US Airways, Inc. v. McCutchen

• Decision Date: 04 January 2012
• Docket Number: No. 10–3836.,10–3836.
• Citation: 663 F.3d 671,52 Employee Benefits Cas. 2143
• Parties: US AIRWAYS, INC., in its capacity as Fiduciary and Plan Administrator of the US Airways, Inc. Employee Benefits Plan v. James E. McCUTCHEN; Rosen Louik & Perry, P.C., Appellants.
• Court: U.S. Court of Appeals — Third Circuit

52 Employee Benefits Cas. 2143

663 F.3d 671

US AIRWAYS, INC., in its capacity as Fiduciary and Plan Administrator of the US Airways, Inc. Employee Benefits Plan

v.James E. McCUTCHEN; Rosen Louik & Perry, P.C., Appellants.

No. 10–3836.

United States Court of Appeals, Third Circuit.

Argued July 11, 2011.Opinion Filed: Nov. 16, 2011.Rehearing and Rehearing En Banc Denied Jan. 4, 2012.

Leslie A. Brueckner, Esq., Matthew W.H. Wessler, Esq. [Argued], Public Justice, Washington, D.C., Paul Hilko, Esq., Neil R. Rosen, Esq., Rosen Louik & Perry, Pittsburgh, PA, for Appellants.

Noah G. Lipschultz, Esq. [Argued], Littler Mendelson, Minneapolis, MN, Shannon H. Paliotta, Esq., Littler Mendelson, Pittsburgh, PA, for Appellee.

Before: SLOVITER, FUENTES, and VANASKIE, Circuit Judges.

OPINION OF THE COURT

FUENTES, Circuit Judge:

After Appellant James McCutchen suffered a serious automobile accident, a benefit plan administered by US Airways paid $66,866 for his medical expenses. McCutchen then recovered $110,000 from third parties, with the assistance of counsel. Then US Airways, which had not sought to enforce its subrogation rights, demanded reimbursement of the entire $66,866 it had paid without allowance for McCutchen's legal costs, which had reduced his net recovery to less than the amount it demanded. US Airways filed this suit against McCutchen for “appropriate equitable relief” pursuant to § 502(a)(3) of the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), 29 U.S.C. § 1132(a)(3)(B). The issue before us is whether McCutchen may assert certain equitable limitations, such as unjust enrichment, on US Airways' equitable claim. We conclude that he may. We therefore vacate the District Court's order requiring McCutchen to pay US Airways the entire $66,866 and remand the case for that Court to fashion “appropriate equitable relief.”

I.

This case stems from a tragic car accident in which a young driver lost control of her car, crossed the median of the road, and struck a car driven by 51–year–old James McCutchen. Then the truck traveling behind McCutchen also slammed into his car. The accident killed one person and left two others with severe brain injuries. McCutchen himself was grievously injured and survived only after emergency surgery. He spent several months in physical therapy and ultimately underwent a complete hip replacement. Since the accident, McCutchen, who had a history of back surgeries and associated chronic pain, has also become unable to effectively treat that pain with medication. The accident has rendered him functionally disabled. McCutchen's Health Benefit Plan (the “Plan”), administered and self-financed by US Airways, paid medical expenses in the amount of $66,866 on his behalf.

After the accident, McCutchen, through his attorneys at Rosen Louik & Perry, P.C., filed an action against the driver of the car that caused the accident. Because she had limited insurance coverage, and because three other people were seriously injured or killed, McCutchen settled with the other driver for only $10,000. However, with his lawyers' assistance, he and his wife received another $100,000 in underinsured motorist coverage for a total third-party recovery of $110,000. After paying a 40% contingency attorneys' fee and expenses, his net recovery was less than $66,000. US Airways demanded reimbursement for the entire $66,866 that it had paid for McCutchen's medical bills. Soon after, Rosen Louik & Perry placed $41,500 in a trust account, reasoning that any lien found to be valid would have to be reduced by a proportional amount of legal costs. The record on appeal does not establish what amount was disbursed to McCutchen.

When McCutchen did not pay, US Airways, in its capacity as administrator of the ERISA benefits plan, filed suit in the District Court under § 502(a)(3) of ERISA, seeking “appropriate equitable relief” in the form of a constructive trust or an equitable lien on the $41,500 held in trust and the remaining $25,366 personally from McCutchen. The Summary Plan Description describing the US Airways benefits plan covering McCutchen contained the following paragraph, entitled “Subrogation and Right of Reimbursement”:

The purpose of the Plan is to provide coverage for qualified expenses that are not covered by a third party. If the Plan pays benefits for any claim you incur as the result of negligence, willful misconduct, or other actions of a third party, the Plan will be subrogated to all your rights of recovery. You will be required to reimburse the Plan for amounts paid for claims out of any monies recovered from a third party, including, but not limited to, your own insurance company as the result of judgment, settlement, or otherwise. In addition you will be required to assist the administrator of the Plan in enforcing these rights and may not negotiate any agreements with a third party that would undermine the subrogation rights of the Plan.

(App.117) (emphasis added). Thus, under the Plan Description, a beneficiary is required to reimburse the Plan for any amounts it has paid out of any monies the beneficiary recovers from a third party.

US Airways claims that this language permits it to recoup the $66,866 it provided for McCutchen's medical care out of the $110,000 total that he recovered regardless of his legal costs. It argues that “[t]he Plan language specifically authorized reimbursement in the amount of benefits paid, out of any recovery.” (Appellee's Br. at 15–16).

McCutchen says that it would be unfair and inequitable to reimburse US Airways in full when he has not been fully compensated for his injuries, including pain and suffering. He argues that US Airways, which made no contribution to his attorneys' fees and expenses, would be unjustly enriched if it were now permitted to recover from him without any allowance for those costs, in essence to reap what McCutchen has sown. Indeed, if legal costs are not taken into account, US Airways will effectively be reaching into its beneficiary's pocket, putting him in a worse position than if he had not pursued a third-party recovery at all.

Citing the Plan's use of the language “any monies recovered,” as well as our previous decisions, the District Court rejected McCutchen's arguments and granted summary judgment to US Airways. The Court required McCutchen to sign over the $41,500 held in trust and to pay $25,366 from his own funds. McCutchen appeals.¹

II.

A.

Congress designed ERISA to protect employee pensions and benefits by providing pension insurance, enumerating certain specific characteristics of pension and benefit plans, and setting forth fiduciary duties for the managers of both pension and nonpension plans. Varity Corp. v. Howe, 516 U.S. 489, 496, 116 S.Ct. 1065, 134 L.Ed.2d 130 (1996). The Supreme Court has repeatedly observed that “ERISA is a comprehensive and reticulated statute, the product of a decade of congressional study of the Nation's private employee benefit system.” Great–West Life & Annuity Ins. Co. v. Knudson, 534 U.S. 204, 209, 122 S.Ct. 708, 151 L.Ed.2d 635 (2002) (quoting Mertens v. Hewitt Assocs., 508 U.S. 248, 251, 113 S.Ct. 2063, 124 L.Ed.2d 161 (1993)) (internal quotation marks omitted). Courts have therefore been reluctant to tamper with its carefully crafted and detailed enforcement scheme. Id. Under this scheme, Congress gave plan beneficiaries greater rights than plan fiduciaries to enforce the terms of a benefit plan. A beneficiary has a general right of action “to enforce his rights under the terms of the plan.” Knudson, 534 U.S. at 221, 122 S.Ct. 708 (quoting 29 U.S.C. § 1132(a)(1)(B)). By contrast, a fiduciary's right to enforce plan terms is governed by ERISA's § 502(a)(3), which limits the available relief to an injunction or “other appropriate equitable relief.” 29 U.S.C. § 1132(a)(3); Knudson, 534 U.S. at 221, 122 S.Ct. 708; Sereboff v. Mid Atlantic Medical Servs., Inc., 547 U.S. 356, 361, 126 S.Ct. 1869, 164 L.Ed.2d 612 (2006). It is under this provision that US Airways seeks to enforce the Plan's subrogation and reimbursement provision against McCutchen.

The Supreme Court has explained that the modifier “appropriate equitable relief” is not superfluous. Mertens, 508 U.S. at 257–58, 113 S.Ct. 2063. Rather, “Congress's choice to limit the relief available under § 502(a)(3) to ‘equitable relief’ requires us to recognize the difference between legal and equitable forms of restitution.” Knudson, 534 U.S. at 218, 122 S.Ct. 708. Thus, the Supreme Court has “interpreted the term ‘appropriate equitable relief’ in § 502(a)(3) as referring to those categories of relief that, traditionally speaking ( i.e., prior to the merger of law and equity) were typically available in equity.” CIGNA Corp. v. Amara, ––– U.S. ––––, 131 S.Ct. 1866, 1878, 179 L.Ed.2d 843 (2011) (quoting Sereboff, 547 U.S. at 361, 126 S.Ct. 1869) (internal quotation marks omitted).

The Supreme Court has twice considered what this limitation means in the context of a fiduciary's action for reimbursement from a beneficiary under an ERISA plan. In Great–West Life & Annuity Insurance Co. v. Knudson, the Court first considered whether an ERISA plan administrator's claim for reimbursement was equitable in nature. See 534 U.S. at 210–12, 122 S.Ct. 708. To decide this question, the Court examined cases and secondary legal materials to determine whether the relief would have been equitable “[i]n the days of the divided bench.” Id. at 212, 122 S.Ct. 708. As the Court explained, one feature of equitable restitution was that it sought to impose a constructive trust or equitable lien on “particular funds or property in the defendant's possession.” Id. at 213, 122 S.Ct. 708. The Court held that this requirement was not met in Knudson because the funds to which the plan claimed an entitlement had been placed in a “Special Needs Trust” under California law. Id. at 214, 122 S.Ct. 708.

In Sereboff v. Mid Atlantic Medical Services,...