United States District Court, W.D. Michigan, Southern Division
S. CARMODY United States Magistrate Judge
matter is before the Court on Defendant Priority
Health's Motion for Summary Judgment, (ECF No. 33),
Defendant Farm Bureau's Motion to Decline
Supplemental Jurisdiction, (ECF No. 39), Defendant
Farm Bureau's Motion for Summary Judgment, (ECF No.
48), Plaintiff's Motion for Summary Judgment as to
Defendant Priority Health, (ECF No. 49), and
Plaintiff's Motion for Summary Judgment as to
Defendant Farm Bureau, (ECF No. 50).
March 7, 2016, the parties consented to proceed in this Court
for all further proceedings, including trial and an order of
final judgment. 28 U.S.C. § 636(c)(1). By Order of
Reference, the Honorable Janet T. Neff referred this case to
the undersigned. (ECF No. 23). For the reasons discussed
herein, Defendant Priority Health's Motion for
Summary Judgment, (ECF No. 33), is denied; Defendant
Farm Bureau's Motion to Decline Supplemental
Jurisdiction, (ECF No. 39), is denied; Defendant
Farm Bureau's Motion for Summary Judgment, (ECF No.
48), is granted; Plaintiff's Motion for Summary
Judgment as to Defendant Priority Health, (ECF No. 49),
is granted; Plaintiff's Motion for Summary Judgment
as to Defendant Farm Bureau, (ECF No. 50), is denied;
and this case is terminated.
about May 27, 2013, Arthur Biegajski was involved in an
automobile accident in Toledo, Ohio. As a result of this
accident, Biegajski was seriously injured and received
significant medical treatment. At the time of this accident,
Biegajski had no-fault automobile insurance through Farm
Bureau and medical insurance through Priority Health. In
light of the coordination of benefits provisions in each of
Biegajski's policies, and the insurers interpretation
thereof, Priority Health assumed primary responsibility for
the payment of Biegajski's medical bills, eventually
paying more than three hundred thousand dollars ($300,
000.00) in medical bills on Biegajski's behalf.
Biegajski's passing, from causes unrelated to the
aforementioned accident, Biegajski's estate (hereinafter
Biegajski) subsequently pursued in Ohio state court a civil
tort action against the other driver involved in the subject
accident. Biegajski settled this lawsuit for payment of six
hundred thousand dollars ($600, 000.00). Priority Health
claimed that it was entitled to recover from this settlement
the amounts it paid for Biegajski's medical care
following his accident. In light of Priority Health's
claim to reimbursement, Biegajski placed in trust a portion
of the settlement proceeds equal to the amount claimed by
Priority Health. Biegajski soon thereafter initiated the
present action seeking a declaration of its rights to the
disputed amount. Priority Health subsequently asserted a
counterclaim alleging entitlement to the disputed amount.
Biegajski also seeks a declaration of rights vis-a-vis Farm
Bureau and its obligation, if any, to pay the medical
expenses incurred by Biegajski following his accident. The
parties have now filed the various motions described above.
judgment “shall” be granted “if the movant
shows that there is no genuine dispute as to any material
fact and the movant is entitled to judgment as a matter of
law.” Fed.R.Civ.P. 56(a). A party moving for summary
judgment can satisfy its burden by demonstrating “that
the respondent, having had sufficient opportunity for
discovery, has no evidence to support an essential element of
his or her case.” Minadeo v. ICI Paints, 398
F.3d 751, 761 (6th Cir. 2005). Once the moving party
demonstrates that “there is an absence of evidence to
support the nonmoving party's case, ” the
non-moving party “must identify specific facts that can
be established by admissible evidence, which demonstrate a
genuine issue for trial.” Amini v. Oberlin
College, 440 F.3d 350, 357 (6th Cir. 2006).
the Court must view the evidence in the light most favorable
to the non-moving party, the party opposing the summary
judgment motion “must do more than simply show that
there is some metaphysical doubt as to the material
facts.” Amini, 440 F.3d at 357. The existence
of a mere “scintilla of evidence” in support of
the non-moving party's position is insufficient.
Daniels v. Woodside, 396 F.3d 730, 734-35 (6th Cir.
2005). The non-moving party “may not rest upon [his]
mere allegations, ” but must instead present
“significant probative evidence” establishing
that “there is a genuine issue for trial.”
Pack v. Damon Corp., 434 F.3d 810, 813-14 (6th Cir.
the non-moving party cannot defeat a properly supported
motion for summary judgment by “simply arguing that it
relies solely or in part upon credibility
considerations.” Fogerty v. MGM Group Holdings
Corp., Inc., 379 F.3d 348, 353 (6th Cir. 2004). Rather,
the non-moving party “must be able to point to some
facts which may or will entitle him to judgment, or refute
the proof of the moving party in some material portion, and.
. .may not merely recite the incantation, ‘Credibility,
' and have a trial on the hope that a jury may disbelieve
factually uncontested proof.” Id. at 353-54.
In sum, summary judgment is appropriate “against a
party who fails to make a showing sufficient to establish the
existence of an element essential to that party's case,
and on which that party will bear the burden of proof at
trial.” Daniels, 396 F.3d at 735.
moving party without the burden of proof need only show that
the opponent cannot sustain his burden at trial, a moving
party with the burden of proof faces a “substantially
higher hurdle.” Arnett v. Myers, 281 F.3d 552,
561 (6th Cir. 2002). Where the moving party has the burden,
the plaintiff on a claim for relief or the defendant on an
affirmative defense, “his showing must be sufficient
for the court to hold that no reasonable trier of fact could
find other than for the moving party.” Calderone v.
United States, 799 F.2d 254, 259 (6th Cir. 1986). The
Sixth Circuit has repeatedly emphasized that the party with
the burden of proof “must show the record contains
evidence satisfying the burden of persuasion and that the
evidence is so powerful that no reasonable jury would be free
to disbelieve it.” Arnett, 281 F.3d at 561.
Accordingly, summary judgment in favor of the party with the
burden of persuasion “is inappropriate when the
evidence is susceptible of different interpretations or
inferences by the trier of fact.” Hunt v.
Cromartie, 526 U.S. 541, 553 (1999).
primary dispute in this matter, between Priority Health and
Arthur Biegajski's Estate, is whether Priority Health is
entitled to reimbursement of the amounts it paid for
Biegajski's care following his accident. Secondarily,
Biegajski's Estate asserts against Farm Bureau the claim
that, in the event Priority Health is entitled to
reimbursement of the amounts it paid for Biegajski's
care, Farm Bureau is obligated to reimburse Biegajski's
Estate. As discussed herein, the Court concludes that: (1)
Priority Health is not entitled to reimbursement of the
amounts it paid for Biegajski's medical care and that,
therefore, (2) Farm Bureau has no obligation to pay or
reimburse Biegajski's Estate.
Health asserts that the health plan pursuant to which it paid
Biegajski's medical bills is a plan governed by the
Employee Retirement Income Security Act of 1974 (ERISA), an
assertion which no other party disputes.
law provides that ERISA “shall supercede any and all
State laws” that “relate to any employee benefit
plan.” 29 U.S.C. § 1144(a). ERISA contains another
provision, however, which saves from preemption “any
law of any State which regulates insurance, banking, or
securities.” 29 U.S.C. § 1144(b)(2)(A); see
also, Kentucky Ass'n of Health Plans, Inc. v.
Miller, 538 U.S. 329, 333 (2003). This provision is
known as the ERISA “saving clause.”
Miller, 538 U.S. at 333. The saving clause must be
considered in conjunction with the “deemer
clause” which provides that a self-funded ERISA plan,
as opposed to a plan which provides coverage through the
purchase of insurance (i.e., an insured plan), is exempt from
state laws which regulate insurance. See FMC Corp. v.
Holliday, 498 U.S. 52, 60-61 (1990) (citing 29 U.S.C.
Health concedes that the plan in question is not a
self-funded plan. Thus, the deemer clause is presently
inapplicable. Accordingly, the Priority Health plan at issue
in this matter is subject to Michigan laws regulating
insurance. See, e.g., Horrell v. CEC Entertainment,
Inc., 2011 WL 4954031 at *4 (W.D. Mich., Oct. 18, 2011).
Priority Health does not dispute this particular conclusion,
but, as discussed below, instead advances several arguments
to avoid the application in the present circumstance of
Michigan regulatory law.
Priority Health was ...