Board of Trustees v. Kyle Moore, 800 F.3d 214

NEI Board administers a self-funded ERISA health plan for elevator-industry employees; subrogation seeks reimbursement of medical expenses paid on Moore’s behalf after his personal-injury settlement.
Trust Agreement authorizes the Board to adopt a Plan of Welfare Benefits but does not itself specify benefits or claim procedures; SPD provides detailed plan terms and includes a subrogation clause.
SPD states that amounts recovered from another party are Plan assets but excess amounts are the separate property of the covered person; the Plan has a right of first reimbursement from any recovery.
Moore settled his state-court claims for $500,000 without notice to the Board, with settlement language excluding medical expenses and subrogation claims; Board later sought reimbursement from settlement proceeds.
District court held SPD controlling and enforceable subrogation, granting summary judgment for the Board; district court also limited discovery, which Moore challenged.
This appeal followed, with the court affirming summary judgment and finding no abuse of discovery ruling.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Is the SPD a controlling plan document?	Moore argues the Trust Agreement is the plan and SPD is not binding.	Board contends SPD governs because it is the only document detailing benefits and subrogation rights.	SPD is controlling plan document; sustains subrogation rights.
Are settlement funds “excess and separate” from medical expenses, exempt from subrogation?	Settlement should not be used to reimburse because amounts recovered exceed plan benefits.	Excess funds are Moore’s separate property only; subrogation still applies to plan benefits.	No; excess funds concept applies as a mathematical limit, not a categorical exemption.
Does subrogation require a judicial finding or admission of liability by the third party?	Liability must be judicially determined to trigger subrogation.	Subrogation covers any liable party, including settlements, without a court finding.	Subrogation applies without need for a judicial finding of liability.
Did the district court abuse its discretion in limiting discovery?	Discovery into other subrogation claims could reveal fiduciary breaches.	Limiting discovery was appropriate; issue was whether SPD controlled, not enforcement history.	No abuse; discovery limits were proper given the focus on the governing plan document.

Feifer v. Prudential Insurance Co. of America, 306 F.3d 1202 (2d Cir. 2002) (SPD describing benefits acts as controlling plan document where no other plan exists)
CIGNA Corp. v. Amara, 131 S. Ct. 1866 (Sup. Ct. 2011) (SPD terms do not trump plan terms when in conflict; plan governs)
Eugene S. v. Horizon Blue Cross Blue Shield of N.J., 663 F.3d 1124 (10th Cir. 2011) (SPD can be part of the Plan and enforceable as such)
Tetreault v. Reliance Standard Life Ins. Co., 769 F.3d 49 (1st Cir. 2014) (SPD creates enforceable rights when expressly incorporated)