United States District Court, D. Connecticut
PRICEWATERHOUSECOOPERS LLP HEALTH AND WELFARE BENEFITS PLAN &PRICEWATERHOUSECOOPERS LLP, Plaintiffs,
ARTHUR A. MAYER & JAMES O. GASTON, Defendants.
RULING AND ORDER ON THE CROSS-MOTIONS FOR SUMMARY
JUDGMENT AND PLAINTIFFS' MOTION FOR A MORE DEFINITE
A. BOLDEN, UNITED STATES DISTRICT JUDGE.
LLP Health and Welfare Benefits Plan and
PricewaterhouseCoopers LLP (collectively
“PricewaterhouseCoopers” or “PWC”)
brings this action against Arthur Mayer and James O. Gaston
(collectively “Defendants”) under the Employee
Retirement Income Security Act of 1974, as amended, 29 U.S.C.
§§ 1001, et seq. (“ERISA”) for
medical payment reimbursement.
moves for summary judgment on its health insurance
reimbursement and against Defendants' counterclaims.
Motion for Summary Judgment by PricewaterhouseCoopers LLP,
ECF No. 51; Motion for Summary judgment on Defendants'
Counterclaim, ECF No. 68.
also move for summary judgment. Motion for Summary Judgment,
ECF No. 58.
following reasons, the Court GRANTS
PricewaterhouseCoopers's motions for summary judgment and
DENIES Defendants' motion for summary
FACTUAL AND PROCEDURAL BACKGROUND
is a self-funded employee welfare benefit plan under 29
U.S.C. § 1001. Amended Complaint, ECF No. 14 (“Am.
Compl.”). PricewaterhouseCoopers covered Mr. Mayer.
Id. at ¶ 5; Pamela Copeland Affidavit, ECF No.
52-4 (“Copeland Aff”). The
PricewaterhouseCoopers Summary Plan Description gives full
rights to PricewaterhouseCoopers to recover from employees or
dependents for the cost of health benefits paid on their
behalf under the PricewaterhouseCoopers health plan. Am.
Compl. at ¶ 8. The plan description states in
RIGHT TO SUBROGATION/THIRD PARTY RECOVERY
You shall cooperate with PWC and its agents in a timely
manner to protect its legal and equitable rights to
subrogation and reimbursement.
If a third party may be liable for a covered medical expense
that you or your Dependent have incurred, the Plan has a
right of subrogation to any claim that you or your Dependent
have against the third party. The Plan will then be entitled
to be paid back from any amount that you or your Dependent
recover against the third party for any expenses that the
Plan has had, and the recipient of any such recovered amounts
shall hold the funds in constructive trust for the Plan. The
Plan has a right of reimbursement against any recovery by you
or your Dependents from a third party. No. court costs or
attorneys' fees may be deducted from the Plan's
recovery without the Plan's express written consent and
the Plan is not required to participate in or pay court costs
or attorneys' fees to the attorney hired by you or your
Dependents to pursue damages or personal injury claims. No.
so-called "fund doctrine" or "common fund
doctrine" right shall defeat the Plan's rights.
Regardless of whether you or your Dependents have been fully
compensated or made whole, the Plan may collect from you or
your Dependents the proceeds of any full or partial recovery
that you or your Dependents or legal representative obtain,
whether in the form of a settlement (either before or after
any determination of liability) or judgment. The proceeds
available for collection by PWC shall include, but not be
limited to, any and all amounts whether designated in any
settlement or judgment as economic damages, noneconomic
damage, punitive damages, attorneys' fees or otherwise.
You shall not, without PWC's written consent, settle any
claim for an amount less than the amount that PWC has paid or
advanced on your behalf.
Id.; Summary Plan Description, ECF No. 52-3, at 109.
11, 2015, Mr. Mayer suffered injuries in an automobile
accident. Am. Compl. at ¶ 9; Mayer v. Kong
Litigation Complaint. ECF No. 52-6 (“Mayer
Litigation Compl.”). PricewaterhouseCoopers spent $44,
167.59 for Mr. Mayer's health care in connection with
those injuries. Am. Compl. at ¶ 9; Copeland Aff. at
¶ 11; Medical Payment Summary, ECF No. 52-5, at 4.
Gaston represented Mr. Mayer in the civil action arising from
Mr. Mayer's accident in Connecticut Superior Court
(“Mayer Litigation”). Am. Compl. at
¶ 6; Mayer Litigation Compl. at 4. Before the
Mayer litigation settled, PricewaterhouseCoopers
allegedly gave notice to Mr. Mayer, through Mr. Gaston, of
PricewaterhouseCoopers's right of subrogation and
reimbursement from all proceeds of payment, settlement, or
judgment in the Mayer Litigation. Am. Compl. at
¶ 12; Copeland Aff. at ¶ 7.
alleges that Mr. Gaston settled the Mayer Litigation
for at least $250, 000. Am. Compl. at ¶ 11; Amended
Answer to Amended Complaint with Special Defenses,
Counterclaim against Plaintiff, ECF No. 64 (“Amended
Answer”), at ¶ 11 (“Admitted that Mayer
v. Long case settled for $250, 000”). The Amended
Complaint also alleges that Mr. Gaston holds or has disbursed
part of the proceeds of the Mayer Litigation to
himself, while no payment has been to PricewaterhouseCoopers.
Am. Compl. at ¶ 13-14; see also Gaston
Memorandum of Law in Support of Motion to Dismiss, ECF No.
20, at 5.
contend that the settlement did not fully compensate Mr.
Mayer for his non-economic damages. James Gaston Affidavit,
ECF No. 59-1 (“Gaston Aff.”), at ¶ 5.
Instead, Defendants contend that PricewaterhouseCoopers paid
for medical expenses related to a preexisting cervical
condition, which was unrelated to the May 11, 2015 automobile
collision. Id. at ¶ 7.
March 28, 2018, PricewaterhouseCoopers filed its Complaint
for equitable relief for medical bill payments under ERISA.
Complaint, ECF No. 1.
5, 2018, Mr. Mayer and Mr. Gaston moved for a more definite
statement because PricewaterhouseCoopers did not specify
which counts applied to Mr. Mayer and which applied to Mr.
Gaston. Motion for a More Definite Statement, ECF No. 12. On
November 1, 2018, the Court found this motion moot. Order,
ECF No. 36.
14, 2018, PricewaterhouseCoopers amended its Complaint,
separating the allegations against Mr. Mayer and Mr. Gaston
into separate counts. Am. Compliant, ECF No. 14.
21, 2018, Mr. Gaston moved for nonsuit. Motion for Nonsuit,
ECF No. 15. On November 1, 2018, the Court found this motion
moot. Order, ECF No. 36.
27, 2018, Mr. Mayer moved to dismiss the Complaint under Rule
12(b)(1). Motion to Dismiss, ECF No. 17. On July 13, 2018,
Mr. Mayer moved to withdraw his motion to dismiss in its
entirety. Motion to Withdraw, ECF No. 21. On August 2, 2018,
the Court granted Mr. Mayer's motion to withdraw motion
to dismiss. Order, ECF No. 27.
27, 2018, Mr. Gaston moved to dismiss the claim brought
against him under Rules 12(b)(1) and 12(b)(6). Motion to
Dismiss, ECF No. 19. On July 13, 2018, Mr. Gaston moved to
withdraw his motion to dismiss, as to the diversity of
jurisdiction, while still preserving the claim that he is an
inappropriate party to this action. Motion to Withdraw, ECF
No. 22. On August 2, 2018, the Court granted Mr. Gaston's
motion to withdraw his 12(b)(1) claim. Order, ECF No. 27.
August 17, 2018, PricewaterhouseCoopers opposed the remaining
portions of Mr. Gaston's motion to dismiss claim, arguing
that Mr. Gaston is a proper party to this action. Memorandum
in Opposition to Defendant Gaston's Motion to Dismiss,
ECF No. 28.
December 10, 2018, the Court held a hearing on Mr.
Gaston's motion to dismiss. Minute Entry, ECF No. 46.
December 13, 2018, the Court denied Mr. Gaston's motion
to dismiss. Order Denying Motion to Dismiss, ECF No. 47.
January 31, 2019, PricewaterhouseCoopers moved for summary
judgment, claiming a legal entitlement to reimbursement from
the proceeds of the Mayer litigation settlement.
Plaintiffs' Motion for Summary Judgment, ECF No. 51.
February 20, 2019, Defendants filed their memorandum in
opposition to Plaintiffs' motion for summary judgment.
Memorandum in Opposition, ECF No. 57 (“Mem. in Opp. to
February 20, 2019, Defendants responded to the Amended
Complaint with special defenses and counterclaims against
PricewaterhouseCoopers. Answer with Special Defenses,
Counterclaim against Plaintiffs, ECF No. 56. On March 4,
2019, PricewaterhouseCoopers moved for a more definite
statement as to the Answer. Motion for a More Definite
Statement as to Defendants' Answer, ECF No. 63. On March
12, 2019, Defendants amended their Answer to provide more
clarity. Amended Answer to Amended Complaint with Special
Defenses, Counterclaim against Plaintiffs, ECF No. 64
(“Am. Answer”). Defendants also objected to the
motion for a more ...