Wimer v. Pennsylvania Employees Benefit Trust Fund

868 A.2d 8, 34 Employee Benefits Cas. (BNA) 2482, 2005 Pa. Super. 36, 2005 Pa. Super. LEXIS 35
CourtSuperior Court of Pennsylvania
DecidedJanuary 27, 2005
StatusPublished
Cited by9 cases

This text of 868 A.2d 8 (Wimer v. Pennsylvania Employees Benefit Trust Fund) is published on Counsel Stack Legal Research, covering Superior Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Wimer v. Pennsylvania Employees Benefit Trust Fund, 868 A.2d 8, 34 Employee Benefits Cas. (BNA) 2482, 2005 Pa. Super. 36, 2005 Pa. Super. LEXIS 35 (Pa. Ct. App. 2005).

Opinions

OPINION BY

MUSMANNO, J.:

¶ 1 Pennsylvania Employees Benefit Trust Fund (“PEBTF”) appeals from the Order denying its Motion for judgment on the pleadings and/or summary judgment, and granting Gary E. Wimer’s (‘Wimer’s”) Cross-motion for summary judgment in this declaratory judgment action. We affirm.

[10]*10¶ 2 The pertinent facts of this case are as follows:

The plaintiff, [Wimer], was injured [in] a motor vehicle accident which occurred on October 3, 1997 in Hempfield Township, Westmoreland County. [Wimer], at the time of the accident, and presently, resides in Mechanicsburg, Cumberland County. At the time of the accident, [Wimer] was employed by the Commonwealth of Pennsylvania, as a corrections officer and was provided healthcare benefits by the defendant [PEBTF]. [Wimer’s] medical bills were initially submitted by him to his insurance carrier, Erie Insurance Company, and when his ten thousand dollar first party limit was exhausted!,] subsequent medical bills were submitted to the PEBTF for payment.
On the date of the accident, PEBTF was a self-funded ERISA1 qualified plan and was entitled to exercise subrogation rights not[ ]withstanding the provisions of [section] 1720 of the Pennsylvania Motor Vehicle [Financial] Responsibility Law [“MVFRL”]. FMC Corp. v. Holiday [Holliday], 498 U.S. 52[, 111 S.Ct. 403, 112 L.Ed.2d 356] (1990). Holiday [Holliday] held that a self-insured ERISA plan was pre-empted under Federal law and, therefore, the Pennsylvania anti-subrogation law contained in the [MVFRL] did not apply to such Federal plans. However, PEBTF[,] as of January 1, 1998, had its status changed from a self-funded ERISA plan to a non-ERISA federally regulated plan. After its change in status, the PEBTF could no longer file subrogation claims in those cases involving motor vehicle accidents in Pennsylvania subject to the [MVFRL],
Prior to January 1, 1998, the PEBTF made medical payments on behalf of [Wimer] totaling one hundred eighty-six ($186.00). dollars. Subsequent to January 1, 1998, the PEBTF made additional medical payments totaling thirty-five thousand eight, hundred fifteen. and 90/100 ($35,815.90) dollars.
PEBTF asserted its subrogation claim in the amount of thirty-five thousand eight hundred fifteen and 90/100 ($35,-815.90)' dollars which is the total of the medical bills paid after its change in status. [Wimer] refused to pay the sub-rogation claim even though he settled his third-party liability action on December 12,1999. Under the PEBTF’s Summary Plan Déscription, it may terminate coverage for any participant that fails or refuses to cooperate with it in the exercise of its subrogation rights. Since [Wimer] refused to pay the subrogation claim, the PEBTF[,] on June 15, 2001, terminated his coverage even, though [Wimer] continues to be an employee of the Commonwealth of Pennsylvania.
[Wimer] filed the subject action, a Complaint for Declaratory Judgment!,] against [PEBTF] on September 10, 2001, and requested [that the trial court] enter a Declaratory Judgment providing that any subrogation rights of PEBTF be limited to the medical bills paid by it prior to January 1, 1998, ordering PEBTF to reinstate [Wimer’s] medical benefits retroactive to June 14, 2001, order PEBTF to reimburse [Wimer] for any medical bills or prescriptions he paid subsequent to the termination of his benefit!,] and direct PEBTF to pay his costs and counsel fees for this action. [PEBTF] ... filed preliminary objections and a petition to transfer this action to Dauphin County-Also included in the preliminary objections were claims that [Wimer] had failed to state a [11]*11valid cause of action and ... failed to exhaust his available internal remedies by failing to take an appeal to [PEBTF’s] board of trustees.
[PEBTF’s] claim that [Wimer] failed to state a cause of action was essentially based on its argument that ... PEBTF continues to have the right of subrogation because, at the controlling date, the time and day of the accident, it was an ERISA-type plan. Of course, [Wimer] asserts that other than the aforesaid one hundred eighty-six ($186.00) dollars, the PEBTF has no subrogation rights to the other medical payments because at the time those payments were made, [PEBTF] was a non-ERISA plan. Both parties submitted briefs and after oral argument[,] [the trial court], after consideration of same and joint stipulation of facts submitted by the parties[,] entered an Order on March 11, 2002, dismissing the Petition to Transfer Venue and the preliminary objections.2
[PEBTF] ... filed a Motion for Judgment on the Pleadings and/or Summary Judgment in which it raises the identical issues that were argued before [the trial court] as a result of the preliminary objections. [Wimer] ... filed an answer to [PEBTF’s] motion and, in addition thereto, a cross-motion for summary judgment.

Trial Court Opinion, 9/10/02, at 1-6 (footnotes omitted).

¶3 On September 10, 2002, the trial court denied PEBTF’s Motion for judgment on the pleadings and/or summary judgment, and granted Wimer’s Cross-motion for summary judgment. The trial court declared that:

[T]he subrogation rights of the defendant are limited to the amount of medical bills paid on behalf of [Wimer] prior to January 1, 1998, and [Wimer] is hereby ORDERED to pay the sum of one hundred eighty-six ($186.00) dollars to [PEBTF] in full satisfaction of [PEBTF’s] liens as a result of the motor vehicle accident that occurred on October 10,1997.

Order of Court, 9/10/02. The trial court further ordered PEBTF to “reinstate to [Wimer] those benefits terminated and/or suspended by [PEBTF] retroactive to June 14, 2001,” and to “reimburse [Wimer] for all medical bills and prescriptions that he has paid for since the termination of his benefits by [PEBTF].” Id. The trial court denied Wimer’s request for counsel fees and costs.

¶ 4 PEBTF filed an appeal of the trial court’s September 10, 2002 Order. PEBTF raises the following issues on appeal:

1. Did the trial court err when it concluded that Wimer was not obligated to exhaust his contractually prescribed internal remedies prior to commencing this litigation?
2. Did the trial court err when it interpreted Commonwealth law to limit the PEBTF’s subrogation rights solely to bills paid on Wimer’s behalf prior to January 1,1998?

See Brief of Appellant at 4.

¶ 5 Before addressing these issues, we must first consider Wimer’s argument that this appeal is untimely. Wimer asserts that PEBTF was required to file an appeal of the trial court’s March 11, 2002 Order because that Order was a final order, pursuant to Nationwide Mutual Insurance [12]*12Co. v. Wickett, 563 Pa. 595, 763 A.2d 813 (2000).

¶ 6 In Wickett, the Pennsylvania Supreme Court held that, pursuant to section 7532 of the Declaratory Judgment Act, 42 Pa.C.S.A. § 7532, “any order in a declaratory judgment action that either affirmatively or negatively declares ‘rights, status, and other legal relations’” constitutes a final order. Wickett, 763 A.2d at 817.

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Cite This Page — Counsel Stack

Bluebook (online)
868 A.2d 8, 34 Employee Benefits Cas. (BNA) 2482, 2005 Pa. Super. 36, 2005 Pa. Super. LEXIS 35, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wimer-v-pennsylvania-employees-benefit-trust-fund-pasuperct-2005.