or to which the fund is subrogated hereby, directly from any party liable to the claimant and hereby directs such party to make such payment directly to the fund upon presentation of a permanent copy of this assignment and right of subrogation. Claimant warrants that no settlement has been made by the undersigned with any person, or corporation against whom a claim may lie, and no release has been given to anyone responsible for the loss, and that no such settlement will be made nor release given by the undersigned without prior notice and the written consent of the said UIU Health and Welfare Fund.

The UIU Fund Plan Document includes the following language pertinent to the question of subrogation:

8.1 Upon payment under this plan and as security for the plan’s right to reimbursement to the extent of its payments, the plan will be subrogated to the covered person’s rights of recovery against any third party causing the injury or sickness for which the claim is made.

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Bluebook (online)
817 F. Supp. 1414, 16 Employee Benefits Cas. (BNA) 1493, 1992 U.S. Dist. LEXIS 20872, 1992 WL 466845, Counsel Stack Legal Research, https://law.counselstack.com/opinion/serembus-ex-rel-uiu-health-welfare-fund-v-mathwig-wied-1992.