Jette v. United of Omaha Life Ins. Co.
Jette v. United of Omaha Life Ins. Co.
Opinion of the Court
In this ERISA action, plaintiff Karen Jette seeks to recover long-term disability benefits from defendant United of Omaha Life Insurance Company ("United"). United has filed counterclaims against Jette, seeking to recover $15,745.99 it allegedly overpaid to Jette due to her receipt of disability benefits under the Social Security Act. Jette has moved to dismiss United's counterclaims. Docket No. 9.
I. FACTS
Jette seeks long-term disability ("LTD") benefits under an employee welfare benefit plan sponsored and maintained by her former employer (the "Plan"). Counterclaim at ¶ 6. LTD benefits under the Plan were at all relevant times funded by a group disability insurance policy issued by United to Jette's former employer. Id. at ¶ 7.
*152United served as the Claim Administrator of the Plan. Id. at ¶ 8.
Jette applied for and received LTD benefits under the Plan. Id. at ¶ 9. The Plan defines the monthly LTD benefit, in part, as follows:
Total Disability
If you are Disabled and earning less than 20% of Your Basic Monthly Earnings, the Monthly Benefit while Disabled is the lesser of:
a) 60% of Your Basic Monthly Earnings, less Other Income Sources; or
b) the Maximum Monthly Benefit, less any Other Income Sources ...
Id. at ¶ 10. The Plan defines "Other Income Sources," in part, as follows:
We take into account the total of all Your income from other sources of income in determining the amount of Your Monthly Benefit. Your Other Income Sources are any of the following amounts that You receive or are eligible to receive as a result of Your Disability or the Sickness and/or Injury that caused, in whole or in part, Your Disability: ...
(e) Any benefits for You or Your Spouse and Dependent Child under:
1. the U.S. Social Security Act; ...
Id. at ¶ 11. The Plan provides United the right to seek a refund from a Plan participant in the event of an overpayment:
Refund to Us
If it is found that We paid more benefits than We should have paid under the Policy, We have the right to a refund from You or the recipient of benefits.
Id. at ¶ 12. In addition, on May 14, 2014, Jette executed a Group Disability Benefits Reimbursement Agreement in which she agreed that:
I will repay the Company, in a lump sum, all monthly and/or weekly benefits that have been paid to me, and which exceed the amount I was entitled under the terms of the Policy, as a result of receipt of Other Benefits. I will make this repayment within 30 days from the date on which Other Benefits are received.
Id. at ¶ 15.
After United began paying LTD benefits to Jette, she also began to receive Social Security Disability Income ("SSDI") benefits under the Social Security Act. Id. at ¶ 13. United alleges that Jette's receipt of SSDI benefits resulted in an overpayment of LTD benefits to her in the amount of $15,745.99. Id. at ¶ 14.
United has made multiple demands upon Jette for a refund of the overpayment balance. Id. at ¶ 16. Jette has failed to refund the overpayment balance in violation of the terms of the Reimbursement Agreement, the Plan, and ERISA. Id. at ¶ 17.
United's counterclaim contains four counts: (1) a claim for enforcement of the Plan provisions; (2) a claim to enforce a lien or constructive trust; (3) a claim for unjust enrichment; and (4) a claim for attorney's fees pursuant to
II. ANALYSIS
A. Standard Of Review
A complaint must contain only "a short and plain statement of the claim showing that the pleader is entitled to relief." Fed. R. Civ. P. 8(a)(2). "To survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to 'state a claim to relief that is plausible on its face.' " Ashcroft v. Iqbal,
In assessing the sufficiency of a claim, "an inquiring court must first separate wheat from chaff; that is, the court must separate the [counterclaim's] factual allegations (which must be accepted as true) from its conclusory legal allegations (which need not be credited)." Guadalupe-Baez v. Pesquera,
B. Section 502(a)(3) Of ERISA
Under Section 502(a)(3) of ERISA a fiduciary such as a United may bring an action:
(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.
The Supreme Court has interpreted "equitable relief" under Section 502(a)(3) as being "limited to 'those categories of relief that were typically available in equity' during the days of the divided bench (meaning, the period before 1938 when courts of law and equity were separate)." Montanile v. Bd. of Trustees of Nat. Elevator Indus. Health Benefit Plan, --- U.S. ----,
In a series of cases involving plan fiduciaries seeking reimbursement of benefits after the plan beneficiary recovered money from a third party, the Supreme Court has developed the meaning of equitable relief for purposes of Section 502(a)(3). In each case, ERISA beneficiaries suffered injuries in car accidents and the ERISA plans paid for their medical care. When the beneficiaries later obtained monetary settlements from tortfeasors, the ERISA plans demanded reimbursement from the settlement proceeds. After the beneficiaries refused, the ERISA plans brought claims *154under Section 502(a)(3) to enforce reimbursement provisions in their plan documents.
First, in Great-West Life & Annuity Ins. Co. v. Knudson,
Next, in Sereboff v. Mid Atl. Med. Servs., Inc.,
In U.S. Airways, Inc. v. McCutchen,
Finally, in Montanile v. Bd. of Trustees of Nat. Elevator Indus. Health Benefit Plan, --- U.S. ----,
The plan beneficiary secured a tort settlement, paid a portion to his attorneys, and retained the remainder.
The Supreme Court reiterated that equitable remedies are, as a general rule, "directed against some specific thing;" that is, "they give or enforce a right to or over some particular thing" rather than "a right to recover a sum of money generally out of the defendant's assets."
Because the lower courts erroneously held that the plan could recover out of the beneficiary's general assets, the Supreme Court remanded for further proceedings to determine whether the beneficiary dissipated the entire fund on non-traceable purchases.
These cases establish the following criteria for securing an equitable lien by agreement in an ERISA action: (1) there must be a promise by the beneficiary to reimburse the fiduciary for benefits paid under the plan in the event of a recovery from a third party; (2) the reimbursement agreement must identify a particular fund, distinct from the beneficiary's general assets, from which the fiduciary will be reimbursed; (3) the funds specifically identified by the fiduciary must be within the possession and control of the beneficiary. See Bilyeu v. Morgan Stanley Long Term Disability Plan,
Jette argues that United's claims are not equitable and must fail as a matter of law because United has "failed to identify a separately identifiable fund from which United can recover $15,745.99." Docket No. 10 at 1; see also id. at 2 ("United has not identified a specific fund where the $15,745.99 is located."); 3 ("United has not identified a segregated fund holding $15,745.99 that Ms. Jette received from the Social Security Administration ..."). This Court disagrees.
United's counterclaim does not seek to impose personal liability upon Jette but rather reimbursement of particular funds or property, namely, overpaid long-term disability benefits paid under the Plan. Counterclaim at ¶¶ 25-26. See, e.g., Cognetta v. Bonavita,
To the extent that Jette argues that the fund must be entirely separate from anything else, i.e., some type of stand-alone fund, that argument is not supported by the caselaw. "If 'separation' were a necessary fact for the imposition of an equitable lien, a claimant could never obtain such a lien over a settlement which either exceeds the amount of benefits paid or includes monies for other claims brought against a third party who provided the settlement funds." Bd. of Trustees of the Nat'l Elevator Indus. Health Benefit Plan v. Goodspeed,
United, however, has not alleged that the funds are in the possession of Jette. Cf. Schiavone,
III. ORDER
For the foregoing reasons, this Court grants Jette's motion to dismiss United's counterclaims without prejudice to United seeking to amend its answer to add counterclaims after limited discovery on the issue of whether the funds are in the possession of Jette. Within two weeks, the parties shall confer regarding the manner and timing and such discovery. Within two weeks, the parties shall, if they agree on the manner and timing of such discovery, file a status report, and if they do not agree, their competing proposals regarding such discovery.
On July 10, 2019, the parties consented to the jurisdiction of a magistrate judge for all purposes, Docket No. 20, and the case was reassigned to the undersigned on July 11, 2019. Docket No. 24.
Because this case is presently before the Court on a motion to dismiss, the Court sets forth the facts taking as true all well-pleaded allegations in the counterclaim and drawing all reasonable inferences in United's favor. See Morales-Tañon v. Puerto Rico Electric Power Authority,
Reference
- Full Case Name
- Karen JETTE v. UNITED OF OMAHA LIFE INSURANCE COMPANY
- Cited By
- 3 cases
- Status
- Published