U.S. Airways, Inc. v. McCutchen

569 U.S. 88, 24 Fla. L. Weekly Fed. S 138, 185 L. Ed. 2d 654, 133 S. Ct. 1537, 55 Employee Benefits Cas. (BNA) 1845, 2013 WL 1567371, 2013 U.S. LEXIS 3156, 13 Cal. Daily Op. Serv. 3677, 81 U.S.L.W. 4236
CourtSupreme Court of the United States
DecidedApril 16, 2013
Docket11–1285.
StatusPublished
Cited by278 cases

This text of 569 U.S. 88 (U.S. Airways, Inc. v. McCutchen) is published on Counsel Stack Legal Research, covering Supreme Court of the United States primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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U.S. Airways, Inc. v. McCutchen, 569 U.S. 88, 24 Fla. L. Weekly Fed. S 138, 185 L. Ed. 2d 654, 133 S. Ct. 1537, 55 Employee Benefits Cas. (BNA) 1845, 2013 WL 1567371, 2013 U.S. LEXIS 3156, 13 Cal. Daily Op. Serv. 3677, 81 U.S.L.W. 4236 (2013).

Opinion

Justice KAGAN delivered the opinion of the Court.

*91 Respondent James McCutchen participated in a health benefits plan that his employer, petitioner U.S. Airways, established under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001 et seq. That plan obliged U.S. Airways to pay any medical expenses McCutchen incurred as a result of a third party's actions-for example, another person's negligent driving. The plan in turn entitled U.S. Airways to reimbursement if McCutchen later recovered money from the third party.

This Court has held that a health-plan administrator like U.S. Airways may enforce such a reimbursement provision by filing suit under § 502(a)(3) of ERISA, 88 Stat. 891 , 29 U.S.C. § 1132 (a)(3). See Sereboff v. Mid Atlantic Medical Services, Inc., 547 U.S. 356 , 126 S.Ct. 1869 , 164 L.Ed.2d 612 (2006). That section authorizes a civil action "to obtain ... appropriate equitable relief ... to enforce ... the terms of the plan." We here consider whether in that kind of suit, a plan participant like McCutchen may raise certain equitable defenses deriving from principles of unjust enrichment. In particular, we address one equitable doctrine limiting reimbursement *1543 to the amount of an insured's "double recovery" and another requiring the party seeking reimbursement to pay a share of the attorney's fees incurred in securing funds from the third party. We hold that neither of those equitable rules can override the clear terms of a plan. But we explain that the latter, usually called the common-fund doctrine, plays a role in interpreting *92 U.S. Airways' plan because the plan is silent about allocating the costs of recovery.

I

In January 2007, McCutchen suffered serious injuries when another driver lost control of her car and collided with McCutchen's. At the time, McCutchen was an employee of U.S. Airways and a participant in its self-funded health plan. The plan paid $66,866 in medical expenses arising from the accident on McCutchen's behalf.

McCutchen retained attorneys, in exchange for a 40% contingency fee, to seek recovery of all his accident-related damages, estimated to exceed $1 million. The attorneys sued the driver responsible for the crash, but settled for only $10,000 because she had limited insurance coverage and the accident had killed or seriously injured three other people. Counsel also secured a payment from McCutchen's own automobile insurer of $100,000, the maximum amount available under his policy. McCutchen thus received $110,000-and after deducting $44,000 for the lawyer's fee, $66,000.

On learning of McCutchen's recovery, U.S. Airways demanded reimbursement of the $66,866 it had paid in medical expenses. In support of that claim, U.S. Airways relied on the following statement in its summary plan description:

"If [US Airways] pays benefits for any claim you incur as the result of negligence, willful misconduct, or other actions of a third party, ... [y]ou will be required to reimburse [US Airways] for amounts paid for claims out of any monies recovered from [the] third party, including, but not limited to, your own insurance company as the result of judgment, settlement, or otherwise." App. 20. 1

*93 McCutchen denied that U.S. Airways was entitled to any reimbursement, but his attorneys placed $41,500 in an escrow account pending resolution of the dispute. That amount represented U.S. Airways' full claim minus a proportionate share of the promised attorney's fees.

US Airways then filed this action under § 502(a)(3), seeking "appropriate equitable relief" to enforce the plan's reimbursement provision. The suit requested an equitable lien on $66,866-the $41,500 in the escrow account and $25,366 more in McCutchen's possession. McCutchen countered by raising two defenses relevant here. First, he maintained that U.S. Airways could not receive the relief it sought because he had recovered only a small *1544 portion of his total damages; absent over-recovery on his part, U.S. Airways' right to reimbursement did not kick in. Second, he contended that U.S. Airways at least had to contribute its fair share to the costs he incurred to get his recovery; any reimbursement therefore had to be marked down by 40%, to cover the promised contingency fee. The District Court rejected both arguments, granting summary judgment to U.S. Airways on the ground that the plan "clear[ly] and unambiguous[ly]" provided for full reimbursement of the medical expenses paid. App. to Pet. for Cert. 30a; see id., at 32a.

The Court of Appeals for the Third Circuit vacated the District Court's order. The Third Circuit reasoned that in a suit for "appropriate equitable relief" under § 502(a)(3), a court must apply any "equitable doctrines and defenses" that traditionally limited the relief requested. 663 F.3d 671 , 676 (C.A.3 2011). And here, the court continued, " 'the principle *94 of unjust enrichment' " should " 'serve to limit the effectiveness' " of the plan's reimbursement provision. See id., at 677 (quoting 4 G. Palmer, Law of Restitution § 23.18, p. 472-473 (1978)). Full reimbursement, the Third Circuit thought, would "leav[e] [McCutchen] with less than full payment" for his medical bills; at the same time, it would provide a "windfall" to U.S.

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569 U.S. 88, 24 Fla. L. Weekly Fed. S 138, 185 L. Ed. 2d 654, 133 S. Ct. 1537, 55 Employee Benefits Cas. (BNA) 1845, 2013 WL 1567371, 2013 U.S. LEXIS 3156, 13 Cal. Daily Op. Serv. 3677, 81 U.S.L.W. 4236, Counsel Stack Legal Research, https://law.counselstack.com/opinion/us-airways-inc-v-mccutchen-scotus-2013.