Martinez v. Ila Prssa

U.S. Court of Appeals for the First Circuit

Martinez v. Ila Prssa

Opinion

USCA1 Opinion









August 11, 1992 [NOT FOR PUBLICATION]

UNITED STATES COURT OF APPEALS
FOR THE FIRST CIRCUIT
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No. 91-2335

ORESTE MORCELO-MARTINEZ, ET AL.,

Plaintiffs, Appellants,

v.

WELFARE FUND ILA-PRSSA,

Defendant, Appellee.


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APPEAL FROM THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF PUERTO RICO

[Hon. Jaime Pieras, Jr., U.S. District Judge]
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Before

Breyer, Chief Judge,
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O'Scannlain,* and Cyr, Circuit Judges.
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John Ward-Llambias for appellants.
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Roberto E. Vega-Pacheco with whom Trias, Acevedo & Otero was on
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brief for appellee.


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*Of the Ninth Circuit, sitting by designation.





















Per Curiam. The Morcelos brought this action against
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Mr. Morcelo's employer-provided health care insurer for

reimbursement of medical expenses pursuant to the Employee

Retirement Income Security Act ("ERISA"), 29 U.S.C. 1132. The

trial court dismissed the complaint for failure to state a claim

upon which relief could be granted. Fed. R. Civ. P. 12(b)(6). We

now affirm.

Mr. Morcelo was advised by his doctor to seek heart

surgery in Texas. The defendant allegedly denied coverage for

such treatment and the surgery was eventually performed in Puerto

Rico and paid for by the Medicaid program of the Puerto Rico

Department of Health. The Morcelos assigned "any right to

remuneration, payment or aid for medical expenses which I or which

any other person may have" to the Medicaid Program. The district

court concluded that the Morcelos lacked standing to bring this

action since they were not the real parties in interest after

having assigned all their rights to reimbursement of medical

expenses to the Medicaid Program.

I.

Mr. Morcelo argues that he is entitled to recover the

difference between what the Medicaid Program paid for his less

expensive operation in Puerto Rico and what an operation in Texas

would have cost. He analogizes his attempted recovery to the

collateral source rule under which a tortfeasor cannot lessen his

liability because the injured party receives assistance from a

separate source. Without reaching the merits of the claim,



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however, we must agree with the district court that the Morcelos'

ERISA claim is barred for lack of standing.

We are persuaded by its express language that the

assignment effectively assigned any and all rights regarding
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medical services for this procedure to Medicaid, not just the

right to payment for the particular services he received. Hence,

the Morcelos are not the real parties in interest in this action

and could not state a claim against the Welfare Fund. Fed. R.

Civ. P. 17(a); Maddalone v. Okada Shosen, KK, 756 F.2d 886, 887
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(1st Cir. 1985) (once injured worker settles with workers

compensation insurer, the insurer is the real party in interest).

Consequently, the district court properly dismissed the action

against the Welfare Fund.

II.

The trial court also properly dismissed Mrs. Morcelo's

pendent state claims for various tort remedies. Once the court

dismissed the federal ERISA claim, it had the discretion also to

dismiss the pendent state claims. 28 U.S.C. 1367(c)(3); United
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Mine Workers v. Gibbs, 383 U.S. 715, 726 (1966).
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Affirmed.
Affirmed.
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Reference

Status
Published