In late 2008, Robert Montanile was involved in a car accident where he was severely injured due to a drunk driver. Due to this, he had medical expenses, amounting to about 121,000 that was evidently covered by the elevator industry’s benefit plan (an ERISA plan) to which he belonged. On the side, he also hired a personal-injury attorney to sue the driver who injured him. The lawyer ended up recovering a settlement of $500,000 for which $200,000 of it went the attorney fee and another $64,000 was used for other expenses, leaving him with an estimated $236,000. After this heaping recovery, the insurance plan asked him to reimburse the money it paid for his medical expenses . Montanile, who was tight on money because of his injury and lawsuit contracted an ERISA lawyer who told the elevator benefit plan that its agreement with Montanile didn’t entitle it to get money back.
However, the benefit plan shot back and said that Montanile had signed an agreement promising to pay back his medical expenses “in full…to the extent of his recovery” if he won his lawsuit against the driver. At odds, the benefit plan sued Montanile for the money. While in the middle of the lawsuit, the original personal injury lawyer disbursed the settlement money to Montanile, who spent the whole sum.
So What Happens Now?
The Employee Retirement Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established pension protections for individuals in these plans. ERISA requires plans to provide participants with plan information including important information about plan features and funding, provides fiduciary responsibilities for those who manage and control plan assets; requires plans to establish a grievance and appeals process for participants to get benefits from their plans; and gives participants the right to sue for benefits and breaches of fiduciary duty .
This act creates an issue for the insurance plan because ERISA provides a detailed set of remedies for ERISA plans and generally preempts all other remedies. This means that the plan can’t recover unless the remedy it seeks is included in the ERISA list. To that extent, the Court has held in earlier cases that ERISA provides “equitable remedies but not legal remedies”. Equitable claims are certain claims that ask the court for an injunction. An injunction is a court order compelling a party to do or refrain from doing a specified act .
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Furthermore, a court awards an injunction to prevent a future harmful action, rather than to compensate for a past injury, or to provide relief from harm for which an award of money damages is not a satisfactory solution for which a monetary value is impossible to calculate. In comparison, in a legal claim, a plaintiff explains to the court how the defendant’s actions cause him or her to suffer a loss. That loss could have occurred in the past, or it may occur in the future. The eventual goal of a legal claim is for the defendant to compensate the plaintiff and to pay damages in relief.
At issue in this lawsuit between Montanile and the benefit plan is whether, under ERISA, a lawsuit by an ERISA fiduciary against a participant to recover an alleged overpayment by the plan seeks “equitable relief” within the meaning of ERISA Section 502 (a)(3), 29 U.S.C. § 1132(a)(3), if the fiduciary (a person who holds a legal or ethical relationship of trust with one or more parties) has not identified a particular fund that is in the participant’s possession and control at the time the fiduciary assets its claim .
Before the Supreme Court
The trial court held that the terms of the plan required Montanile to repay the initial $120,000, and that this repayment was appropriate equitable relief in part because the plan was able to identify a source of funds within the participant’s possession—the $500,000 settlement. Montanile appealed and claimed that they repayment would not be equitable relief because the settlement had been spent or disbursed to other parties. The U.S. Court of Appeals for the Eleventh Circuit held that, since the plan had a right to repayment, the plan’s lien against Montanile’s $500,000 settlement attached before Montanile spent or disbursed the funds. Thus, Montanile cannot avoid the reimbursement by claiming the settlement funds had been spend . However, if the identified source of the reimbursement has already been spent, is a reimbursement to the benefit plan “appropriate equitable relief” ?
Now at the Supreme Court, Montanile’s lawyer tried to answer that question relying on a precedent from 2002 that clearly restates the classic ERISA doctrine: You can’t get equitable relief if you’re after “some funds” instead of “particular funds.” This is the answer that the justices need to examine to see if it falls under an equitable definition.
Whatever the justices decide will have an impact on personal injury law. If the plan loses, other personal injury lawyers may get the idea to find ways to pay off their clients before insurers seek reimbursements. If the justices hold it against Montanile, it would empower the lower court judges to make up definitions on their own .
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In the end, the justices have a tough decision based on the interpretation of “appropriate equitable relief”. Due to the fact that Montanile’s lawyer disbursed the funds while also in a legal battle with the insurance plan, it could also be seen as the fault of the attorney. Either way, this is a problem that you would never experience with Dolman lawyers.
At Dolman Law Group Accident Injury Lawyers, PA, the client will experience the Dolman Law Difference — the commitment to personal service and accessibility. All injury claims are handled by one of our lawyers, every client will get the personal cell phone number and email of the attorney handling their case, legal work is only produced and processed by members of the Florida Bar, we only focus on both injury and insurance related claims — never representing an insurance company. We hold our standards very high and we hope that you consider our experienced and personable attorneys for representation. Call (727) 451-6900 today.
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