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PRIMAX RECOVERIES, INC. v. LEE

April 15, 2003

PRIMAX RECOVERIES, INC., Plaintiff,
v.
Annabell LEE, Defendant.



The opinion of the court was delivered by: PAUL FRIEDMAN, District Judge.

OPINION

The Court has before it defendant Annabell Lee's motion to dismiss the complaint against her, plaintiff's opposition and defendant's reply, as well as supplemental briefs concerning the impact of the recent opinion of the Supreme Court in Great-West Life & Annuity Ins. Co. v. Knudson, 534 U.S. 204, 122 S.Ct. 708, 151 L.Ed.2d 635 (2002). After considering the complaint in the light most favorable to plaintiff, the Court concludes that defendant's motion to dismiss for lack of subject matter jurisdiction, failure to state a claim, failure to join an indispensable party, and failure to sue the real party in interest must be denied.

  I. FACTUAL BACKGROUND

  Defendant Annabell Lee suffered personal injuries in an automobile accident on January 17, 1992. See Complaint ¶ 11; Motion to Dismiss at 1. Her injuries required hospitalization, with medical treatment continuing for two and a half years at a total cost of $89,843.17 to defendant's health insurer, The George Washington University Health Plan ("the Plan"). See Complaint ¶ 12. Following her accident, defendant filed a civil action against a third-party tortfeasor, who she alleged was responsible for the accident and her injuries. A settlement was reached between defendant and the third party, and defendant received what she characterizes as a non-differentiated, lump sum settlement of $450,000. See Motion to Dismiss at 2. It is from this recovery that plaintiff seeks reimbursement.

  Plaintiff brought this action pursuant to Section 1132(a)(3) of the Employee Retirement Income Security Act of 1974 ("ERISA"), claiming that as an assignee for purposes of collection and as a fiduciary of the George Washington University Health Plan, it is entitled to reimbursement from defendant for medical expenses based on the reimbursement clause contained in defendant's health plan. In relevant part, that provision states: "If a Member is injured or suffers illness as a

[260 F. Supp.2d 46]

      result of an act caused by or involving a third party, the Health Plan shall be reimbursed for Covered Services it provides or pays that are recovered or may be recoverable from the third party. . . ." Complaint, Exhibit 1, The George Washington University Health Plan, Inc., District of Columbia Standard Option Plan at 22, Art. 10(A). Plaintiff contends that the benefits defendant received from the Plan were subject to and conditioned upon the Plan's right of reimbursement, and that defendant's refusal to reimburse the Plan out of the settlement proceeds violated her contractual obligation under the policy. See Complaint ¶¶ 15, 21.

  The Plan is a health care plan sponsored by The George Washington University. See Complaint ¶ 2.*fn1 The University established and maintains the Plan for the purpose of providing its employees and their eligible dependents with medical, surgical and/or hospital care. See id. Plaintiff asserts, and defendant does not contest, that the Plan therefore is an "employee welfare benefit plan" within the meaning of ERISA. See id.; 29 U.S.C. § 1002(1).

  Seeking to assert its rights under the Plan and to obtain equitable and "restitutionary relief' under ERISA in an amount equivalent to the benefits it has paid for medical expenses incurred by defendant, plaintiff filed suit against defendant on July 28, 1999. See Complaint ¶¶ 5, 19, 22. Plaintiff asserts that it has standing to bring this suit as the assignee and fiduciary of the Plan pursuant to 29 U.S.C. § 1132(a)(3), which provides that a civil action may be brought under ERISA

 
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.
According to plaintiff, the Plan duly appointed and authorized plaintiff to administer and prosecute all of the Plan's rights and claims to reimbursement and subrogation, making plaintiff an assignee for purposes of collection and a fiduciary under ERISA. Id. ¶¶ 3, 6.*fn2 Plaintiff bases its claim of fiduciary status on its assertion that it has discretionary authority in the settlement and prosecution of claims for reimbursement and subrogation, as well as in the collection, management, investment and disbursement of Plan assets. Id. ¶ 6.

  II. DISCUSSION

  Defendant moves to dismiss plaintiff's complaint on the grounds that: (1) this Court lacks subject matter jurisdiction; (2) plaintiff has failed to state a claim upon which relief can be granted; (3) plaintiff has failed to join an indispensable party, namely the Plan; and (4) plaintiff must sue the real party in interest, the Plan, rather

[260 F. Supp.2d 47]

      than defendant. The Court will address each of these arguments in turn.

  A. Subject Matter Jurisdiction

  Defendant contends that the Court does not have subject matter jurisdiction over this matter because plaintiff's cause of action is not a genuine ERISA claim. Defendant bases this claim on two separate theories: (1) that plaintiff is not a fiduciary, and ...


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