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Wycihowski v. Clariant Medical Plan

United States District Court, W.D. Michigan, Southern Division

March 28, 2017

MARK WYCIHOWSKI, Plaintiff,
v.
CLARIANT MEDICAL PLAN, et al., Defendants.

          OPINION

          ELLEN S. CARMODY UNITED STATES MAGISTRATE JUDGE.

         This 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).

         On June 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 denied.

         BACKGROUND

         In 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.

         Plaintiff 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.

         SUMMARY JUDGMENT STANDARD

         Summary 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).

         While 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. 2006).

         Moreover, 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.

         While a 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).

         ANALYSIS

         I. Defendant/Counter-Claimant Clariant's Motion for Summary Judgment

         A. Plaintiff's Primary Insurer

         At the 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.

         B. ERISA Preemption

         Clariant's 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).

         Federal 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. ยง 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 ...


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