Stephens v. Farmland Industries, Unpublished Decision (8-24-1999)
Stephens v. Farmland Industries, Unpublished Decision (8-24-1999)
Opinion of the Court
This appeal, having been heretofore placed on the accelerated calendar, is being considered pursuant to App.R. 11.1(E) and Local Rule 12. Pursuant to Local Rule 12(5), we have elected to issue a full opinion in lieu of a judgment entry.
The Plaintiff-Appellant, David J. Stephens ("Stephens"), appeals the decision of the Seneca County Court of Common Pleas granting summary judgment in favor of the Plaintiff-Appellee, Farmland Industries, Inc. ("Farmland").
The pertinent facts of the case are as follows. On November 6, 1996, through the fault of Stewart Emanhiser ("Defendant"), Stephens was injured in an automobile accident. At the time of the accident, Stephens was a passenger in a vehicle driven by the Defendant. Both Stephens and the Defendant were employees of Farmland. As a result of the accident, Stephens suffered a permanent injury to his right leg, as well as numerous other injuries. Stephens has incurred medical bills totaling approximately $85,000, and has suffered lost wages in the amount of $20,000.
At the time of the accident, Stephens had employee health coverage through his employer, Farmland.1 Thus, Farmland paid the majority of the medical bills incurred by Stephens as a result of the accident.2 The Defendant, meanwhile, had automobile liability coverage through Allstate Insurance Company in the amount of $12,500. Farmland asserts that it has a subrogation interest in any recovery Stephens might receive from the Allstate insurance policy in the amount of the medical benefits it has paid upon his behalf. Stephens, however, has refused to reimburse Farmland. Thus, Farmland filed the present suit.
Both Stephens and Farmland filed motions for summary judgment asserting priority to the proceeds of the Allstate policy. On February 2, 1999, the trial court overruled Stephens' motion and granted summary judgment in Farmland's favor.
Appellant now appeals, asserting one assignment of error.
In considering an appeal from the granting of a summary judgment, we review the grant of the motion for summary judgment independently and do not give deference to the trial court's determination. Schuch v. Rogers (1996),113 Ohio App.3d 718 ,720 . Accordingly, we apply the same standard for summary judgment as did the trial court. Midwest Specialties, Inc. v. Firestone Tire Rubber Co. (1988),42 Ohio App.3d 6 ,8 .
Summary judgment is proper when, looking at the evidence as a whole (1) no genuine issue of material fact remains to be litigated, (2) the moving party is entitled to judgment as a matter of law, and (3) it appears from the evidence, construed most strongly in favor of the nonmoving party, that reasonable minds could only conclude in favor of the moving party. Civ.R. 56(C); Horton v. Harwick Chemical Corp. (1995),
Having set forth the proper standard of review, we now turn to the merits of Stephens' sole assignment of error.
The trial court erred in holding the "make-whole" doctrine did not apply; both state and federal case law, as well as the insurance contract itself, embrace the "make-whole" doctrine.
Stephens asserts in his sole assignment of error that the trial court erred in overruling his motion and granting summary judgment in favor of Farmland. Specifically, Stephens alleges that he has not been fully compensated for his physical injuries and economic loss. Thus, Stephens contends that Farmland cannot be reimbursed on a subrogation claim.
In support of his position, Stephens cites both state and federal common law principles for the proposition that, because he has not been made whole, Farmland does not have a subrogation interest in any recovery he might receive from Allstate Insurance Company.
Farmland, meanwhile, cites both state and federal case law for the proposition that the make-whole doctrine is merely a principle of interpretation that can be overridden by the clear language of a subrogation provision contained within an employee benefit plan.
The subrogation provision at issue in the present case provides as follows:
The plan shall be subrogated, to the extent of benefits paid or payable by this Plan, to any monies paid or payable by any other plan (as defined in this Article) or person by reason of the illness or injury which occasioned the payment of benefits by this plan, whether or not those monies are sufficient to make whole the Participant to whom or on whose behalf this Plan made its payments.
Farmland maintains that the foregoing subrogation provision specifically disclaims the make-whole doctrine and, thus, controls the outcome of the present case.
We will now determine relative priority under Ohio state law.
This Court reaffirmed the above principle in Risner v. ErieIns. Co. (1993),
The subrogation provision at issue in the case gave Erie the unqualified right of subrogation to the entire amount paid to the insured pursuant to the insurance contract. In finding for the insurer, we focused on the express language of the subrogation agreement. On the basis of that language, we held that the right of an insured to retain the total sum recovered from a tortfeasor was not an unqualified right, even where the insured had not been fully compensated for his injuries and losses. Id. at 700.
Thus, under Ohio state law, a subrogation provision controls where clear language states that the participant's right to be made whole is superseded by the plan's right to subrogation. Having determined priority under Ohio state law, we will now turn to relative priority under federal common law.
The Employment Retirement Income Security Act of 1974 ("ERISA") governs the establishment, operation, and administration of employee benefit plans, including those employer-established plans providing health care benefits to employees and their beneficiaries.
It is a well-settled axiom that ERISA preempts state regulatory laws and common-law rules related to self-funded employee benefit plans. See Marshall v. Employers Health Ins. Co. (6th Cir. Dec. 30, 1997), Case Nos. 96-6063 96-6112, Slip Op., unreported, WL 809997. We are also cognizant of the principle that federal common law can only be applied as a gap-filler where a clause or provision is found to be ambiguous or silent on a particular issue. Marshall, supra, at 3.
Where the language of an ERISA plan is silent or ambiguous as to subrogation rights, federal courts generally hold that the make-whole doctrine governs the parties' relative priorities in recovery from the tortfeasor. See Marshall, supra; Fenicle v.Michigan Livestock Exch. (N.D.Ohio Jan. 8, 1998), No. 3:96 CV 7183, unreported. Further, where a subrogation clause within an insurance plan is silent or ambiguous as to the issue of priority of payments, the make-whole doctrine likewise operates as a default rule in favor of the insured under federal common law principles. Marshall, supra at 3; Fenicle, supra. Thus, under federal common law, like Ohio state law, the insurer does not have a right of subrogation until the insured has been fully compensated, unless the subrogation provision itself clearly and unequivocally provides to the contrary.
We must now determine whether the subrogation clause at issue in the present case is ambiguous or silent as to the priority of payments. The subrogation clause states in pertinent part that "[t]he plan shall be subrogated * * * whether or not those monies are sufficient to make whole the Participant to whom this Plan made its payments."
The above language clearly states that the participant's right to be made whole is superseded by the plan's right to subrogation. Therefore, we find that the insurance contract requires subrogation, whether or not Stephen was made whole for his injuries and losses.
In conclusion, we find that the trial court did not err in granting Farmland's motion for summary judgment.3 Accordingly, Stephens' assignment of error is not well-taken and is overruled.
Judgment affirmed. WALTERS and SHAW, JJ., concur.
Case-law data current through December 31, 2025. Source: CourtListener bulk data.