WPC # VUNa % 0w@ 4   0J 0Te 0^ 0h 0r 0| 0m 0 1u 0dU>\U*B)DC AM0U*} BRv~ov D3 0@ AO3 0DH D/ BHP LaserJet 4HPPCL5MS,,,,,,0nLh(hH  Z 6Times New Roman RegularX(3c$7|XXdXXd7  HTXXTR[A' Legal[A' LegalA' LegalA' LegalT DDDD !"#Ӏf|$3|x.2 0Indent123  2" 0Indent20 23  2, 0Indent30 0 23  26 0Indent40 0 0 23  2@ 0Indent50 0 0 0 23  2J 0Indent60 0 0 0 0 23  2T 0Indent70 0 0 0 0 0 23  2^ 0Indent80 0 0 0 0 0 0 23   ?AGMSYaioIndent0I.A.1.a.(1)(a)i)a)P 8Mac DefaultMac Default ` X<  9p`(&Times New Roman<  9p`(Times% Line 7 d 7Border 1dd-!C << G<  9p`(Arial  !  #d#    H \RA'\  ##   YYY FILED#X June25,1998CecilCrowson,Jr.#AppellateCourtClerk  dPtPtHH(FG(HH(d'`Styl{WP}01  HH  2$HH  Geneva  <Px443!#4$*$$*$ KK  Geneva  Geneva .,6 Geneva   ellan Geneva  ellan Geneva %%%%'dxd("$    -C<< CLevel 1Level 2Level 3Level 4Level 5($$   1  ' dxdP Pd ! . #Xd#    H \RA'\    7XdXXd7   R"$!A1-j|` . `@Rߛ INTHECOURTOFAPPEALSOFTENNESSEEATKNOXVILLE  PAULAM.YORKand   )BRIANYORK,    ) SEVIERCIRCUIT      ) Plaintiffs/Appellees  ) NO.3A019801CV00033      )v.      ) HON.RICHARDR.VANCE      ) JUDGESEVIERCOUNTYAMBULANCE )AUTHORITY,ETAL,and  )BLUECROSS/BLUESHIELDof )TENNESSEE,    )      ) Defendants/Appellants  ) REVERSEDDanielM.Gass,Knoxville,forAppellants.RichardT.Wallace,Sevierville,andStephenJ.Cox,Knoxville,forAppellees. @  OPINION       INMAN,SeniorJudge @ I  PaulaYorkandherson,BrianYork,age9,wereinjuredinacollisiononNovember4,1994inwhichMs.YorksautomobilewasstruckfrombehindbyaSevierCountyAmbulance.ShesustainedsevereinjuriesandBriansustainedatraumaticarthrotomyoftheleftknee,abrokenleftfemur,͜permanentscarringofhislegsandpsychologicalinjuries.TheyfiledsuitagainstSevierCountyAmbulanceAuthorityonJune22,1995. Eachplaintiffwasawarded$130,000.00bywayofagreed,approvedjudgment. BrianYorkwascoveredbyapolicyofinsurancewithBlueCrossandBlueShield( BCBS),whichhadpaidhismedicalexpensesof$19,149.97.TheAuthoritywithheldthissumandseparatelydepositeditwiththecourt.AnamendedcomplaintwasfiledaddingBCBSasadefendanttodeterminewhetheritsmedicalpaymentsweresubrogable. ThetrialcourtdeterminedthatBrianYorkwasnot madewholebythejudgmentof$130,000.00andthereforeBCBSwas notentitledtosubrogationinanyamountandshouldtakenothing. BCBSappeals,insistingthatitiscontractuallyentitledtorecoveryundereitherthe reimbursementprovisionofitspolicy,whichauthorizesrecoveryregardlessofwhetherBrianYorkwasmadewhole,orinthealternative,underthe subrogationprovisionofthepolicy,becauseBrianYorkwasmadewhole. WefindthatBCBSisentitledtoenforceitsrecoveryunderthe righttoreimbursementclauseofitscontractwithYork.TheissueofwhetherBrianYorkwasmadewholeismoot. @ @ II ThecontractofinsurancebetweenBCBSandPaulaYorkforhersonprovides,aspertinent:X8  H` ` ` 8  RIGHTOFRECOVERYANDREIMBURSEMENT  8 Recoveryandreimbursementisanothermethodusedtopreventduplicatepayments.Itworksthisway:8 1.8 Weassumeyourlegalrightstotherecoveryofanypaymentsformedicalexpensespaidbyuswhereyourinjuryorillnessresultedfromtheactionorfaultofanotherperson.BlueCrossandBlueShieldofTennesseehastherighttorecoveramountsequaltoourpaymentsbysuit,settlementorotherwisefromtheinjuredpartysowninsuranceorfromthepersonwhocausedtheillnessorinjury,fromhisorherinsurancecompany,oranyothersource,suchasuninsuredmotoristcoverage.8 2.8 Youmustgiveusinformationandassistanceandsignnecessarypapers.Ifthisisnotdoneoryousettleanyclaimwithoutourwrittenconsent,wewillbeentitledtorecoverfromyouallpaymentsformedicalexpensesmadebyus,plusreasonableandnecessaryattorneyfeesandcourtcostsweincurintryingtorecoversuchpayments.8 3.8 Inaddition,youagreetoreimburseusuptotheamountwehaveprovidedfromanymoneyyou(oramemberofyourfamily)recoverfromanysource.Youwillberesponsibleforreimbursingustheamountofmoneyrecoveredthroughjudgmentorsettlementfromyourowninsuranceorfromthethirdparty(orhisinsurance),uptotheamountofbenefitsprovidedbyus.Thisrighttoreimbursementcomesfirst,evenifyouhavenotbeenpaidforallofyourclaimfordamagesagainstthethirdpartyorifthepayment(s)youreceivearefor(oraredescribedasfor)otherdamages,suchaspersonalinjuriesorotherhealthcareexpensesorifthememberrecoveringthemoneyisaminor.   Paragraph(1)isastandardinsurerssubrogationclausewhichallowsϜBCBStosucceedtotherightsofBrianYorktotheextentthatBCBShaspaidmedicalbenefitsunderitspolicy.CastlemanConstructionCompanyv.ϜPennington,432S.W.2d669,674(Tenn.1968).ItiswellestablishedthatthisclauseislimitedbyTennessees madewholedoctrine,whichprovidesthataninsurercannotrecoverunderthetermsofasubrogationclauseunlesstheinsuredismadewhole.Wimberlyv.AmericanCasualtyCompany,584S.W.2d200(Tenn.1979). Paragraph(3)ofthecontractestablishesamuchbroader rightofreimbursement.Underthisclause,theinsurerhasarighttobereimbursedfrom anymoneyreceivedbythePlaintiffsfromanysource,regardlessofwhethertheyhavebeenmadewhole.` X? XӀThetrialcourtheldthat,despiteparagraph(3)ofthecontract,Tennesseelawrequiresthataninjuredmustbe madewholebeforeheisrequiredtoreimburseaninsurerandthisis anequitableprinciplethatyoucantcontractaway. BCBSarguesthatapolicyofinsurancewhichhasbothareimbursementclauseandasubrogationclausepermitstheinsurerwhoisunabletorecoverunderthesubrogationclausebecausetheinsuredhasnotbeenmadewholetoneverthelessrecoverunderthereimbursementclausewithouttheapplicationofthe madewholedoctrinewhenthelanguageinthecontractisclear,citingMarshallv.EmployersHealthIns.Co.,927F.Supp.1068(M.D.Tenn.1996)andWalMartAssociatesGroupHealthPlanv.MaryWhiteandLewisGarrison,22TAM3645(W.D.Tenn.1997). Marshall,supra,involvedarecoverybyEmployersHealthInsuranceCompanyoffundspaidtotheinsuredbyabeneficiaryofanEmployeeRetirementIncomeSecurity(ERISA)plan,whorecoveredjudgmentinstatecourtfromathirdpartytortfeasorbutwasnotmadewholebythejudgment.EmployersHealthInsuranceCompanysoughtrecoveryunderareimbursementprovisionwhich,likethecontractbeforeus,providedforsuchreimbursementregardlessofwhethertheinsuredwasmadewhole.Inallowingtheinsurertorecover,thecourtheld:  8 (1)Tennesseessubrogationlaw,includingthemakewholedoctrine,ispreemptedbyERISA;underfederalcommonlaw,intheabsenceofaclearcontractualprovisiontothecontrary,aninsuredmustbemadewholebeforeaninsurercanenforceitsrightofsubrogationunderERISA.Sincethesubrogationprovisioninthiscasedoesnotclearlyprovidetothecontrary,themakewholedoctrineappliestotheDefendantsrightofsubrogation;and(3)theERISAplaninthiscasecontainsarightofreimbursementthatisindependentoftherightofsubrogationandthemakewholedoctrine.Accordingly,undertherightofreimbursementprovision,DefendantisentitledtoreimbursementofthemedicalexpensesitpaidonbehalfofPlaintiffs.    WalMart,supra,anotherdistrictcourtERISAcase,againenforceda righttoreimbursementclauseunderfederalcommonlaw. ThiscourthasrecentlyrenderedadecisioninanERISAcaseinwhichJudgeKoch,applyingfederalcommonlaw,heldthat ERISAdoesnotregulatethesubstantivecontentofemployeebenefitplans...thus,itneitherrequiresnorbarssubrogationorreimbursementclauses,anditdoesnototherwiseregulatethecontentoftheseclauses.Inthatcase,weupheldtheenforcementoftheinsurersrighttoreimbursementunderthetermsofitscontract.Woodv.Prosser,(No.01A019510CV00468,Nashville,June11,1997). WhilewedonotfeelconstrainedtoapplyfederalcommonlawundertheERISAstatutesinthecaseatBar,wethinkJudgeKochsreasoninginWoodisparticularlyappropo:  8 Theunambiguousplanlanguageiscontrollingandmustbeenforcedaswritten.Thecourtsshouldnotinvokethecommonlawrulesofconstructiontooverturncarefullycraftedplanprovisions.Theyshouldlikewisedeclinetotorturetheplanlanguagetoreachaparticularresultthatthecontractingpartiesneverintendedorimagined,ortoignoretheplanlanguageinordertoprovidecoverageforwhichnopremiumhasbeenpaid...clausessuchastheoneatissueinthiscaseshouldbegiveneffectunlesstheyviolatepublicpolicyorareinvalidforsomeotherreasonofgeneralcontractlaw....weperceiveno[public]policybasisforinvalidating[theclause].[citationsomitted]   Thejudgmentisreversedandthecaseisremandedwithinstructionstoenteranorderdirectingtheclerkofthecourttopayoverthe$19,149.97plusaccruedinterestnowintheclerkshandstoBCBS.CostsofthisappealareϜtaxedagainsttheappellees.Ӏ      _______________________________      WilliamH.Inman,SeniorJudge̜CONCUR:̛̛̜_______________________________̜HoustonM.Goddard,PresidingJudge̜_______________________________̜CharlesD.Susano,Jr.,Judge