513 F.3d 1223 (11th Cir. 2008), 07-10012, Administrative Committee for Wal-Mart Stores, Inc. Associates' Health and Welfare Plan v. Horton

Docket Nº:07-10012.
Citation:513 F.3d 1223
Party Name:ADMINISTRATIVE COMMITTEE FOR THE WAL-MART STORES, INC. ASSOCIATES' HEALTH AND WELFARE PLAN, Plaintiff-Appellant, v. Joshua HORTON, a Minor, Denica Jayne Werber, Individually, and as Conservator of Joshua Horton, Troy Millikan, ABC Bank, Regions Bank, Defendants-Appellees.
Case Date:January 15, 2008
Court:United States Courts of Appeals, Court of Appeals for the Eleventh Circuit

Page 1223

513 F.3d 1223 (11th Cir. 2008)

ADMINISTRATIVE COMMITTEE FOR THE WAL-MART STORES, INC. ASSOCIATES' HEALTH AND WELFARE PLAN, Plaintiff-Appellant,

v.

Joshua HORTON, a Minor, Denica Jayne Werber, Individually, and as Conservator of Joshua Horton, Troy Millikan, ABC Bank, Regions Bank, Defendants-Appellees.

No. 07-10012.

United States Court of Appeals, Eleventh Circuit.

Jan. 15, 2008

Page 1224

Thomas H. Lawrence, Edwin L. Rawson, Lawrence & Russell, LLP, Memphis, TN, for Plaintiff-Appellant.

Troy R. Millikan, Gainesville, GA, for Defendants-Appellees.

Appeal from the United States District Court for the Northern District of Georgia.

Before TJOFLAT, ANDERSON and COX, Circuit Judges.

ANDERSON, Circuit Judge

The Administrative Committee for the Wal-Mart Stores, Inc. Associates' Health and Welfare Plan ("the Administrative Committee") appeals the district court's grant of summary judgment in favor of Joshua Horton (a minor), Denica Jayne Werber (sued individually and in her capacity as Joshua's conservator), and Regions Bank. This case arises under the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001 et seq. Specifically, the Administrative Committee brought suit under ERISA § 502(a)(3), 29 U.S.C. § 1132(a)(3) (2000), seeking to enforce the reimbursement provisions of an employee health and welfare plan. The district court granted summary judgment in favor of Joshua, Ms. Werber, and Regions Bank, ruling that the Administrative Committee's requested remedy did not qualify as "other appropriate equitable relief" cognizable under § 502(a)(3). We reverse and remand for further proceedings.

We review de novo a district court's grant or denial of summary judgment. Holloman v. Mail-Well Corp., 443 F.3d 832, 836 (11th Cir.2006). Summary judgment is appropriate only when the evidence, viewed in the light most favorable to the nonmoving party, presents no genuine issue of fact and compels judgment as a matter of law. Fed.R.Civ.P. 56(c); Celotex Corp. v. Catrett, 477 U.S. 317, 322-23, 106 S.Ct. 2548, 2552, 91 L.Ed.2d 265 (1986); Holloman, 443 F.3d at 836.

I. BACKGROUND

The parties do not dispute the relevant facts in this case. At the age of fourteen, Joshua suffered permanent injuries when he was struck by an automobile. At the time, Joshua's mother, Ms. Werber, was a Wal-Mart employee and a participant in the Wal-Mart Stores, Inc. Associates' Health and Welfare Plan ("the Plan"), and Joshua was a "covered person" under the Plan. Following the accident, the Plan paid $51,446.03 in medical benefits on Joshua's behalf.

Subsequently, Joshua, through Ms. Werber as his next friend, filed a tort claim in the Superior Court of Hall County, Georgia, against the third-party driver and received a $99,000 settlement. The superior court ordered division of the settlement as follows: $1,000 to Ms. Werber for any claims she might have had as Joshua's custodial parent; $33,000 as attorney's fees to Joshua's attorney; and $65,000 to be deposited into the Hall County Probate Court account for the benefit of Joshua. Pursuant to Georgia law, the probate court appointed Ms. Werber as Joshua's conservator. Ms. Werber, in her capacity as conservator, took possession of Joshua's portion of the settlement and deposited it in a trust account at Regions Bank. 1

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Pursuant to the Plan's terms, any covered person who obtains a tort judgment or settlement must reimburse the Plan out of such funds for 100% of any benefits paid. Accordingly, the Administrative Committee sought to exercise the Plan's reimbursement provisions to recover $51,446.03 from the $66,000 awarded to Joshua and Ms. Werber. Initially, the Administrative Committee requested reimbursement, but Joshua and Ms. Werber refused. Subsequently, the Administrative Committee filed this suit to enforce the terms of the Plan, seeking what the Administrative Committee describes as "equitable relief" under ERISA § 502(a)(3)(B). Specifically, the Administrative Committee prayed for restitution and for imposition of a constructive trust and an equitable lien to enforce ERISA and the terms of the Plan. Pending the outcome of this litigation, the disputed money remains in the Regions Bank account pursuant to a consent preliminary injunction.

II. DISCUSSION

The Administrative Committee, as fiduciary of the Plan, seeks relief under ERISA § 502(a)(3), which reads as follows:

(a) Persons empowered to bring a civil action

A civil action may be brought--

....

(3) by a participant, beneficiary, or fiduciary (A) to enjoin any act or practice which violates any provision of this subchapter or the terms of the plan, or (B) to obtain other appropriate equitable relief (i) to redress such violations or (ii) to enforce any provisions of this subchapter or the terms of the plan; ....

29 U.S.C. § 1132(a)(3) (2000). The U.S. Supreme Court first analyzed this section's "other appropriate equitable relief" language in Mertens v. Hewitt Associates, 508 U.S. 248, 255-59, 113 S.Ct. 2063, 2068-70, 124 L.Ed.2d 161 (1993). The Mertens Court rejected a broad interpretation of the phrase, instead reading "equitable relief" to include only "those categories of relief that were typically available in equity (such as injunction, mandamus, and restitution, but not compensatory damages)." Id. The Court further narrowed the definition in Great-West Life & Annuity Insurance Co. v. Knudson, 534 U.S. 204, 122 S.Ct. 708, 151 L.Ed.2d 635 (2002), a case with facts similar to those in the case at bar.

In Knudson, a woman who had been severely injured in an auto accident received medical benefits from her husband's employer's health and welfare plan. Id. at 207, 122 S.Ct. at 711. Subsequently, the woman settled a tort claim arising out of the accident, and her portion of the settlement was paid directly into a special needs trust. Id. at 207-08, 122 S.Ct. at 711. The insurer of the benefit plan sought full reimbursement from the settlement funds pursuant to a provision in the plan. Id. at 207, 122 S.Ct. at 711-12. When the woman refused to pay, the insurer sued her under ERISA § 502(a)(3) to enforce the plan, seeking, inter alia, restitution, which it characterized as a form of equitable relief. Id. at 208, 212, 122 S.Ct. at 712, 714. The Supreme Court, however, characterized the insurer's claim as legal rather than equitable, noting that "not all relief falling under the rubric of restitution is

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available in equity." Id. at 212, 122 S.Ct. at 714.

The Knudson Court explained that "whether [restitution] is legal or equitable in a particular case (and hence whether it is authorized by § 502(a)(3)) remains dependent on the nature of the relief sought." Id. at 215, 122 S.Ct. at 715. For instance, a plaintiff might seek restitution at law in cases in which he "could not assert title or right to possession of particular property, but in which nevertheless he might be able to show just grounds for recovering money to pay for some benefit the defendant had received from him." Id. at 213, 122 S.Ct. at 714 (quoting 1 Dan B. Dobbs, Law of Remedies § 4.2(1) (2d ed.1993)). Such claims, which impose " 'a merely personal liability upon the defendant to pay a sum of money,' ... were viewed essentially as actions at law for breach of contract (whether the contract was actual or implied)." Id. (quoting Restatement of Restitution § 160 cmt. a (1936)). On the other hand, "a plaintiff could seek restitution in equity, ordinarily in the form of a constructive trust or an equitable lien, where money or property identified as belonging in good conscience to the plaintiff could clearly be traced to particular funds or property in the defendant's possession." Id. In sum, "for restitution to lie in equity, the action generally must seek not to impose personal liability on the defendant, but to restore to the plaintiff particular funds or property in the defendant's possession." Id. at 214, 122 S.Ct. at...

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