Unisys Medical Plan v. Timm

917 F. Supp. 650, 1996 U.S. Dist. LEXIS 3075, 1996 WL 109784
CourtDistrict Court, W.D. Wisconsin
DecidedJanuary 24, 1996
DocketNo. 95-C-517-S
StatusPublished
Cited by1 cases

This text of 917 F. Supp. 650 (Unisys Medical Plan v. Timm) 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
Unisys Medical Plan v. Timm, 917 F. Supp. 650, 1996 U.S. Dist. LEXIS 3075, 1996 WL 109784 (W.D. Wis. 1996).

Opinion

MEMORANDUM AND ORDER

SHABAZ, Chief Judge.

Plaintiff Unisys Medical Plan, a self-funded employee welfare benefit plan, commenced this ERISA action to recover medical expenses paid on behalf of its plan member defendant Gary Timm. The matter is presently before the Court on plaintiffs motion for summary judgment. Jurisdiction is based upon 28 U.S.C. § 1331.

FACTS

On January 30, 1991 while defendant Gary Timm was a participant in the plaintiff Uni-sys Medical Plan he was iiijured in an accident. Plaintiff paid $55,484.45 in medical expenses on behalf of defendant Gary Timm as a result of his injuries. The third party liability provision of the plan provides in relevant part:

If payments are made by the Unisys Medical Plan and you receive a settlement or are otherwise compensated by a third party as result of your injuries, you are required to reimburse the Unisys Medical Plan for the payments made from the plan.

In 1993 defendants commenced an action against John Roby, Dynamic Feeding Systems, Inc., Whispering Silos, Inc. and Rural Mutual Insurance Company in the Circuit Court for St. Croix, Wisconsin to recover damages for Gary Timm’s injuries. On November 17,1994 two of the defendants filed a third party complaint against Unisys Medical Plan which stated as follows:

Third party defendant is being joined, pursuant to Wis.Stat. § 803.03(2) as a result of their claim for subrogation for payments made on behalf of Gary Timm.

No claim was filed by the Timms against Unisys in the action. No answer to the third party complaint was filed by Unisys prior to February 16,1995.

[652]*652On February 16,. 1995 Unisys moved for leave to file an answer to the third party complaint and a cross claim against the Timms. Its proposed cross claim made the following demand:

WHEREFORE, in the event Gary Timm recovers for his injuries of January 30, 1991 from the defendants in this case, Uni-sys Medical Plan moves this Court to judgment in its behalf enforcing its subrogation interest against Gary Timm in the amount of $55,484.45 and for such other and further relief as this Court deems warranted.

On May 3,1995 the Timms settled with the state court defendants for $255,462.81. On May 22, 1995 the Circuit Court entered a stipulation and order for dismissal which provided that the action between Timms and the defendants would be dismissed with prejudice. The stipulation and order further provided:

Further, the plaintiffs agree to hold harmless and indemnify John Roby d/b/a K & R Farm Service and Rural Mutual Insurance Company and Whispering Silos, Inc. and Rural Mutual Insurance Company for any and all liability relating to a claim for subrogation including, but not limited to the claim by Unisys Medical Plan, a/k/a Unisys Benefit Payment Office, relating to the accident of January 30,1991.

On August 31,1995 the Circuit Court entered an order dismissing Unisys’ answer to the third party complaint as untimely, entering default judgment against Unisys for failure to timely respond and implicitly denying Uni-sys the right to assert its cross claim against the plaintiff.

MEMORANDUM

Plaintiff seeks summary judgment in the amount of medical expenses it paid on defendants’ behalf, relying on the plain language of the plan and the undisputed fact that defendants settled an injury claim for more than the medical expenses paid by the plan as a result of the injury. Defendants challenge plaintiffs right to recover principally on the basis that the prior state court proceeding should act as a bar to this action. Defendants urge the Court to stay the action or alternatively to find waiver of the present claim based upon plaintiffs conduct in state court. Defendants also assert a right under Wisconsin law to reduce any recovery by one-third to compensate defendants for their attorney’s fees in prosecuting the tort claim.

There being no dispute as to any material fact, this matter is subject to resolution on summary judgment. Rule 56(e), Federal Rules of Civil Procedure.

Request For Stay.

There is no basis to grant a stay because it would be appropriate to proceed in this Court regardless of the ultimate resolution of the state court action. There are two potential outcomes in the state court action. The court may affirm its prior ruling granting default judgment on the third-party complaint and denying Unisys the opportunity to proceed on its cross claim against plaintiff. Alternatively, the court may reconsider its prior order and grant plaintiff leave to proceed on its cross claim.

A reconsideration permitting plaintiff to proceed with its ERISA claim as a cross' claim in state court would not be a basis for stay since the claim is based exclusively on federal law and this Court is in a position to resolve it without delay. There is no basis to defer to a state court which has invested no time or consideration in a strictly legal issue based on federal law.

Alternatively, if the state court enters judgment consistent with its prior ruling, such judgment would have no claim or issue preclusion effect on the pending claim. There is no need to await it. The Defendant correctly notes that Wisconsin has adopted the Restatement of Judgments transactional approach to claim preclusion embodied in §§ 24 and 25 of the Restatement (Second) of Judgments, DePratt v. West Bend Mut. Ins. Co., 113 Wis.2d 306, 311, 334 N.W.2d 883 (1983). However, plaintiff and defendants having never been adversaries under the pleadings in the prior action, and no judgment having been entered involving a claim between them, the doctrine of claim preclusion is clearly inapplicable. The Restatement addresses this circumstance at § 38:

[653]*653Parties who are not adversaries to each other under the pleadings in an action involving them and a third party are bound by and entitled to the benefits of issue preclusion with respect to issues they actually litigate fully and fairly as adversaries to each other and which are essential to the judgment rendered.

Comment a to section 38 further clarifies “Where no such pleadings have been interposed, the possibility of merger and bar by definition does not arise.” See also, Davis & Cox v. Summa Corp., 751 F.2d 1507, 1518 (9th Cir.1985)

Neither, of course, can issue preclusion be asserted since the issue of plaintiffs subrogation or reimbursement right was never “actually litigated” in the state court action. See Comment e to § 27, Restatement (Second) of Judgments (Default judgment does not constitute actual litigation.) Indeed, the state court’s refusal to permit plaintiff to proceed on its cross claim effectively precluded actual litigation of the issue.-

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Bluebook (online)
917 F. Supp. 650, 1996 U.S. Dist. LEXIS 3075, 1996 WL 109784, Counsel Stack Legal Research, https://law.counselstack.com/opinion/unisys-medical-plan-v-timm-wiwd-1996.