Danko v. National Railroad Passenger Corp.
Danko v. National Railroad Passenger Corp.
Opinion of the Court
MEMORANDUM OPINION
In this case brought under the Employee Retirement Income Security Act (“ERISA”),
I. FACTUAL ALLEGATIONS
Plaintiffs, husband and wife, filed this action on their own behalf and on behalf of a proposed class of similarly-situated individuals. The Complaint alleges that Mark Danko, an Amtrak employee, and his wife Pauline receive health insurance coverage through Amtrak’s Group Health Plan. Ms. Danko was injured in a motor vehicle accident in 2011, and received benefits under the Plan. Ms. Danko filed a lawsuit against the driver responsible for the accident and settled for the limits available under the driver’s policy, and asserted an uninsured or underinsured motorist claim under her own automobile policy, which also settled. Pursuant to the terms of the Plan, Amtrak had a subrogation lien of $7,893.95 against the settlements so that it could be reimbursed for the medical benefits it had paid.
Amtrak sought the entire amount of the lien, while Ms. Danko’s attorney took the position that the amount should be reduced by the proportionate amount of attorneys’ fees expended to obtain the settlements, for a total of $5,262.63 in satisfaction of the lien. Ms. Danko’s attorney sent a check for that amount, which was eventually cashed. From March until June of 2015, Ms. Danko’s attorney and a representative from Optum, Amtrak’s subrogation administrator, exchanged emails with regard to whether or not Amtrak was entitled to the remaining $2,631.32, without a clear resolution. The funds remained in the attorney’s client security fund. On November 15, 2015, Ms. Danko’s attorney wrote to the administra
Several months later, Plaintiff filed this suit, alleging that' 'Defendant violated the subrogation terms of the Plan and seeking recovery of benefits due, declaratory and injunctive relief, interest, and attorneys’ fees. Upon receipt of the Complaint, Defendant’s counsel sent a letter “to confirm that the Plan absolutely and irrevocably waives any and all right to further reimbursement relating to any benefit claims paid to Pauline Danko” in connection with the accident.
II. LEGAL STANDARDS
Pursuant to Federal Rule of Civil Procedure 12(b)(6), dismissal of a complaint for failure to state a claim upon which relief can be granted is appropriate where a plaintiffs “plain statement” lacks enough substance to show that he is entitled to relief.
A motion to dismiss for lack of subject matter jurisdiction pursuant to.-Federal Rule of Civil Procedure. 12(b)(1). .may, raise either a facial or a. factual challenge. A facial challenge alleges a failure to plead jurisdictional prerequisites, whereas a factual challenge alleges that the prerequisites for jurisdiction do not in fact exist.
III. DISCUSSION
A. Standing
Amtrak argues that there is no case or controversy to give Plaintiffs standing to pursue the case.- To establish Article III standing, “a plaintiff must show (1) an ‘injury' in fact,’ i.e., an actual or imminently threatened injury that is ‘concrete and particularized’ to the plaintiff;
Defendant argues that Plaintiffs lack standing because they have not suffered any injury or loss. The Court disagrees. Plaintiffs allege that Amtrak’s lien required that the funds at issue remain in the attorney’s trust account, and that they therefore were deprived of the use of the money until after suit was filed. This injury, although slight, is sufficient to confer standing.
As outlined under the Plan’s Right of Reimbursement, Amtrak will have a lien on the proceeds of any recovery.
I’m assuming that you have distributed remaining settlement proceeds in this matter to your client. An ERISA Plan can enforce an equitable lien against settlement funds, if they are in the member’s possession.
The health plan has a reimbursement right in that settlement and to those settlement funds. The plan is legally permitted to assert such a right and that right is still enforceable.
The Plan is still owed $2631.32 but in an effort to resolve this matter fairly and reasonably the Plan has agreed to accept half that, or $1306.66.17
As Amtrak asserted that at least part of the lien was “still owed,” and Plaintiffs have alleged this deprived them of use of the disputed funds, Plaintiffs have met the threshold for standing.
B. Mootness
“While the doctrine of standing concerns whether a plaintiff is permitted to bring suit at the pleading stage, ‘the central question of all mootness problems is whether changes in circumstances that prevailed at the beginning of the litigation have forestalled any occasion for meaningful relief.’ ”
But Plaintiffs allege that on November 15, 2015, their counsel wrote to Amtrak, stating his understanding that any administrative process had been exhausted, and “asking Amtrak to specify what if any additional administrative steps Ms. Danko must take in order to be able to pursue her rights against Amtrak in court.”
C. Failure to State a Claim
Amtrak argues that Plaintiffs cannot state a claim pursuant to § 502(a)(1)(B) of ERISA, which allows a plan participant “to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan.”
Defendant also argues that because Plaintiffs seek to recover benefits under § 502(a)(1)(B), they cannot proceed under § 502(a)(3), which allows beneficiaries to seek “appropriate equitable relief’ that cannot be addressed adequately by other provisions of ERISA.
Finally, Defendant argues- that Plaintiffs failed to exhaust administrative remedies, as required under ERISA.
IV. CONCLUSION
For the reasons explained above, Defendant’s motion to dismiss will be granted in part, as Amtrak has renounced any lien as to the $2,631.32, rendering relief as to that claim moot. The motion is otherwise denied. An order will be entered.
. 29 U.S.C. §§ 1001 et seq.
. Def. Ex. B.
. Def. Ex. C.
. Bell Atl. Corp. v. Twombly, 550 U.S. 544, 557, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007).
. ALA, Inc. v. CCAIR, Inc., 29 F.3d 855, 859 (3d Cir. 1994); Fay v. Muhlenberg Coll., No. 07-4516, 2008 WL 205227, at *2 (E.D. Pa. Jan. 24, 2008).
. Twombly, 550 U.S. at 555, 564, 127 S.Ct. 1955.
. Id. at 570, 127 S.Ct. 1955.
. Id. at 562, 127 S.Ct. 1955 (quoting Car Carriers, Inc. v. Ford Motor Co., 745 F.2d 1101, 1106 (7th Cir. 1984)) (internal quotation mark omitted).
. CNA v. United States, 535 F.3d 132, 139 (3d Cir. 2008).
. United States ex rel. Atkinson v. PA. Shipbuilding Co., 473 F.3d 506, 514 (3d Cir. 2007).
. NCAA v. Governor of N.J., 730 F.3d 208, 218 (3d Cir. 2013) (quoting Summers v. Earth Island Inst., 555 U.S. 488, 493, 129 S.Ct. 1142, 173 L.Ed.2d 1 (2009)).
. Blunt v. Lower Merion School Dist., 767 F.3d 247, 278 (3d Cir. 2014) (internal quotation marks, brackets, and citations omitted).
. Taliaferro v. Darby Twp. Zoning Bd., 458 F.3d 181, 188 (3d Cir. 2006).
. In re Schering-Plough Corp. Intron/Temodar Consumer Class Action, 678 F.3d 235, 243 (3d Cir. 2012).
. Cramer v. John Alden Life Ins. Co., 763 F.Supp.2d 1196, 1208 (D. Mont. 2011) (holding that the plaintiff adequately alleged loss of use of benefits so as to confer standing).
. West v. Health Net of the NE, 217 F.R.D. 163, 174-75 (D.N.J. 2003) (where evidence showed lien was withdrawn before suit was filed, Plaintiff lacked standing, but where lien was not abandoned until after suit was filed, Plaintiff had standing).
. Def. Ex. H (email of June 8, 2015).
. Boyle v. Int’l Bhd. of Teamsters Local 863 Welfare Fund, 579 Fed.Appx. 72, 75 (3d Cir. 2014) (quoting Jersey Cent. Power & Light Co. v. New Jersey, 772 F.2d 35, 39 (3d Cir. 1985) (internal citation omitted)).
. Id. at 75. Whether or not Plaintiffs would be entitled to interest other than that earned in the attorney’s trust account is not clear at this point.
. Def. Reply at 6-7 [Doc. No. 10].
. Compl. ¶ 32.
. 29 U.S.C. § 1132(a)(1)(B).
. Montanile v. Bd. of Trustees of Nat'l Elevator Indus., - U.S. -, 136 S.Ct. 651, 662, 193 L.Ed.2d 556 (2016).
. The Court assumes that Amtrak does not wish to argue that funds subject to the right of subrogation should not be maintained separately until the lien is resolved; otherwise, Amtrak could find itself unable to enforce equitable liens in the event the funds are dissipated. Id. at 662.
. 29 U.S.C. § 1132(a)(3).
. Shah v. Horizon Blue Cross Blue Shield of N.J., No. 15-8590, 2016 WL 4499551, at *10 (D.N.J. Aug. 25, 2016).
. See Mallon v. Trover Solutions, Inc., 613 Fed.Appx. 142, 143 (3d Cir. 2015).
Reference
- Full Case Name
- Pauline DANKO and Mark Danko, Individually and on behalf of all others similarly situated v. NATIONAL RAILROAD PASSENGER CORPORATION
- Cited By
- 3 cases
- Status
- Published