Opinion
Case No. 1:05-CV-02954.
March 5, 2007
MEMORANDUM AND ORDER
Before the court are cross-motions for summary judgment by plaintiff Trustees of the Pipe Fitters Local Union No. 120 Insurance Fund (the "Trustees") [Docket No. 13] and defendant AIG Life Insurance Company ("AIG") [Docket No. 11]. For the following reasons, the court grants the Trustees' motion, denies AIG's motion, and enters judgment in favor of the Trustees.
I. Background
William Reading ("William") is a member of the Pipe Fitters Local Union No. 120. His son, Joffre Reading ("Joffre"), was injured while playing hockey as a registered team member at a game sponsored by USA Hockey, Inc. ("USA Hockey") on December 26, 2000. William is a participant in his union's insurance fund, which is managed by the Trustees. The union's insurance fund (the "Fund") is an employee benefit plan within the meaning of the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. §§ 1002(1), (3), (37), and provides coverage for Joffre as William's dependent. However, Joffre is directly covered under the insurance policy issued to USA Hockey by AIG. The policy issued by AIG quite clearly covers all participants in USA Hockey, "including USA Ice Hockey registered team members." Joint Stipulation ("J.S."), Ex. A, at Master Application for Blanket Accident Insurance Policy, ¶ 2 [Docket No. 14]. Therefore, Joffre Reading was an "insured" under AIG's insurance policy and was covered directly for the hockey injury loss.
Following his injury, Joffre incurred medical expenses totaling $10,903.74, which were submitted to and paid by the Fund. The Fund's coordination of benefits ("COB") clause, however, specifies the order of priority between the Fund and other insurers regarding which insurer is to pay first. The Fund's COB clause provides that the insurance policy covering the patient — in this case, Joffre — directly, is primary, rather than the Fund, which covers Joffre as William's dependent. Pl.'s Mot. for Summ. J., Ex. F, at X-1 [Docket No. 13]. AIG, in its motion for summary judgment, concedes that it is subject to the Fund's COB clause as a "Plan". However, AIG refused to pay Joffre's medical expenses as the primary insurer, and the Trustees brought the instant action under the ERISA, 29 U.S.C. § 1132.
II. Discussion
Under Rule 56(c), summary judgment is appropriate "if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(c). The moving party bears the initial burden of demonstrating the absence of a genuine issue of material fact. See Celotex Corp. v. Catrett, 477 U.S. 317, 323-25 (1986); Hedrick v. W. Reserve Care Sys., 355 F.3d 444, 451 (6th Cir. 2004).
If the movant succeeds, the burden then shifts to the nonmoving party to demonstrate the existence of a material dispute as provided in Rule 56(e):
[a]n adverse party may not rest upon the mere allegations or denials of the adverse party's pleading, but the adverse party's response, by affidavits or as otherwise provided in this rule, must set forth specific facts showing that there is a genuine issue for trial. If the adverse party does not so respond, summary judgment, if appropriate, shall be entered against the adverse party.
Fed.R.Civ.P. 56(e); see also Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 250 (1986). Parties opposing summary judgment must go beyond the pleadings and produce some type of evidentiary material in support of their position. See Celotex, 477 U.S. at 324.
In determining whether a genuine issue of material fact exists, this Court must view the evidence in a light most favorable to the nonmoving party. See Adickes v. S.H. Kress Co., 398 U.S. 144, 157 (1970); Hamby v. Neel, 368 F.3d 549, 556 (6th Cir. 2004); Williams v. Int'l Paper Co., 227 F.3d 706, 710 (6th Cir. 2000). A fact is "material" only if its resolution will affect the outcome of the lawsuit. Anderson, 477 U.S. at 248. Determination of whether an issue is "genuine" requires consideration of the applicable evidentiary standards. Thus, in most civil cases, the Court must decide whether the evidence is such that "reasonable jurors could find by a preponderance of the evidence that the [nonmoving party] is entitled to a verdict" or whether the evidence is "so one-sided that [the moving party] must prevail as a matter of law." Id. at 252. Rule 56(c) "mandates the entry of summary judgment, after adequate time for discovery and upon motion, 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." Celotex, 477 U.S. at 322.
In this case, the Fund's COB clause clearly requires that AIG, which insures Joffre directly as a USA Hockey participant, be the primary insurer, and that the Fund be the secondary insurer because it insures Joffre as a dependent of William, not directly. AIG argues that the COB clause in its policy requires that the Fund assume primary status and AIG's policy secondary status. However, assuming that the COB clause in AIG's policy conflicts with the arrangement mandated by the Fund's COB clause, binding Sixth Circuit precedent holds that where a conflict over coordination of benefits exists between a normal insurance policy and an ERISA plan, federal law requires the ERISA policy to be secondary. Auto Owners Ins. Co. v. Thorn Apple Valley, Inc., 31 F.3d 371, 374 (6th Cir. 1994). Therefore, the court finds that under the Fund's COB clause, AIG has primary responsibility for the medical expenses incurred by Joffre as a result of his injuries while playing hockey at the USA Hockey-sponsored game, and that AIG must pay the Fund for those expenses.
III. Conclusion
For the foregoing reasons, the court grants the Trustess' motion for summary judgment [Docket No. 13], denies AIG's motion for summary judgment [Docket No. 11] and enters judgment in favor of the Trustees on its claim for relief. AIG is ordered to pay Joffre Reading's medical expenses of $10,903.74.
This order is final and appealable.
IT IS SO ORDERED.