Central States, Southeast and Southwest Areas Health and Welfare Fund v. First Agency, Inc., 756 F.3d 954

Background

Central States (an ERISA-governed employee benefit plan) provided general health coverage to Teamsters’ children as dependents; Guarantee Trust provided sports-injury insurance directly to the same student-athletes.
Thirteen student-athletes were injured during sports between 2006–2009; Guarantee Trust denied coverage and Central States paid the medical bills under protest.
Central States sued Guarantee Trust (and First Agency) under 29 U.S.C. § 1132(a)(3)(B) seeking declaratory relief, reimbursement for past payments, and attorneys’ fees; the district court held Guarantee Trust primary, awarded reimbursement (~$112,000), and awarded fees.
The core contractual conflict: Central States’ coordination clause made other coverage primary when the insured is covered “other than as a Dependent”; Guarantee Trust’s blanket clause made any other insurer primary when overlap exists — producing a mutual "you first" conflict.
The Sixth Circuit affirmed that the ERISA plan’s coordination clause controls but reversed the district court’s monetary reimbursement award as not permissible “equitable relief” under § 1132(a)(3)(B); it affirmed the fee award.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Which insurer is primary when plan and policy coordination clauses conflict?	Central States: ERISA plan’s coordination clause controls and makes Guarantee Trust primary.	Guarantee Trust: its policy is excess insurance and thus should not be subordinated to the ERISA plan (or only subordinated if plan expressly references excess insurance).	Hold: ERISA plan’s terms control; Guarantee Trust’s policy is ordinary coverage with a blanket COB clause, so Guarantee Trust is primary.
Does Guarantee Trust’s coverage qualify as "excess" to evade coordination?	Central States: Guarantee Trust’s policy is ordinary (not pure excess) and even if excess, ERISA plans can coordinate with excess policies; no special privileged status.	Guarantee Trust: its policy is excess (or must be treated as such) and thus should not be forced to pay where an ERISA plan purports to be primary unless plan references excess policies.	Hold: Policy is not pure excess; even for excess policies, ERISA plans may coordinate benefits and enforce plan terms without re-writing the insurer’s coverage.
May Central States recover past payments as monetary restitution under § 1132(a)(3)(B)?	Central States: the reimbursement is restitution (equitable) and therefore authorized under § 1132(a)(3)(B).	Guarantee Trust: such a money judgment is legal relief/damages and not permitted under § 1132(a)(3)(B).	Hold: Reimbursement ordered by district court is a money judgment constituting legal restitution (not equitable); § 1132(a)(3)(B) authorizes only equitable relief—reversal of monetary award.
Did Guarantee Trust forfeit its objection to monetary relief and are other defenses (limitations) relevant?	Central States: Guarantee Trust forfeited the objection by not raising it earlier.	Guarantee Trust: preserved the objection by briefing it at the appropriate time; statute-of-limitations policy provision may bar some past claims.	Hold: Guarantee Trust preserved its objection to monetary relief; limitations defense might affect past claims but is irrelevant to the declaratory ruling; fee award affirmed as not an abuse of discretion.

Key Cases Cited

Auto Owners Ins. Co. v. Thorn Apple Valley, Inc., 31 F.3d 371 (6th Cir.) (ERISA plan coordination clauses control conflicting clauses)
Great-West Life & Annuity Ins. Co. v. Knudson, 534 U.S. 204 (2002) (distinguishing equitable restitution from legal restitution under § 1132(a)(3))
Sereboff v. Mid Atlantic Med. Servs., 547 U.S. 356 (2006) (equitable restitution allowed when specific funds are identifiable and subject to constructive trust)
McGurl v. Trucking Empls. of N. Jersey Welfare Fund, 124 F.3d 471 (3d Cir.) (discussion of pure excess insurance vs. ordinary coverage)
PM Group Life Ins. Co. v. W. Growers Assur. Trust, 953 F.2d 543 (9th Cir.) (commentary on problems caused by overlapping insurance coverage)
US Airways, Inc. v. McCutchen, 569 U.S. 88 (2013) (importance of enforcing the face of written ERISA plan documents)