U.S. Airways, Inc. v. McCutchen
U.S. Airways, Inc. v. McCutchen
Opinion
*91
Respondent James McCutchen participated in a health benefits plan that his employer, petitioner U.S. Airways, established under the Employee Retirement Income Security Act of 1974 (ERISA),
This Court has held that a health-plan administrator like U.S. Airways may enforce such a reimbursement provision by filing suit under § 502(a)(3) of ERISA,
I
In January 2007, McCutchen suffered serious injuries when another driver lost control of her car and collided with McCutchen's. At the time, McCutchen was an employee of U.S. Airways and a participant in its self-funded health plan. The plan paid $66,866 in medical expenses arising from the accident on McCutchen's behalf.
McCutchen retained attorneys, in exchange for a 40% contingency fee, to seek recovery of all his accident-related damages, estimated to exceed $1 million. The attorneys sued the driver responsible for the crash, but settled for only $10,000 because she had limited insurance coverage and the accident had killed or seriously injured three other people. Counsel also secured a payment from McCutchen's own automobile insurer of $100,000, the maximum amount available under his policy. McCutchen thus received $110,000-and after deducting $44,000 for the lawyer's fee, $66,000.
On learning of McCutchen's recovery, U.S. Airways demanded reimbursement of the $66,866 it had paid in medical expenses. In support of that claim, U.S. Airways relied on the following statement in its summary plan description:
"If [US Airways] pays benefits for any claim you incur as the result of negligence, willful misconduct, or other actions of a third party, ... [y]ou will be required to reimburse [US Airways] for amounts paid for claims out of any monies recovered from [the] third party, including, but not limited to, your own insurance company as the result of judgment, settlement, or otherwise." App. 20. 1
*93 McCutchen denied that U.S. Airways was entitled to any reimbursement, but his attorneys placed $41,500 in an escrow account pending resolution of the dispute. That amount represented U.S. Airways' full claim minus a proportionate share of the promised attorney's fees.
US Airways then filed this action under § 502(a)(3), seeking "appropriate equitable relief" to enforce the plan's reimbursement provision. The suit requested an equitable lien on $66,866-the $41,500 in the escrow account and $25,366 more in McCutchen's possession. McCutchen countered by raising two defenses relevant here. First, he maintained that U.S. Airways could not receive the relief it sought because he had recovered only a small
*1544
portion of his total damages; absent over-recovery on his part, U.S. Airways' right to reimbursement did not kick in. Second, he contended that U.S. Airways at least had to contribute its fair share to the costs he incurred to get his recovery; any reimbursement therefore had to be marked down by 40%, to cover the promised contingency fee. The District Court rejected both arguments, granting summary judgment to U.S. Airways on the ground that the plan "clear[ly] and unambiguous[ly]" provided for full reimbursement of the medical expenses paid. App. to Pet. for Cert. 30a; see
The Court of Appeals for the Third Circuit vacated the District Court's order. The Third Circuit reasoned that in a suit for "appropriate equitable relief" under § 502(a)(3), a court must apply any "equitable doctrines and defenses" that traditionally limited the relief requested.
We granted certiorari, 567 U.S. ----,
II
A health-plan administrator like U.S. Airways may bring suit under § 502(a)(3) for "appropriate equitable relief ... to enforce ... the terms of the plan."
3
That provision, we have held, authorizes the kinds of relief "typically available in equity" in the days of "the divided bench," before law and
*95
equity merged.
Mertens v. Hewitt Associates,
In
Sereboff v. Mid Atlantic Medical Services,
we allowed a health-plan administrator to bring a suit just like this one under § 502(a)(3). Mid Atlantic had paid medical expenses for the Sereboffs after they were injured in a car crash. When they settled a tort suit against the other driver, Mid Atlantic claimed a share of the proceeds, invoking the plan's reimbursement clause. We held that Mid Atlantic's action
*1545
sought "equitable relief," as § 502(a)(3) requires. See
The question in this case concerns the role that equitable defenses alleging unjust enrichment can play in such a suit. As earlier noted, the Third Circuit held that "the principle of unjust enrichment" overrides U.S. Airways' reimbursement clause if and when they come into conflict.
We rejected a similar claim in
Sereboff,
though without altogether foreclosing
*1546
McCutchen's position. The Sereboffs argued, among other things, that the lower courts erred in enforcing Mid Atlantic's reimbursement clause "without imposing
*97
various limitations" that would " apply to truly equitable relief grounded in principles of subrogation."
5
In the end, however,
Sereboff
's logic dooms McCutchen's effort. US Airways, like Mid Atlantic, is seeking to enforce the modern-day equivalent of an "equitable lien by agreement." And that kind of lien-as its name announces-both arises from and serves to carry out a contract's provisions. See
We have found nothing to the contrary in the historic practice of equity courts. McCutchen offers us a slew of cases in which those courts applied the double-recovery or common-fund rule to limit insurers' efforts to recoup funds from their beneficiaries' tort judgments. See Brief for Respondents 21-25. But his citations are not on point. In some of McCutchen's cases, courts apparently applied equitable doctrines in the absence of any relevant contract provision.
See
,
e.g.,
*99
Washtenaw Mut. Fire Ins. Co. v. Budd,
Nevertheless, the United States, appearing as amicus curiae, claims that the common-fund rule has a special capacity to trump a conflicting contract. The Government begins its brief foursquare with our (and Sereboff 's) analysis: In a suit like this one, to enforce an equitable lien by agreement, "the agreement, not general restitutionary principles of unjust enrichment, provides the measure of relief due." Brief for United States 6. Because that is so, the Government (naturally enough) concludes, McCutchen cannot invoke the double-recovery rule to defeat the plan. But then the Government takes an unexpected turn. "When it comes to the costs incurred" by a beneficiary to obtain money from a third party, "the terms of the plan do not control." Id., at 21. An equity court, the Government contends, has "inherent authority" to apportion litigation costs in accord with the "longstanding equitable common-fund doctrine," even if that conflicts with the parties' contract. Id., at 22.
But if the agreement governs, the agreement governs: The reasons we have given (and the Government mostly accepts)
*100
for looking to the contract's terms do not permit an attorney's-fees exception. We have no doubt that the common-fund doctrine has deep roots in equity. See
Sprague v. Ticonic Nat. Bank,
The result we reach, based on the historical analysis our prior cases prescribe, fits lock and key with ERISA's focus on what a plan provides. The section under which this suit is brought "does not, after all, authorize 'appropriate equitable relief'
at large,
"
Mertens,
III
Yet McCutchen's arguments are not all for naught. If the equitable rules he describes cannot trump a reimbursement provision, they still might aid in properly construing it. And for U.S. Airways' plan, the common-fund doctrine (though not the double-recovery rule) serves that function. The plan is silent on the allocation of attorney's fees, and in those circumstances, the common-fund doctrine provides the appropriate default. In other words, if U.S. Airways wished to depart from the well-established common-fund rule, it had to draft its contract to say so-and here it did not. 7
*102 Ordinary principles of contract interpretation point toward this conclusion.
*1549
Courts construe ERISA plans, as they do other contracts, by "looking to the terms of the plan" as well as to "other manifestations of the parties' intent."
Firestone Tire & Rubber Co. v. Bruch,
The reimbursement provision at issue here precludes looking to the double-recovery rule in this manner. Both the contract term and the equitable principle address the same problem: how to apportion, as between an insurer and a beneficiary, a third party's payment to recompense an injury. But the allocation formulas they prescribe differ markedly.
*103 According to the plan, U.S. Airways has first claim on the entire recovery-as the plan description states, on "any monies recovered from [the] third party"; McCutchen receives only whatever is left over (if anything). See supra, at 1543. By contrast, the double-recovery rule would give McCutchen first dibs on the portion of the recovery compensating for losses that the plan did not cover ( e.g., future earnings or pain and suffering); US Airways' claim would attach only to the share of the recovery for medical expenses. See supra, at 1545 - 1546. The express contract term, in short, contradicts the background equitable rule; and where that is so, for all the reasons we have given, the agreement must govern.
By contrast, the plan provision here leaves space for the common-fund rule to operate. That equitable doctrine, as earlier noted, addresses not how to allocate a third-party recovery, but instead how to pay for the costs of obtaining it. See
supra,
at 1546. And the contract, for its part, says nothing specific about that issue. The District Court below thus erred when it found that the plan clearly repudiated the common-fund rule. See
supra,
at 1544. To be sure, the plan's allocation formula-first claim on the recovery goes to U.S. Airways-
might
operate on every dollar received from a third party, even those covering the beneficiary's litigation costs. But alternatively, that formula could apply to only the true recovery, after the costs of obtaining it are deducted. (Consider, for comparative purposes, how an income tax is levied on net, not gross, receipts.) See Dawson, Lawyers and Involuntary Clients: Attorney Fees From Funds,
IV
*106 Our holding today has two parts, one favoring U.S. Airways, the other McCutchen. First, in an action brought under § 502(a)(3) based on an equitable lien by agreement, the terms of the ERISA plan govern. Neither general principles of unjust enrichment nor specific doctrines reflecting those principles-such as the double-recovery or common-fund rules-can override the applicable contract. We therefore reject the Third Circuit's decision. But second, the common-fund rule informs interpretation of U.S. Airways' reimbursement provision. Because that term does not advert to the costs of recovery, it is properly read to retain the common-fund doctrine. We therefore also disagree with the District Court's decision. In light of these rulings, we vacate the judgment below and remand the case for further proceedings consistent with this opinion.
It is so ordered.
Justice SCALIA, with whom THE CHIEF JUSTICE, Justice THOMAS, and Justice ALITO join, dissenting.
I agree with Parts I and II of the Court's opinion, which conclude that equity cannot override the plain terms of the contract.
The Court goes on in Parts III and IV, however, to hold that the terms are
not
plain and to apply the "common-fund" doctrine to fill that "contractual gap,"
ante,
at 1549. The problem with this is that we granted certiorari on a question that presumed the contract's terms were unambiguous-namely, "where the plan's terms give it an absolute right to full reimbursement." Pet. for Cert. i. Respondents interpreted "full reimbursement" to mean what it plainly says-reimbursement of
all
the funds the Plan had expended. In their brief in opposition to the petition they conceded that, under the contract, "a beneficiary is required to reimburse the Plan for any amounts it has paid out of any monies the beneficiary recovers from a third-party,
without any contribution
*107
to attorney's fees and expenses
." Brief in Opposition 5 (emphasis added). All the parties, as well as the Solicitor General, have treated that concession as valid. See Brief for Petitioner 18, and n. 6; Brief for Respondents 29; Brief for United States as
Amicus Curiae
21. The Court thus has no business deploying against petitioner an argument that was neither preserved, see
Baldwin v. Reese,
I would reverse the judgment of the Third Circuit.
We have made clear that the statements in a summary plan description "communicat[e] with beneficiaries
about
the plan, but ... do not themselves constitute the
terms
of the plan."
CIGNA Corp. v. Amara,
563 U.S. ----, ----,
Compare
Sans ellipses, § 502(a)(3) provides that a plan administrator may bring a civil 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."
Both our prior cases and secondary sources confirm McCutchen's characterization of the common-fund and double-recovery rules as deriving primarily from principles of unjust enrichment. See
Boeing,
"Subrogation simply means substitution of one person for another; that is, one person is allowed to stand in the shoes of another and assert that person's rights against" a third party. 1 Dobbs § 4.3(4), at 604; see 8B Appleman § 4941, at 11 (" 'Subrogation' involves the substitution of the insurer ... to the rights of the insured").
The Sereboff Court's analysis concerned only subrogation actions based on equitable principles independent of any agreement. A subrogation action may also be founded on a contract incorporating those principles. See 1 Dobbs § 4.3(4), at 604. US Airways suggested at oral argument that McCutchen's case would "ge[t] a lot stronger" if the plan here spoke only of subrogation, without separately granting a right of reimbursement. Tr. of Oral Arg. 18. We need not consider that question because U.S. Airways seeks to enforce a reimbursement provision, of the same kind we considered in Sereboff .
The dissent faults us for addressing this issue, but we think it adequately preserved and presented. The language the dissent highlights in McCutchen's brief in opposition, indicating that the plan clearly abrogates the common-fund doctrine, comes from his description of US Airways' claim in the District Court. See post, at 1551 (opinion of SCALIA, J.); Brief in Opposition 5. McCutchen's argument in that court urged the very position we adopt-that the common-fund doctrine applies because the plan is silent. See App. to Pet. for Cert. 30a; Defendants' Memorandum in Opposition to Plaintiff's Motion for Summary Judgment in No. 2:08-cv-1593 (WD Pa., Dec. 4, 2011), Doc. 33, pp. 12-13 ("If [US Airways] wanted to exclude a deduction for attorney fees, it easily could have so expressed"). To be sure, McCutchen shifted ground on appeal because the District Court ruled that Third Circuit precedent foreclosed his contract-based argument, see App. to Pet. for Cert. 31a; the Court of Appeals' decision then put front-and-center his alternative contention that the common-fund rule trumps a contract. But both claims have the same basis (the nature and function of the common-fund doctrine), which the parties have disputed throughout this litigation. And similarly, the question we decide here is included in the question presented. The principal clause of that question asks whether a court may use "equitable principles to rewrite contractual language." Pet. for Cert. i. We answer "not rewrite, but inform"-a reply well within the question's scope.
For that reason, almost every state court that has confronted the issue has done what we do here: apply the common-fund doctrine in the face of a contract giving an insurer a general right to recoup funds from an insured's third-party recovery, without specifically addressing attorney's fees. See,
e.g.,
Ex parte State Farm Mut. Auto. Ins. Co.,
Reference
- Full Case Name
- US AIRWAYS, INC., in Its Capacity as Fiduciary and Plan Administrator of the US Airways, Inc. Employee Benefits Plan, Petitioner v. James E. McCUTCHEN Et Al.
- Cited By
- 278 cases
- Status
- Published