No. 03-10195

 

IN THE UNITED STATES COURT OF APPEALS

FOR THE FIFTH CIRCUIT

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BOMBARDIER AEROSPACE EMPLOYEE WELFARE PLAN,

 

Plaintiff-Appellee,

 

v.

 

FERRER, POIROT & WANSBROUGH, PC, et al.,

 

Defendants-Appellants.

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APPEAL FROM THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF TEXAS

------------------------------------------------

BRIEF OF AMICUS CURIAE ELAINE L. CHAO,

SECRETARY OF THE UNITED STATES DEPARTMENT OF LABOR

IN SUPPORT OF APPELLEE REQUESTING AFFIRMANCE

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                                                For the Secretary of Labor:

 

                                               
HOWARD M. RADZELY
Acting Solicitor of Labor

                                     
TIMOTHY D. HAUSER
Associate Solicitor

                                     
ELIZABETH HOPKINS
Counsel for Appellate and Special Litigation

U.S. Department of Labor
Office of the Solicitor
Plan Benefits Security Division
200 Constitution Avenue, N.W., Room N-4611
Washington, D.C.
20210

(202) 693-5600

TABLE OF CONTENTS

 

STATEMENT OF THE ISSUES         

INTEREST OF THE SECRETARY OF LABOR         

STATEMENT OF THE CASE         

SUMMARY OF ARGUMENT      

ARGUMENT      

          I.         The Imposition of a Constructive Trust Over Specifically Identifiable Funds in an Attorney's Trust Account Constitutes Appropriate Equitable Relief Under ERISA Section 502(a)(3)

 

          II.         Plan Terms that Provide that Attorney Fees are the Sole Responsibility of the Participant Override the Common Fund" Doctrine         

 

CONCLUSION

TABLE OF AUTHORITIES

 

Federal Cases:                                                                                  

 

Admin. Comm. of the Wal-Mart Stores, Inc. v. Hummel, 245 F. Supp. 2d 908 (N.D. Ill. 2003)         

 

Admin. Comm. of the Wal-Mart Stores, Inc. v. Varco, 338 F.3d 680 (7th Cir. 2003)         

 

Admin. Comm. of the Wal-Mart Stores, Inc. v. Varco, 2002 WL 31189717 (N.D. Ill. Oct. 2, 2002)

 

Allison v. Wellmark, Inc., No. C00-3015-MWB, 2002 WL 31818946 (N.D. Iowa Oct. 15, 2002)

 

Asbestos Workers Local No. 42 Welfare Fund v. Brewster, 227 F. Supp. 2d 226 (D. Del. 2002)

 

Bauer v. Glyten, Nos. A3-00-161, A3-02-27, 2002 WL 664034 (D.N.D. Apr. 22, 2002)

 

Bauhaus USA, Inc. v. Copeland, 292 F.3d 439 (5th Cir. 2002)

 

Blackburn v. Sundstrand Corp., 115 F.3d 493 (7th Cir. 1997)

 

Bombardier Aerospace Employee Welfare Benefits Plan v. Ferrer, Poirot & Wansbrough, PC, No. Civ. A. 3:02-CV-1982, 2003 WL 282443 (N.D. Tex. Feb. 4, 2003

Chambers v. NASCO, Inc., 501 U.S. 32 (1991)


Corporate Benefit Servs. of Am., Inc. v. Sempf, No. 03-C-0048-C, 2003 WL 21704145 (W.D. Wis. May 9, 2003)

 

  Community Ins. Co. v. Morgan, 54 Fed. Appx. 828, 2002 WL 31870325 (6th Cir. 2002)          

 

Donovan v. Cunningham, 716 F.2d 1455 (5th Cir. 1983)

 

Extendicare v. Crow, No. Civ.A. 1:02-CV-109-C, 2002 WL 32079263 (N.D. Tex. Oct. 23, 2002)         

 

Forsling v. J.J. Keller & Assocs., Inc., 241 F. Supp. 2d 915 (E.D. Wis. 2003)         

 

Great-West Life & Annuity Ins. Co. v. Berlin, 45 Fed. Appx. 750, 2002 WL 2017076 (9th Cir. 2002)

 

Great-West Life & Annuity Ins. Co. v. Knudson, 534 U.S. 204 (2002)          passim

 

Great-West Life & Annuity Ins. Co. v.  Perkins, No. C:02-5294-FDB, 2002 WL 1816438 (W.D.Wash. July 9, 2002)

 

Great-West Life & Annuity Ins. Co. v. Unger, No. CIV. 02-082-TUC-WBD, 2002 WL 2012528 (D. Ariz. July 24, 2002)

 

Guidry v. Sheet Metal Workers' Nat'l Pension Fund, 493 U.S. 365 (1990)         

 

Harris Trust & Sav. Bank v. Salomon Smith Barney, Inc., 530 U.S. 238 (2000)         

 

Hotel & Restaurant & Bar Employees Fringe Benefit Funds v. Truong, No. CIV.01-873(MJD/RLE), 2002 WL 171725 (D. Minn. Jan. 31, 2002)

         

 

IBEW-NECA Southwestern Health & Benefit Fund v. Douthitt, 211 F. Supp. 2d 812 (N.D. Tex. 2002)

                   

 

In re Carpenter, 36 Fed. Appx. 80, 2002 WL 1162277 (4th Cir. 2002)

 

Jamail, Inc. v. Carpenters Dist. Council of Houston Pension & Welfare Trusts, 954 F.2d 299 (5th Cir. 1992)

 

Mank v. Green, No. 03-42-P-C, 2003 WL 21250676 (D. Me. May 30, 2003)

         

 

Mertens v. Hewitt Assocs., 508 U.S. 248 (1993)         

 

Moore v. Crawford, 130 U.S. 122 (1889)         

 

Primax Recoveries, Inc. v. Carey, 247 F. Supp. 2d 337 (S.D.N.Y. 2002)

Primax Recoveries, Inc. v. Duffy, 204 F. Supp. 2d 1111 (N.D. Ill. 2002),

                   

 

Primax Recoveries, Inc. v. Goss, 240 F. Supp. 2d 800 (N.D. Ill. 2002)

         

 

Primax Recoveries, Inc. v. Lee, 260 F. Supp. 2d 43 (D.D.C. 2003)

 

 

Primax Recoveries, Inc. v. Sevilla, 324 F.3d 544 (7th Cir. 2003)

 

Secretary of Labor  v. Fitzsimmons, 805 F.2d 682 (7th Cir. 1986)

 

Smith v. Wal-Mart Assocs. Group Health Plan, No. 99-6464, 2000 WL 1909387 (6th Cir. Dec. 27, 2000)

    

 

UNUM Life Ins. Co. of America v. Ward, 526 U.S. 358 (1999)         

Unicare Life & Health Ins. Co. v. Saiter, 37 Fed. Appx. 171, 2002 WL 1301574 (6th Cir. 2002)

 

Walker v. Wal-Mart Stores, Inc., 159 F.3d 938 (5th Cir. 1998)

 

Wellmark, Inc. v. Deguara, 257 F. Supp. 2d 1209 (S.D. Iowa 2003)         

Westaff (USA) Inc. v. Arce, 298 F.3d 1164 (9th Cir. 2002)

 

Wausau Benefits v. Progressive Ins. Co.,, No. CIV.A. 2:02-CV-107, 2003 WL 21648693(S.D. Ohio July 9, 2003)

         

         

 

State Cases:

 

Bishop v. Burgard, 764 N.E.2d 24 (Ill. App. Ct. 2002)

 

Brodzik v. Szpakowicz, No. CV000500564S, 2002 WL 31502353 (Conn. Super. Ct. Oct. 22, 2002)

Palmerton v. Associates' Health & Welfare Plan, 659 N.W.2d 183 (Wis. Ct. App. 2003)

                   

Uber v. TIG Specialty Ins. Co., No. 232687, 2003 WL 231321 (Mich. Ct. App. Jan. 31, 2003)

 

Yerby v. United Healthcare Ins. Co., 846 So. 2d 179 (Miss. Ct. App. 2003)         

 

Federal Statutes and Rules:

 

Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C § 1001, et seq.:

 

Section 404(a)(1)(D), 29 U.S.C. § 1104(a)(1)(D)       

 

Section 502, 29 U.S.C. § 1132 

 

Section 502(a)(3), 29 U.S.C. § 1132(a)(3)passim

 

Section 502(a)(3)(ii), 29 U.S.C. § 1132(a)(3)(ii)       

 

Section 505, 29 U.S.C. § 1135 

 

Section 514(b)(2)(A), 29 U.S.C. § 1144(b)(2)(A)     

 

Other Authorities:

 

1 Dobbs Law of Remedies § 4.3(2), at 589 (2d ed. 1993)

 

Scott on Trusts § 462 (4th ed. 2001)

 

Scott on Trusts § 462.2 (4th ed. 2001)10

 

4 J. Pomeroy, Equity Jurisprudence § 1053 (5th ed. 1941)10

         

STATEMENT OF THE ISSUES

1.  Whether, pursuant to a subrogation/reimbursement provision in the Bombardier Employee Welfare Benefit Plan (the Plan), the district court properly imposed a constructive trust over funds obtained in the settlement of a third-party tort claim, which currently are held in the trust account of the plan participant's attorney.

2.  Whether the district court properly enforced Plan terms that make Plan participants liable for all attorney fees incurred in pursuing third-party recoveries, and thus disallowed a setoff for these fees from the amount recoverable by the Plan.

INTEREST OF THE SECRETARY OF LABOR

The Secretary of the United States Department of Labor (the "Secretary") has primary authority to interpret and enforce the provisions of Title I of ERISA and therefore has a strong interest in ensuring that the fiduciary duties of loyalty and prudence in the administration of plan assets are strictly applied.  29 U.S.C. §§ 1132, 1135.  See Donovan v. Cunningham, 716 F.2d 1455, 1462-63 (5th Cir. 1983).  The Secretary's interests further include promoting the uniform application of the Act, protecting plan participants and beneficiaries, and ensuring the financial stability of plan assets.  Secretary of Labor v. Fitzsimmons, 805 F.2d 682 (7th Cir. 1986) (en banc).  The ability of welfare plans to seek reimbursement of benefits from injured plan participants who have recovered funds to compensate them for injuries from third parties is important to the continued financial stability of these plans, and so long as this is accomplished through the imposition of constructive trusts over specifically identifiable funds, the Secretary believes that it constitutes "appropriate equitable relief" under Section 502(a)(3) of ERISA, 29 U.S.C. § 1132(a)(3).

STATEMENT OF THE CASE

          Appellant Stephen Mestemacher was an employee of Bombardier Aerospace, and as such was a participant in the Bombardier Aerospace Employee Welfare Plan ("Bombardier" or the "Plan"), a self-funded employee welfare plan designed to provide managed care and medical services for Bombardier Aerospace employees and their dependents.  Bombardier Aerospace Employee Welfare Benefits Plan v. Ferrer, Poirot & Wansbrough, PC, No. Civ. A. 3:02-CV-1982, 2003 WL 282443, at *1 (N.D. Tex. Feb. 4, 2003).  After Mestemacher was injured in an automobile accident in January 2002, Bombardier paid his medical bills totaling $13,643.63.  Id.  In March 2002, Mestemacher settled his tort claim against the third party responsible for the accident for $65,000.  Id. at *2.  Appellant Ferrer, Poirot, & Wansbrough, PC ("Ferrer") acted as Mestemacher's attorneys in the tort action.  Id.  Through an agreed order, Ferrer consented to hold $18,500 of the settlement monies in a trust account deposited in a Bank of America account, pending resolution of Bombardier's claim.  Id.  Bombardier then filed suit in federal court in the Northern District of Texas against Mestemacher, Ferrer and Bank of America, seeking the imposition of a constructive trust over the settlement funds held in Ferrer's trust account.  Id. at *3.

Bombardier claims a right to be reimbursed for the $13,643.63 in benefits it had advanced to Mestemacher under the Plan, and seeks injunctive and declaratory relief to enforce that right, asserting that Mestemacher as the principal, and Ferrer as his agent, possess and control the funds.  2003 WL 282443, at *3.  At the time of the accident, the Plan provided not only for a right to be reimbursed 100% of the plan's expenditures out of a plan participant or beneficiary's recovery in a third-party tort action, but also provided that plan participants are required to cooperate in seeking such tort recoveries and that any associated attorney fees are the sole responsibility of the participant.[1]

 

On February 4, 2003, the District Court granted Bombardier's motion for summary judgment and ordered Ferrer to transfer $13,643.63 from the trust account to Bombardier, without any setoff for attorneys' fees or expenses.  The court reasoned that the Plan's "clear and unambiguous reimbursement provisions . . . combined with the fact that the Plan is not seeking personal liability from Mestemacher and that the settlement funds are not . . . in the registry of the court, entitle the Plan to the imposition of a constructive trust."  2003 WL 282443, at *4.  Additionally, the court relied on the Plan's express provision making attorney fees the responsibility of Mestemacher and not the Plan.  Id.  The judgment has been executed and the disputed funds have been turned over to Bombardier.

SUMMARY OF ARGUMENT

Building on its prior decision in Mertens v. Hewitt Assocs., 508 U.S. 248, 256 (1993), the Supreme Court held in Great-West Life & Annuity Ins. Co. v. Knudson,  534 U.S. 204, 214 (2002), that for an action for restitution to lie in equity within the meaning of ERISA Section 502(a)(3),  29 U.S.C. 1132(a)(3), it must seek to restore to the plaintiff specifically identifiable funds or property in the defendant's possession that belong in good conscience to the plaintiff.

  Bombardier's claim against Mestemacher and Ferrer for reimbursement under the terms of the Plan of the amount of medical benefits it paid on account of Mestemacher's injuries from funds recovered by Mestemacher in a tort action fits comfortably within this common law construct.  Because, under the Plan language, Mestemacher agreed when he accepted benefits under the Plan to reimburse the Plan out of any third-party recoveries,  the disputed amount "belong[s] in good conscience" to Bombardier.  Moreover, because the funds were specially held in Mestemacher's attorney's trust account pending resolution of Bombardier's claim, the amount sought by Bombardier under the Plan's reimbursement provision can "clearly be traced to particular funds or property in the defendant's possession."  Great-West, 534 U.S. at 213.  No more is required for equitable restitution to lie under Great-West, and the Ninth Circuit decisional law to the contrary is based on a misreading of Great-West and Mertens.

Nor is Mestemacher entitled under the "common fund" doctrine to a setoff for the amount he spent on attorney fees in obtaining the third-party recovery, given the clear Plan language making him solely responsible for the payment of those fees.  Indeed, this Court has held that the common fund doctrine is inapplicable even in the absence of such a clear Plan provision.  Great-West, which did not involve any attorney fee provision, is not to the contrary.  Thus, as most courts have held, at least where the language of the plan is clear, courts have no occasion to apply a setoff for attorney fees under a common fund doctrine.     

ARGUMENT

I.       The Imposition of a Constructive Trust Over Specifically Identifiable Funds in an Attorney's Trust Account Constitutes Appropriate Equitable Relief Under ERISA Section 502(a)(3)

 

Section 502(a)(3) of ERISA authorizes a civil action "by a . . . fiduciary (A) to enjoin any act or practice which violates . . . 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 title or the terms of the plan."  29 U.S.C. § 1132(a)(3).  In Great-West, the Supreme Court held that "appropriate equitable relief" under ERISA Section 502(a)(3) refers to "'those categories of relief that were typically available in equity.'"  534 U.S. at 210 (quoting Mertens, 508 U.S. at 256).  "[F]or restitution to lie in equity," the Court explained, "the action generally must seek not to impose personal liability on the defendant, but to restore to the plaintiff particular funds or property in the defendant's possession."  Great-West, 534 U.S. at 214. 

In Great-West, Great-West sought restitution of $411,157 in medical expenses it had paid on behalf of beneficiary Janette Knudson after Knudson secured a $650,000 settlement from the third parties responsible for her injuries.  The settlement allocated $256,745.30 to a Special Needs Trust to provide for Knudson's long-term medical care, $373,426 to attorney fees and costs, $5000 to reimburse the California Medicaid Program, and $13,828.70 to reimburse Great-West.  The state court approved the settlement and ordered the third parties to pay the amount allocated to the Special Needs Trust directly to the trust.  Knudson's attorney sent Great-West a check for $13,828.70, but Great-West refused to cash it.  Instead, Great-West sued Knudson in federal district court seeking full reimbursement of the $411,157 it had paid on her behalf.  The Supreme Court held that Great-West's suit was not authorized by ERISA Section 502(a)(3).  Great-West, 534 U.S. at 218.  The Court observed that the money from the settlement was not in Knudson's possession; it had been dispersed to the Special Needs Trust and her attorney to pay for attorney fees.  Id. at 214.  The Court found that Great-West, therefore, was not trying to recover particular funds that belonged to Great-West that happened to be in Knudson's possession, but rather was trying to impose personal liability upon Knudson for any funds equal to the benefits it had advanced to her.  Id.  The Court concluded that Great-West sought legal restitution not authorized by ERISA.  Id. at 218.

Great-West, however, does not foreclose the ability of plans to seek equitable restitution.  Rather, the Court in Great-West specified:

[A] plaintiff could seek restitution in equity, ordinarily in the form of a constructive trust or an equitable lien, where money or property identified as belonging in good conscience to the plaintiff could clearly be traced to particular funds or property in the defendant's possession. . . . A court of equity could then order a defendant to transfer title (in the case of a constructive trust) or to give a security interest (in the case of the equitable lien) to a plaintiff who was, in the eyes of equity, the true owner. 

 

Id. at 213 (internal citations omitted).  Moreover, the Court expressly left open the question whether Great-West could have obtained equitable relief against Knudson's attorney or the trustee of the Special Needs Trust.  Id. at 220.

The Plan here seeks to enforce the subrogation provision, or in statutory terms, "to enforce . . . the terms of the plan."  29 U.S.C. 1132(a)(3)(ii).[2]  The District Court's imposition of a constructive trust to accomplish this result fits within the bounds of equitable relief recognized by the Supreme Court in Great-West.  The $13,643.63 in dispute "belong[s] in good conscience," 534 U.S. at 213, to Bombardier because Mestemacher agreed to reimburse the Plan out of any third-party recoveries when he accepted benefits under the Plan.[3] Unlike the money in Great-West, the money in this case can "clearly be traced to particular funds or property in the defendant's possession" because the funds were specially held in Mestemacher's attorney's trust account pending resolution of Bombardier's claim.  Either defendant Ferrer had possession of the funds as the trustee of the account, or Mestemacher had possession of the funds as the principal who could authorize Ferrer to release the funds to Bombardier.  Thus, the District Court properly imposed a constructive trust over the $13,643.63 and transferred title to Bombardier as an equitable remedy under ERISA Section 502(a)(3).

A majority of courts presented with ERISA subrogation/reimbursement claims after the Great-West decision have concluded that Great-West permits the imposition of a constructive trust over specifically identifiable funds in the defendant's possession.[4]  Most recently, the Seventh Circuit affirmed the district court's imposition of a constructive trust over settlement funds placed in a separate "reserve account" in anticipation of litigation over the Plan's reimbursement rights.  Admin. Comm. of the Wal-Mart Stores, Inc. v. Varco, 338 F.3d 680, 687 (7th Cir. 2003).  The Seventh Circuit noted that "[u]nlike the legal action addressed in Great-West Life, the funds at issue here are identifiable, have not been dissipated, and are still in the control of a Plan participant due to the fact that [the participant's attorney] placed them in a reserve account in [the participant's] name when they were disbursed."  Id.  Constructive trusts have also been imposed in Forsling v. J.J. Keller & Assocs., Inc., 241 F. Supp. 2d 915 (E.D. Wis. 2003); Allison v. Wellmark, Inc., No. C00-3015-MWB, 2002 WL 31818946 (N.D. Iowa Oct. 15, 2002); IBEW-NECA Southwestern Health & Benefit Fund v. Douthitt, 211 F. Supp. 2d 812 (N.D. Tex. 2002); and Bauer v. Glyten, Nos. A3-00-161, A3-02-27, 2002 WL 664034 (D.N.D. Apr. 22, 2002) (permitting plaintiffs to amend their original complaint to include a request for the imposition of a constructive trust, pursuant to the Supreme Court's recent decision in Great-West).

Other courts, although not imposing a constructive trust, have also held that ERISA plan fiduciaries state a valid claim for equitable reimbursement when the disputed monies can clearly be traced to particular funds or property in the defendant's possession.  The D.C. District Court held that a recovery agent's claim for restitution constitutes a claim for equitable relief when a portion of the settlement funds are being held in trust by the beneficiary's former attorney "for the precise purpose of reimbursing the Plan."  Primax Recoveries, Inc. v. Lee, 260 F. Supp. 2d 43, 48 (D.D.C. 2003).  Likewise, the District Court for the Southern District of Iowa held that an insurer properly states a claim for equitable restitution where the settlement funds are being held in an attorney's trust account.  Wellmark, Inc. v. Deguara, 257 F. Supp. 2d 1209, 1216 (S.D. Iowa 2003) ("This Court finds the possession theory is the correct read of Great-West.  That is, attempts by an ERISA plan or insurer to recover settlement proceeds to which it is entitled under a subrogation or reimbursement provision are only prohibited under § 502(a)(3) if the insured is not in the possession of clearly identifiable proceeds.").  Other courts have supported ERISA plans' rights to reimbursement by permitting a plan to add the trustee of a beneficiary's revocable living trust as a defendant so that the plan can state a valid claim for equitable restitution under Great-West, Corporate Benefit Servs. of Am., Inc. v. Sempf, No. 03-C-0048-C, 2003 WL 21704145 (W.D. Wis. May 9, 2003); and by issuing a preliminary injunction to enjoin a beneficiary from disposing of settlement funds against which an ERISA plan has asserted a right of recovery, Great-West Life & Annuity Ins. Co. v. Perkins, No. C:02-5294-FDB, 2002 WL 1816438 (W.D. Wash. July 9, 2002).

Nearly all of the cases in which an ERISA plan's claim for reimbursement were denied involved monies which could not clearly be traced to particular funds in the defendant's possession, and can thus be distinguished from the present case.  In some cases, the funds were no longer clearly identifiable because they had been disbursed and dissipated.  See Mank v. Green, No. 03-42-P-C, 2003 WL 21250676 (D. Me. May 30, 2003); Asbestos Workers Local No. 42 Welfare Fund v. Brewster, 227 F. Supp. 2d 226 (D. Del. 2002).  In other cases, the funds were not yet in the defendant's possession because the beneficiary had not yet settled or won the suit against the third party tortfeasor.  See Primax Recoveries, Inc. v. Goss, 240 F. Supp. 2d 800 (N.D. Ill. 2002); Extendicare v. Crow, No. Civ.A. 1:02-CV-109-C, 2002 WL 32079263 (N.D. Tex. Oct. 23, 2002); Primax Recoveries, Inc. v. Carey, 247 F. Supp. 2d 337 (S.D.N.Y. 2002) ("[A] constructive trust [is] an inappropriate remedy . . . when the 'settlement proceeds' are in nobody's possession, because they are the entirely hypothetical fruit of a potential future settlement that does not yet exist and may never come into being at all.").[5]

This Court's decision in Bauhaus USA, Inc. v. Copeland, 292 F.3d 439 (5th Cir. 2002) stands in the same camp.  In Bauhaus, this Court held that the recovery there sought was not equitable because the disputed funds were not in the defendant participant's possession or control because the settlement proceeds had been placed into the registry of the Mississippi Chancery Court.  Id. at 445.  Like Great-West, the decision in Bauhaus implies that where, as here, the defendants do have possession and/or control over funds that in good conscience are owed to the Plan, a cause of action for equitable restitution lies.  See Bombardier, 2003 WL 282443, at *4 (reading Bauhaus to allow a claim for equitable restitution where the defendant has possession of the disputed funds); IBEW-NECA Southwestern Health & Benefit Fund, 211 F. Supp. 2d at 816 (same).  

Only the Ninth Circuit has held that any attempt by an ERISA plan to seek reimbursement/subrogation under the terms of the plan constitutes a legal claim that is not authorized by ERISA Section 502(a)(3).  See Wellmark v. Deguara, 257 F. Supp. 2d at 1215 (criticizing the Ninth Circuit's approach).  The Ninth Circuit has denied recovery even in cases where the funds sought by the ERISA plan could clearly be traced to particular funds or property in the defendant's possession.  Great-West Life & Annuity Ins. Co. v. Berlin, 45 Fed. Appx. 750, 2002WL 2017076 (9th Cir. 2002) ("The fact the funds sought by Great-West have been placed in a trust account and are specifically identifiable does not transform its action into one of equitable relief."); Westaff (USA) Inc. v. Arce, 298 F.3d 1164, 1167 (9th Cir. 2002) ("The escrow account was set up through an agreement with the beneficiary to make it easier for Westaff to obtain the funds in the event it is determined to be entitled to them. The beneficiary's cooperation should not now be used as a weapon by the insurance company to force the beneficiary into a lawsuit in federal court that Congress, in enacting ERISA, intended to bar.").[6] 

These Ninth Circuit decisions are inconsistent with the rule established in Great-West that "appropriate equitable relief" under ERISA refers to "'those categories of relief that were typically available in equity,'" 534 U.S. at 210 (emphasis in original).  Even more obviously, they are inconsistent with the Court's recognition in Great-West that "a plaintiff could seek restitution in equity, ordinarily in the form of a constructive trust or an equitable lien, where money or property identified as belonging in good conscience to the plaintiff could clearly be traced to particular funds or property in the defendant's possession," id. at 213 (emphasis in original).  In the words of the district court in Wellmark v. Deguara, "[t]he Ninth Circuit follows the ultimate reasoning of Great-West without noting the essential factual distinction Justice Scalia specifically discussed when the 'money or property identified as belonging in good conscience to the plaintiff could clearly be traced to particular funds or property in the defendant's possession.'  That factual distinction has importance that cannot be disregarded."  257 F. Supp. 2d at 1215-16.  We therefore urge this Court to heed the factual distinction drawn by Justice Scalia in Great-West, and to follow the majority of courts that have held that the imposition of a constructive trust over specifically identifiable funds in the defendant's possession is an appropriate equitable remedy under ERISA.      

II.                Plan Terms that Provide that Attorney Fees are the Sole Responsibility of the Participant Override the "Common Fund" Doctrine

 

          The "common fund" doctrine operates at common law to spread the costs of litigation among all those who benefit from a lawsuit.  See, e.g., Chambers v. NASCO, Inc., 501 U.S. 32, 45 (1991).   In the subrogation context, it accomplishes this cost-spreading by allowing a plan participant or beneficiary to offset the amount he spent on attorney fees in obtaining a third-party recovery from the amount the plan is entitled to recover.  See Palmerton v. Associates' Health & Welfare Plan, 659 N.W.2d 183, 188 (Wis. Ct. App. 2003) ("Normally, where an ERISA plan's only participation in a personal injury suit was to assert its subrogation claim . . . the plan has a common law obligation to pay its fair share of attorney fees and costs.") (citation omitted).  Whatever the applicability of this doctrine as a default rule of federal common law where a plan does not expressly address the issue, ERISA plan terms that expressly provide that participants are solely responsible for the attorney fees and costs they incur in pursuit of a third-party recovery override the common fund doctrine.

This Court has held that ERISA plans can recover the full amount of benefits paid on behalf of a beneficiary, without a setoff for the beneficiary's attorney fees, if the plan calls for reimbursement from "any and all" third party recoveries.  Walker v. Wal-Mart Stores, Inc., 159 F.3d 938, 940 (5th Cir. 1998).  In Walker, the Fifth Circuit ordered the beneficiary to reimburse the plan in full, even though the text of the plan did not specifically mention attorney fees or expenses.  Id.  Under this controlling precedent, there is no occasion for this Court to fashion and apply a federal common law rule allowing for a setoff of attorney fees.  In this case, however, the argument for full reimbursement is substantially stronger than in Walker, because the Bombardier Plan calls for reimbursement of "100% of the Benefits paid" and expressly provides that "Attorney fees and court costs are the responsibility of the participant, not the Plan."[7]  Indeed, ERISA expressly provides that plans must be administered "in accordance with the documents and instruments governing the plan."  29 U.S.C. § 1104(a)(1)(D).   

Appellants Ferrer and Mestemacher suggest that Great-West now requires lower courts to conduct a "balancing of the equities," and to reduce plans' recovery by a fair share of the attorney fees and costs incurred by a beneficiary in the pursuit of a third party recovery.  Brief of Appellants, 28.  Great-West, however, did not address the issue of attorney fees.  Even after Great-West, courts have continued to refuse to apply the common fund doctrine in cases where the terms of the plan clearly provide for full reimbursement without a setoff for participants' attorneys' fees.  Most recently, the Seventh Circuit refused to apply state or federal common fund doctrine to reduce a plan's recovery where the terms of the plan expressly provided that participants were responsible for all attorney fees.  Varco, 338 F.3d at 688-92.[8]  The court found that the state common fund doctrine was preempted by ERISA, since it "contradicts the terms of the Plan and therefore contravenes ERISA's requirements that plans be administered, and benefits be paid, in accordance with plan documents."  Id. at 690.  The court further found that the federal common fund doctrine should not be applied because it is generally "inappropriate to fashion a common law rule that would override the express terms of a private plan."  Id. at 692.  Varco confirmed similar, earlier decisions by district courts in the Seventh Circuit.  See Admin. Comm. of the Wal-Mart Stores, Inc. v. Hummel, 245 F. Supp. 2d 908, 912 (N.D. Ill. 2003) ("There is too much support for the proposition that state law cannot void explicit and lawful provisions in ERISA plans."); Forsling v. J.J. Keller & Assocs., 241 F. Supp. 2d at 921.  See also Wausau Benefits v. Progressive Ins. Co., No. CIV.A. 2:02-CV-107, 2003 WL 21648693 (S.D. Ohio July 9, 2003) (rejecting a common fund defense and distinguishing the Sixth Circuit's application of the common fund doctrine in its unpublished decision in Smith v. Wal-Mart Assocs. Group Health Plan, No. 99-6464, 2000 WL 1909387 (6th Cir. Dec. 27, 2000) on the grounds that the plan in the earlier case did not specifically prohibit the equitable allocation of attorney fees); Yerby v. United Healthcare Ins. Co., 846 So. 2d at 190; Palmerton v. Associates' Health &Welfare Plan, 659 N.W.2d at 188.     

Consistent with these cases, once a court has determined that an ERISA plan has stated a valid claim for equitable reimbursement under Great-West, the court should first look to the terms of the plan to determine the amount that "belong[s] in good conscience" to the plan.  If the terms of the plan expressly provide for full reimbursement from third-party recoveries and disclaim responsibility for attorney fees and costs incurred in the pursuit of those recoveries, the terms of the plan should override any "common fund" doctrine that may otherwise be available at state or federal common law.  See Guidry v. Sheet Metal Workers' Nat'l Pension Fund, 493 U.S. 365, 376 (1990) ("courts should be loath to announce equitable exceptions to legislative requirements or prohibitions that are unqualified by the statutory text"). [9]

 

 

CONCLUSION

The decision of the district court should be affirmed.

                             Respectfully submitted,

                                                HOWARD M. RADZELY

                                       Acting Solicitor of Labor

 

                                                TIMOTHY D. HAUSER

                                                Associate Solicitor

 

                             ELIZABETH HOPKINS

                                          Counsel for Appellate and

                             Special Litigation

 

                             U.S. Department of Labor

                             Office of the Solicitor

                             Plan Benefits Security Division

                             200 Constitution Avenue, N.W.

                             Room N-4611

                             Washington, D.C.  20210

                             (202) 693-5600

CERTIFICATE OF SERVICE

 

          I hereby certify that a paper copy of the Brief of Amicus Curiae Elaine L. Chao, Secretary of the United States Department of Labor and a 3½ diskette containing a PDF version of brief, as well as a copy of the Secretary's motion to accept the brief out of time, were sent to counsel listed below by Federal Express overnight courier service, this 11th day of September 2003:

 

JOHN T. KIRTLEY

              Ferrer, Poirot & Wansbrough

                  2603 Oak Lawn Ave., Suite 300

                                                  Dallas, TX 75219

                  

                                                  NEAL MANNE, SUSAN GODFREY, LLP

                                                  1000 Louisiana

                                                  Suite 5100

                                                  Houston, TX 77002

 

                                                  WILLIAM P. HUTTENBACH

                                                  MICHAEL D. CONNER

                                                  Hirsch & Westheimer, P.C.

                                                  700 Louisiana, 25th Floor

                                                  Houston, TX 77002-2728

 

                                                  DANIEL W. JACKSON

                                                  Emmons & Jackson, P.C.

                                                  3000 Essex Lane, Suite 1116

                                                  Houston, TX 77002

 

 

 

 

                                                _

                                                ELIZABETH HOPKINS