WPC, # VUNa % 0 N 0 b w@ 4 , ;   0DN m 0J 0T@ 0^ 0h 0rZ 0| 0H 0 1u^ 0d B7 D3TU> 0@B)DC. AMqU*-1F1 v~%#v$ AOv** 0D+ D/+ B+HP LaserJet 4Si/4SiMX PS 600dpiPSCRIPT0nLH'"  Z 6Times New Roman Regular(&y$   (}(2r$ y!     X3X `   0  - - [\]D^eUfUgehiӀsD 452(Supp.13|xsERISAMcClendon InsMonsantoBruchHaleyIntl FlamN.W.2dWhitworth2d 6thEmeeAssn 13thPacard 11th 1strevd Luby 3rdComeau KanMertensHewittAssocsNatl 8thGarredTraynorKunin3d 7thSocyWaynesboroSerembusMathwigIndemCorbinFortecKrachtAALFSH.C.P.PratherCocke 5th Dix 4thWilkinsonQuinnKeetonWidissN.E.2d CasHigginbotham L.J.tortfeasor ppsMcInnisMcIntoshS.E.2dAetnaWestendorfStassonProsserElectro OganD.N.H. 92CMcDONOUGHCAPERTONwood v. prosser - opinion   ' IB011C20IB011C2 .   (#$  0   U 2 0Indent123  2" 0Indent20 23  2, 0Indent30 0 23  26 0Indent40 0 0 23  2@ 0Indent50 0 0 0 23  2J 0Indent60 0 0 0 0 23  2T 0Indent70 0 0 0 0 0 23  2^ 0Indent80 0 0 0 0 0 0 23   ! ?AGMSYaioIndent0I.A.1.a.(1)(a)i)a)P 8Mac DefaultMac Default ` X d$$$$'dxd<  9p`(&Times New Roman("$    % Line 7 d....7Border 1dd-/C << G<  9p`(Arial # !  #d#,,   11   YYY FILED1XJune11,1997CecilW.CrowsonAppellateCourtClerk   ' !#d#,,   $    ,X       _Thetrialcourtapproveddisbursingtheremainingsettlementproceedsasfollows:$7,268.10toMr.WoodsparentstoreimbursethemfortheexpensesofMr.Woodsfuneral;$11,151.16tothelawyerrepresentingMr.Woodsparents,and$15,034.24tobeheldbythetrialcourtclerkforMr.Woodsson.  !#d#,,   $    ,X       _TheEmploymentRetirementSecurityAct( _ERISA_)iscodifiedat29U.S.C.A.1001through1461(1985&Supp.1997).  !#d#,,   $    ,X       _Initsmostbasicform,_subrogation_ԀmeansthatPartyAissubstitutedforPartyBandmayassertthepresubstitutionrightsPartyBhadagainstPartyCdirectlyagainstPartyC. { !#d#,,   $    ,X       _Reimbursement,initsmostbasicform,permitsPartyAtorecoverfromPartyBpaymentstoPartyCthatPartyAmadeonPartyBsbehalf.  !#d#,,   $    ,X       _Mr.WoodsparentshavenotassertedthetypicaldefensestoMcDonoughCapertonsclaimsforreimbursement__.TheyhaveneitherclaimednorprovedthattheirsettlementwithMr.Prosserdidnotincludethemedicalexpensesstemmingfromtheaccidentorthatthesettlementdidnotfullycompensatethemormakethemwhole.TheyhavelikewisenotattemptedtoargueorprovethattheycouldnothavepursuedaclaimforbenefitsunderthePrincipalFinancialGroupplan.PtPtHH(FG(HH(d'hStyl{WP}01  HH  2$HH  Geneva  <Px443!#4$*$$*$ KK  Geneva  Geneva .,6 Geneva   h HD: Geneva  h HD: Geneva -C<< CLevel 1Level 2Level 3Level 4Level 5($$   1  ' dxdP Pd ! . ,,   _        \RA'\  \RA'\7dd7    ћ ̀@ , INTHECOURTOFAPPEALSOFTENNESSEE@ MIDDLESECTIONATNASHVILLE,̜ R02/A1-j|$`  `@RߛHARRYJ.WOOD,JR.and  )CATHERINED.WOOD,asnext )ofkinasAdministratorsofthe  )EstateofMarcJamesWood,  )deceased,andIndividually,  )      ) Plaintiffs/Appellees,  )      )      )VS.      ) DavidsonCircuit      ) No.92C2112      )MARCUSM.PROSSER,  ) AppealNo.      ) 01A019510CV00468 Defendant,    )      )_McDONOUGH_Ԁ_CAPERTON_  )INSURANCEADMINISTRATORS, )      ) _Intervenor_/Appellant.  )@ APPEALFROMTHECIRCUITCOURTFORDAVIDSONCOUNTY@ ATNASHVILLE,TENNESSEE@ THEHONORABLEMARIETTAM.SHIPLEY,JUDGEForthePlaintiffs/Appellees:   Forthe_Intervenor_/Appellant:DanielB._Eisenstein_    JohnD._Schwalb_Nashville,Tennessee    Brewer,Krause,Brooks&Mills       Nashville,Tennessee@ , REVERSEDANDREMANDED ,       WILLIAMC.KOCH,JR.,JUDGE,@ OPINION , Thisappealinvolvestherightofanemployeebenefitplantobereimbursedforitspaymentofthemedicalexpensesofoneofitsmemberswhowaskilledinanautomobilecollision.TheparentsofthedeceasedemployeefiledawrongfuldeathactionintheCircuitCourtforDavidsonCountyagainstthedriveroftheothervehicleinvolvedinthecollision.Theplanintervenedintheparentsactionseekingtorecoverthemedicalpaymentsithadmadeontheirsonsbehalf.Aftertheparentssettledthewrongfuldeathclaim,thetrialcourtheldthattheplanwasnotentitledtobereimbursedfromthesettlementproceeds.Theplanappealed.Wehavedeterminedthatthetrialcourterredandthattheplanhasacontractualrighttobereimbursedfromtheproceedsofthesettlementofthewrongfuldeathaction.@ I.  MarcJamesWoodwasseriouslyinjuredonMay12,1992whenthecarhewasdrivingcollidedheadonwithatruckbeingdrivenbyMarcusProsser.Mr.WoodwasrushedtotheemergencyroomatWilliamsonCountyMedicalCenterwherehediedlaterthatday.ThechargesforMr.Woodscareintheemergencyroomamountedto$11,546.50. Mr.Woodwascoveredbytwoinsurancepolicieswhenthecollisionoccurred.ThefirstwasaPrincipalFinancialGrouppolicypurchasedbyhisparentsin1984whenhegraduatedfromcollege.Thesecondwasagroupplanprovidedbyhisemployer,FoodLion,Inc.,wherehehadworkedsince1991.PrincipalFinancialGroupinitiallypaidforMr.Woodsmedicaltreatment.WhenFoodLionsgroupplanlaterpaidforthesametreatment,theWilliamsonCountyMedicalCenterrefundedPrincipalFinancialGroupspayments. InAugust1992,Mr.WoodsparentsfiledawrongfuldeathactionintheCircuitCourtforDavidsonCountyagainstMr.Prosser.ThetrialcourtlaterpermittedMcDonough_Caperton_ԀInsuranceAdministrators( McDonough_Caperton_),theadministratorofFoodLionsgroupplan,tointerveneinthewrongfuldeathsuitinordertorecoverthe$11,546.50itpaidonMrWoodsbehalf.Mr.WoodsparentssettledtheirwrongfuldeathactionagainstMr.Prosserfor$45,000,andinAugust1993,thetrialcourtdirectedthat$11,546.50ofthesettlementproceedsbeheldbythecircuitcourtclerkpendingtheresolutionofMcDonough_Caperton_sasserted medicallien. 3   ׀ BothMcDonough_Caperton_ԀandMr.Woodsparentsfiledsummaryjudgmentmotions.McDonough_Caperton_ԀclaimedthatFoodLionsgroupplanhadacontractualrighttoreimbursementforthemedicalpaymentsmadeonMr.Woodsbehalf.Mr.WoodsparentsassertedthatMcDonough_Caperton_ԀwasnotentitledtothesettlementproceedsandthatitshouldseekreimbursementfromthePrincipalFinancialGroup.InanorderenteredonDecember30,1994,thetrialcourtfoundthatMcDonough_Caperton_Ԁwasnotentitledtothe$11,546.50beingheldbythetrialcourtclerkanddirectedMcDonough_Caperton_Ԁtobringsuitagainstanyotherparty whoMcDonough...believesmayoweitforthefundsitpaidtoWilliamsonMedicalCenterfortreatmentofMarcJamesWood.McDonough_Caperton_Ԁtooknoactionagainstanyotherparty,andonAugust15,1995,thetrialcourtdismisseditsinterveningcomplaintanddirectedtheclerktodisbursethe$11,546.50plusaccruedinteresttoMr.Woodsparents.Thisappealfollowed.@ II.  Thefactsofthiscaseareundisputed.Accordingly,thequestionpresentedbyMcDonough_Caperton_Ԁisoneoflaw.Wemustdeterminewhetheraselffundedemployeebenefitplanmayseekreimbursementfromanemployeesestateforitspaymentoftheemployeesmedicalexpenseswhenitwasnotrequiredtomakethesepayments.WehavedeterminedthatFoodLionsgroupplanisentitledtoaportionofthesettlementproceedsbecauseofaprovisionintheplanpermittingtheplantorecovermedicalbenefitspaidasaresultofinjuriesoccurringthroughtheactoromissionofanotherperson.@ A.  FoodLionsgroupplanisafullyselffundedemployeebenefitplangovernedbytheEmployeeRetirementSecurityAct._ 4   ׀ERISA_Ԁfederalizesthelawdealingwithcoveredselffundedemployeebenefitplansandexpresslypreempts anyandallStatelawsinsofarastheymaynoworhereafterrelatetoany[covered]employeebenefitplan.29U.S.C.A.1144(a)(1985).Thispreemptionprovisionis clearlyexpansive,NewYorkStateConferenceofBlueCrossandBlueShieldPlansv.TravelersIns.Co.,514U.S.645,___,115S.Ct.1671,1677(1995),and broadlyworded.IngersollRandCo.v._McClendon_,498U.S.133,138,111S.Ct.478,482(1990). Inordertodeterminewhetheraparticularstatelaw relatestoanemployeebenefitplan,thecourtsmustdeterminewhetherthelawhasaconnectionwithorreferstotheplanitself.CaliforniaDiv.ofLaborStandardsEnforcementv._Dillingham_ԀConstr.,N.A.Inc.,___U.S.___,___,117S.Ct.832,837(1997);DistrictofColumbiav.GreaterWashingtonBd.ofTrade,506U.S.125,129,113S.Ct.580,583(1992).Acauseofactionpremisedontheexistenceofacoveredplanordirectingthecourtsattentiontoacoveredplan relatestotheplanforpreemptionpurposes.CaliforniaDiv.ofLaborStandardsEnforcementv._Dillingham_ԀConstr.,N.A.,Inc.,___U.S.at___,117S.Ct.at83738;IngersollRandCo.v._McClendon_,498U.S.at140,111S.Ct.at483.Causesofactioninvolving_subrogation_Ԁorreimbursementrightsunderacoveredemployeebenefitplanarepremisedontheplanitselfand,therefore,aregovernedbyfederalcommonlawratherthanstatelaw._FMC_ԀCorp.v._Holliday_,498U.S.52,5861,111S.Ct.403,40709(1990);_Dugan_Ԁv._Nickla_,763F.Supp.981,983(N.D.Ill.1991);BlueCross/BlueShieldv._Flam_,509N.W.2d393,398(Minn.Ct.App.1993). Thebasicfederalcommonlawprinciplesrequiredtoresolvethisdisputearestraightforwardandarenotdissimilartofamiliarprinciplesofcontractconstruction.Anemployeebenefitplanisessentiallyacontract._Kemmerer_Ԁv._ICI_ԀAmericas,Inc.,70F.3d281,287(3dCir.1995);_Conley_Ԁv._Pitney_Ԁ_Bowes_,34F.3d714,717(8thCir.1994);Williamsv.CordisCorp.,30F.3d1429,1432(11thCir.1994);Landv.ChicagoTruckDrivers,Helpers&WarehouseWorkersUnion(Independent)HealthandWelfareFund,25F.3d509,514(7thCir.1994).Thus,adjudicatingrightsof_subrogation_Ԁorreimbursementarisingunderacoveredemployeebenefitplanrequirestheapplicationofthefederalcommonlawrulesofcontractconstruction.CentralStates,SoutheastandSouthwestAreasPensionFundv.KrogerCo.,73F.3d727,731(7thCir.1996). Thefederalcontractconstructionrulesrequirethecourtstofirstlooktothelanguageoftheemployeebenefitplan,_Armistead_Ԁv._Vernitron_ԀCorp.,944F.2d1287,1293(6thCir.1991),andtointerpretthislanguageinitspopularandordinarysensejustasapersonofaverageintelligenceandexperiencewould.Cashv.WalMartGroupHealthPlan,107F.3d637,643(8thCir.1997);_McClure_Ԁv.LifeIns.Co.ofN.Am.,84F.3d1129,1134(9thCir.1996);Brewerv._Protexall,Inc._,50F.3d453,457(7thCir.1995).Unambiguousplanlanguageiscontrolling,Meadowsv._Cagle_s,Inc.,954F.2d686,691(11thCir.1992),andmustbeenforcedaswritten.Ryanv.FederalExpressCorp.,78F.3d123,128(3dCir.1996);_Bellino_Ԁv._Schlumberger_Techs.,Inc.,944F.2d26,2930(1stCir.1991);_Danowski_Ԁv.UnitedStates,924F.Supp.661,672(_D.N.J._Ԁ1996).Thecourtsshouldnotinvokethecommonlawrulesofconstructionto overturncarefullycraftedplanprovisions.Singerv.Black&DeckerCorp.,964F.2d1449,1454(4thCir.1992)(Wilkinson,J.,concurring).Theyshouldlikewisedeclinetotorturetheplanlanguagetoreachaparticularresultthatthecontractingpartiesneverintendedorimagined,Ryanv.FederalExpressCorp.,78F.3dat126,ortoignoretheplanlanguageinordertoprovidecoverageforwhichnopremiumhasbeenpaid.Colemanv.NationwideLifeIns.Co.,969F.2d54,5758(4thCir.1992). Thelanguageofanemployeebenefitplanisambiguousonlyifitissubjecttoreasonablealternativeinterpretations._Wahlin_Ԁv.Sears,Roebuck&Co.,78F.3d1232,1235(7thCir.1996);_Wulf_Ԁv.QuantumChem.Corp.,26F.3d1368,1376(6thCir.1994).Ambiguitiesinanemployeebenefitplanmustbe_construed_Ԁagainstthedrafterandinfavoroftheinsured.Barnesv.IndependentAuto.DealersAssoc.ofCal.Health&WelfareBenefitPlan,64F.3d1389,1393(9thCal.1995);Leev.BlueCross/BlueShieldofAla.,10F.3d1547,1551(11thCir.1994);_McMahan_Ԁv.NewEnglandMut.LifeIns.Co.,888F.2d426,429(6thCir.1989).@ B.  _ERISA_Ԁdoesnotregulatethesubstantivecontentofemployeebenefitplans.Hughesv.GeneralMotorsCorp.,764F.Supp.1231,1235(W.D.Mich.1990).Thus,itneitherrequiresnorbars_subrogation_Ԁorreimbursementclauses,anditdoesnototherwiseregulatethecontentoftheseclauses.Ryanv.FederalExpressCorp.,78F.3dat127;Landv.ChicagoTruckDrivers,Helpers&WarehouseWorkersUnion(Independent)HealthandWelfareFund,25F.3dat514.Thus,reimbursementand_subrogation_Ԁclausesincludedinanemployeebenefitplanshouldbeenforcedaccordingtotheirplainmeaning.Therighttoreimbursementor_subrogation_Ԁthusdependsonthetermsoftheemployeebenefitplanitself._Serembus_Ԁexrel._UIU_ԀHealth&WelfareFundv._Mathwig_,817F.Supp.1414,1423(E.D.Wis.1992);BlueCross/BlueShieldv._Flam_,509N.W.2dat398. FoodLionsgroupplancontainsthefollowingprovisionwithregardtocoverageforinjuriesoccurringasaresultofactsofthirdpersons:8 8 Medicalcarebenefitsanddisabilitypaymentsarenotpayabletoorforapersoncoveredunderthisplanwhentheinjuryorillnesstothecoveredpersonoccursthroughtheactoromissionofanotherperson.However,theEmployermayelecttoadvancepaymentformedicalanddisabilityexpensesincurredforaninjuryorillnessinwhichathirdpartymaybeliable.Forthistohappen,thecoveredpersonorguardianmustsignanagreementtorepaytheEmployerinfullanysumsadvancedtocoversuchmedicalordisabilityexpensesfromthejudgmentorsettlementreceived.ThisprovisiongivestotheEmployertherighttorecoverthemedicalordisabilityexpensesadvancedregardlessofwhetherthatpersonactuallysignstherepaymentagreement.ItisonlynecessarythattheinjuryoccurredthroughtheactofathirdpartyandtheEmployersrightofrecoverymaybefromthethirdpartyoranyliabilityinsurancecoveringthethirdparty,orthecoveredpersonsownuninsuredmotoristbenefits,_underinsured_Ԁmotoristbenefitsoranynofaultbenefitswhicharepaidorpayable.AlthoughMcDonoughcallsthisprovisiona"_subrogation_Ԁendorsement,"itpermitsboth_subrogation__ 5   _Ԁandreimbursement. 6    Clausessuchastheoneatissueinthiscaseshouldbegiveneffectunlesstheyviolatepublicpolicyorareinvalidforsomeotherreasonofgeneralcontractlaw.Mr.Woodsparentshavenotassertedthatthisclauseisvoidasagainstpublicpolicy,andweperceiveofnopolicybasisforinvalidatingit.FoodLioncouldappropriatelyexcludefromitsplanscoveragemedicalexpensesstemmingfrominjuriesresultingfromactsofthirdparties,anditcouldalsoconditionmakingadvancepaymentsfornoncoveredmedicalexpensesontherequirementthattheemployeereimbursetheplanforthesepayments.Othercourtshaveconsistentlyupheldthevalidityofprovisionssuchasthese.Seee.g.,_Bollman_ԀHatCo.v.Root,112F.3d113,116(3dCir.1997);UnisysMed.Planv._Timm_.98F.3d971,973(7thCir.1996);Wendys_Intl_,Inc.v._Karsko_,94F.3d1010,1013(6thCir.1996)HarrisTrust&_Sav_.Bankv.ProvidentLife&AccidentIns.Co.,57F.3d608,61516(7thCir.1995);Blackburnv.Becker,933F.Supp.724,729(N.D.Ill.1996);Crumbv.BeverlyEnters.,Inc.,841F.Supp.389,391(M.D.Fla.1993);Singletonv.BoardofTrusteesof_IBEW_ԀLocal613,830F.Supp.630,___(N.D.Ga.1993). FoodLionsgroupplanisunambiguousanddoesnothingsubstantiallydifferentfromtheotherERISAplansapprovedbythefederalcourts.Itexcludesfromcoverageinjuriesresultingfromactsofthirdparties,butitalsoaccommodatesitsemployeesbyallowingadvancedmedicalpaymentsfortheseinjuries.TheplanpermitsFoodLiontoobtainreimbursementdirectlyfromanemployeewhosignsarepaymentagreement,and,iftheemployeedoesnotsignarepaymentagreement,itpermitsFoodLiontoseekrecoveryfromanythirdpartyoritsliabilityinsurerorfromtheemployeesownuninsuredor_underinsured_Ԁmotoristinsurer. McDonough_Caperton_sinterveningcomplaintisconsistentwiththetermsofFoodLionsgroupplan.ItseekstorecoverfromMr.Prosserandhisliabilityinsurancecarrier.Theplanhasaclearrighttoassertthisclaim.Toruleotherwisewouldbetovitiatethecontractualagreementbetweentheinsurerandtheinsured.@ C.  Ratherthanconfrontingthecontractissuedirectly,Mr.Woodsparentsassertthatthisis,inessence,acoordinationofbenefitsdispute._ 7   _ԀWedonotagree.ThecoordinationofbenefitsclauseinFoodLionsgroupplanappliesonlywhen thecoveredpersoniscoveredundermorethanoneplanandislimitedtomedicalexpenses forwhichtheclaimantiscoveredunderoneormoreplans.FoodLionsgroupplandidnotcovermedicalexpensesstemmingfrominjuriesresultingfromactsofbythirdpartiesand,therefore,FoodLionwasnevercontractuallyboundtopayMr.Woodsmedicalexpenses.Accordingly,forthepurposesofthisdispute,Mr.Woodwasnotapersoncoveredbymorethanoneplan.@ III.  WereversethesummaryjudgmentdismissingMcDonough_Caperton_sinterveningcomplaintandremandthecasetothetrialcourtwithinstructionstograntMcDonough_Caperton_scrossmotionforsummaryjudgmentandtoenteranorderdirectingtheclerkofthecourttopayoverthe$11,546.50plusaccruedinterestnowintheclerkshandstoMcDonough_Caperton_,astheadministratorofFoodLionsgroupplan.Thecostsofthisappealaretaxedagainsttheproceedsnowinthehandsofthetrialcourtclerk.       ___________________________       WILLIAMC.KOCH,JR.,JUDGECONCUR:________________________________SAMUELL.LEWIS,JUDGE________________________________BENH.CANTRELL,JUDGE