Slavik v. Dr. Pepper Bottling Co. of Texas Employee Welfare Benefit Plan

867 F. Supp. 472, 1994 U.S. Dist. LEXIS 14878, 1994 WL 568860
CourtDistrict Court, N.D. Texas
DecidedAugust 31, 1994
DocketCiv. A. No. 4:93-CV-144-K
StatusPublished

This text of 867 F. Supp. 472 (Slavik v. Dr. Pepper Bottling Co. of Texas Employee Welfare Benefit Plan) is published on Counsel Stack Legal Research, covering District Court, N.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Slavik v. Dr. Pepper Bottling Co. of Texas Employee Welfare Benefit Plan, 867 F. Supp. 472, 1994 U.S. Dist. LEXIS 14878, 1994 WL 568860 (N.D. Tex. 1994).

Opinion

SUMMARY JUDGMENT MEMORANDUM ORDER

BELEW, District Judge.

Pending before the Court are motions for summary judgment and or Fed.R.Civ.P. 12(b)(6) dismissal filed by Dr. Pepper and the Slaviks. The Benefits Plan has agreed, by stipulation entered on June 30, 1994, to be bound by the Court’s decision of these Motions.

After careful review of the parties motions, arguments, authorities and law, it is the considered opinion of the Court that Plaintiffs’ Motion for Summary Judgment should be granted in part, denied in part and that the Defendants’ Motion for Summary Judgment should be granted in part, denied in part.

ERISA1 suits, like the one before the Court, are often difficult, not so much because the substantive law is complex, but because the facts underlying the cases are often wrenching. The court is usually faced with the prospect of denying insurance or pension benefits to someone who desperately needs them because of cold, hard actuarial [475]*475decisions backed by the muscle of super-statute ERISA.2

1. SUMMARY JUDGMENT STANDARD

To prevail on a summary judgment motion under Fed.R.Civ.P. 56(e), a movant must show that it is entitled to a judgment as a matter of law because there are no genuine issues of material fact for trial. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 256, 106 S.Ct. 2505, 2514, 91 L.Ed.2d 202 (1986) and Slaughter v. Southern Talc Co., 949 F.2d 167, 170 (5th Cir.1991). A material fact is one that “might affect the outcome of the suit” under the governing substantive law. Liberty Lobby, 477 U.S. at 248, 106 S.Ct. at 2510. A movant shows that no genuine issues of material fact exist when it demonstrates that a rational fact finder could not decide the issue in favor of the non-movant after considering the record as a whole. Matsushita Electric Industrial Co. v. Zenith Radio Corp., 475 U.S. 574, 587, 106 S.Ct. 1348, 1356, 89 L.Ed.2d 538 (1986).

In ruling on this motion, the Court will look at the full record, including the pleadings, depositions, answers to interrogatories, admissions on file, as well as any affidavits or other evidence attached to the summary judgment motion. Adams v. Williams, 836 F.2d 958, 961 (5th Cir.1988) and Fed.R.Civ.P. 56(c). The Court will draw all reasonable inferences from the underlying facts in the light most favorable to the non-movant and any doubt will be resolved in its favor. Eastman Kodak Co. v. Image Technical Serv., Inc., - U.S. -, -, 112 S.Ct. 2072, 2083, 119 L.Ed.2d 265 (1992) and Resolution Trust Corporation v. Sharif-Munir-Davidson Development Company, 992 F.2d 1398, 1401 (5th Cir.1993). The Court’s function is not, however, to “weigh the evidence and determine the truth of the matter,” rather the Court’s inquiry is to determine “whether the evidence presents a sufficient disagreement to require submission to a jury or is the matter so one-sided that one party must prevail as a matter of law.” Liberty Lobby, 477 U.S. at 249, 251-52, 106 S.Ct. at 2510, 2511-12.

The movant’s burden of proof depends on the movant’s litigation proof burdens. “[I]f the movant bears the burden of proof on an issue, whether because he is the plaintiff or as a defendant he is asserting an affirmative defense, he must establish beyond peradventure all of the essential elements of the claim or defense to warrant judgment in his favor.” Fontenot v. Upjohn Co., 780 F.2d 1190, 1194 (5th Cir.1986).

If the non-movant bears the burden of proof on the issue, the movant is entitled to summary judgment if it can show that the non-movant has failed, after adequate discovery, to sufficiently establish each and every element essential to its case. Celotex Corp. v. Catrett, 477 U.S. 317, 322-23, 106 S.Ct. 2548, 2552-53, 91 L.Ed.2d 265 (1986); Lavespere v. Niagara Mach. & Tool Works, Inc., 910 F.2d 167, 178 (5th Cir.1990), cert. denied, — U.S. -, 114 S.Ct. 171, 126 L.Ed.2d 131 (1993).

Once the moving party has made its initial showing, non-movant must come forward with competent evidence creating a genuine fact issue. Matsushita, 475 U.S. at 585, 106 S.Ct. at 1355 and Liberty Lobby, 477 U.S. at 257, 106 S.Ct. at 2514. In order to avoid summary judgment, the non-moving party “must do more than simply show that there is some metaphysical doubt as to the material facts.” Matsushita, 475 U.S. at 586, 106 S.Ct. at 1355. Rule 56(e) requires that the non-moving party “set forth specific facts showing that there is a genuine issue for trial.” Liberty Lobby, 477 U.S. at 256, 106 S.Ct. at 2514.

II. FACTUAL BACKGROUND

Kurtis Slavik was run over by his school bus on January 8, 1992, grievously injuring the eight year old boy. Kurtis’ father, Robert Slavik is an employee of the Dr. Pepper Bottling Company of Texas. Kurtis is an insured beneficiary under his father’s policy with the Dr. Pepper Employee Medical and Dental Benefits Plan (the “Plan”) which, the [476]*476parties agree, covers Kurtis and Ms injuries. Kurtis’ medical bills total over $150,000 and continue to rise.

The Dr. Pepper Employee Medical and Dental Benefits Plan is a self-funded employee welfare benefit plan within the meaning of the Employee Retirement Income Security Act of 1974 (ERISA). See 29 U.S.C. § 1002(1) (1988). Dr. Pepper is the Plan administrator and admits it is a Plan fiduciary.

The conflict that drives this case is simple: who is entitled to how much of Kurtis’ tort claim against the school district and others in state court litigation.3 It is clear that Kurtis’ injuries are covered by the Plan, but Dr. Pepper, acting according to what it thinks is the correct interpretation of its Plan, refuses to pay his medical expenses until the Slaviks execute an “acknowledgement,” or agreement, subrogating Kurtis’ entire tort claim to the Plan. While Kurtis’ escalating medical bills already exceeding $150,000, his tort claim recovery against the school district is capped at $100,000 by the Texas Tort Claims Act. Tex.Civ.Prac. & Rem.Code Ann. § 101.023(b). Dr.

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867 F. Supp. 472, 1994 U.S. Dist. LEXIS 14878, 1994 WL 568860, Counsel Stack Legal Research, https://law.counselstack.com/opinion/slavik-v-dr-pepper-bottling-co-of-texas-employee-welfare-benefit-plan-txnd-1994.