United States District Court, W.D. Michigan, Southern Division
S. CARMODY UNITED STATES MAGISTRATE JUDGE.
matter is before the Court on Defendant Clariant Medical
Plan's Motion for Summary Judgment, (ECF No. 41),
Plaintiff's Motion for Summary Judgment, (ECF
No. 43), and Defendant State Farm's Motion for
Summary Judgment, (ECF No. 47).
13, 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. 30). For the reasons discussed
herein, Defendant Clariant Medical Plan's Motion for
Summary Judgment, (ECF No. 41), is
granted; Plaintiff's Motion for
Summary Judgment, (ECF No. 43), is
granted; and Defendant State Farm's
Motion for Summary Judgment, (ECF No. 47), is
September 2014, Plaintiff Mark Wycihowski was severely
injured after he was struck by a truck. As of the date of
this accident, Plaintiff was a participant in a medical plan
sponsored by the Clariant Corporation (the Clariant Medical
Plan). Plaintiff was also covered by a no-fault insurance
policy issued by State Farm. As a result of this accident,
Plaintiff incurred medical expenses in the amount of several
hundred thousand dollars all of which were paid by Defendant
Clariant Medical Plan. Plaintiff later initiated a tort claim
against the driver responsible for his injuries which settled
for one million dollars. Clariant placed a lien on this award
claiming that it is entitled to reimbursement of the amounts
it paid for Plaintiff's medical treatment. As part of the
aforementioned settlement agreement, Plaintiff placed in
escrow $450, 000.00.
initiated the present declaratory action seeking: (1) a
determination of priority of coverage vis-a-vis Defendant
Clariant Medical Plan and Defendant State Farm; (2) a
declaration that Clariant is not entitled to reimbursement of
the amounts expended for Plaintiff's medical care; and
(3) a declaration that, in the event Clariant is entitled to
reimbursement, State Farm is required to, in turn, reimburse
Plaintiff. Defendant Clariant Medical Plan has asserted
against Plaintiff a counterclaim for reimbursement of the
amounts it has paid for Plaintiff's medical care. The
parties have now each filed motions for summary judgment.
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).
Defendant/Counter-Claimant Clariant's Motion for Summary
Plaintiff's Primary Insurer
outset, the Court must first address whether Clariant or
State Farm was primarily responsible to make payment for
Wycihowski's medical expenses. Clariant asserts that it
was primarily responsible for payment of Plaintiff's
medical expenses. (ECF No. 42-1 at PageID.236). This
assertion is consistent with the Clariant Plan as well as
Plaintiff's State Farm policy. (ECF No. 42-2 at
PageID.239-79; ECF No. 42-3 at PageID.281-326). Moreover,
neither Plaintiff nor State Farm challenges the assertion by
Clariant that it was Plaintiff's primary insurer in this
matter. Accordingly, the Court finds that Clariant was
primarily responsible for payment of Plaintiff's medical
expenses incurred as a result of the aforementioned accident.
reimbursement claim is asserted pursuant to 29 U.S.C. §
1132(a)(3) which authorizes participants, beneficiaries, or
fiduciaries to initiate civil actions to enforce an ERISA
plan. The parties do not dispute that the health plan
pursuant to which Clariant paid Plaintiff's medical bills
is a plan governed by the Employee Retirement Income Security
Act of 1974 (ERISA).
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.
§ 1144(b)(2)(B). Clariant asserts that the plan in
question is a self-funded plan, an assertion which no party
disputes. Thus, the Clariant Medical Plan is not subject to
Michigan laws regulating insurance, but is instead governed
by federal law. Pursuant to federal law, unambiguous ...