Central States, Southeast & Southwest Areas Health & Welfare Fund Ex Rel. Bunte v. Health Special Risk, Inc.
756 F.3d 356
5th Cir.2014Background
- Central States (an ERISA health plan) paid medical bills for 11 insureds who also had coverage from non‑ERISA insurers (Markel, Federal, Ace) administered by Health Special Risk (HRS).
- Central States sought reimbursement from those insurers, which refused, claiming their policies were excess and secondary.
- Central States sued, invoking ERISA § 502(a)(3) for (a) declaratory relief enforcing the plan’s coordination‑of‑benefits (COB) terms, (b) restitution/reimbursement, (c) equitable lien/constructive trust, (d) subrogation, and (e) federal common‑law unjust enrichment.
- The district court dismissed most claims for failing to allege "appropriate equitable relief" under § 502(a)(3); the remaining state‑law subrogation claim was preempted by ERISA.
- Central States appealed, arguing § 502(a)(3) permits the equitable monetary relief it seeks, that federal common law fills any enforcement gap, and that a declaratory judgment on future obligations is proper.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether § 502(a)(3) authorizes Central States to recover monetary reimbursement from non‑ERISA insurers as "appropriate equitable relief" | Central States: Plan COB and reimbursement provisions create an equitable lien/constructive trust or make defendants constructive trustees, so money recovery is equitable | Defendants: Relief sought is legal (money damages); Central States cannot show an equitable basis or an identifiable res | Held: Dismissed — Central States seeks monetary relief not within the narrow categories of equitable relief under § 502(a)(3) |
| Whether Defendants can be treated as fiduciaries/constructive trustees of the ERISA plan | Central States: Defendants’ refusal to reimburse and the plan terms impose duties akin to fiduciary/trustee obligations | Defendants: They exert no control over plan administration or assets and are not parties to plan contracts; no fiduciary duties exist | Held: Dismissed — Defendants are not fiduciaries or constructive trustees; no equitable basis established |
| Whether federal common law unjust enrichment fills an alleged enforcement gap in ERISA | Central States: If § 502(a)(3) bars relief, federal common law should supply a remedy to enforce COB/subrogation | Defendants: ERISA’s text limits remedies to equitable relief; where statute speaks, there is no gap for federal common law | Held: Dismissed — no gap exists; ERISA’s limitations control and federal common law cannot create the requested remedy |
| Whether a declaratory judgment resolving future payment obligations is ripe and permissible under § 502(a)(3) | Central States: Count I seeks a declaratory ruling on present and future obligations (not merely money now) | Defendants: Count I effectively seeks an order compelling future payment and reimbursement (monetary), and future‑oriented claims are unripe without a concrete dispute | Held: Dismissed — Count I seeks monetary obligations and is not ripe as to future claims; fails § 502(a)(3) requirements |
Key Cases Cited
- Mertens v. Hewitt Associates, 508 U.S. 248 (1993) (§ 502(a)(3) limited to traditional equitable remedies)
- Great‑West Life & Annuity Ins. Co. v. Knudson, 534 U.S. 204 (2002) (restitution may be legal or equitable; money judgments for contractual reimbursement typically legal)
- Sereboff v. Mid Atlantic Medical Services, 547 U.S. 356 (2006) (equitable lien by agreement allowed when funds are identifiable in defendant’s possession)
- CIGNA Corp. v. Amara, 131 S. Ct. 1866 (2011) (monetary relief for breach of fiduciary duty may be equitable where analogous to trustee remedies)
- US Airways, Inc. v. McCutchen, 133 S. Ct. 1537 (2013) (enforcing plan terms that create an equitable lien by agreement; equitable defenses cannot override plan’s clear promises)