MBI Energy Services v. Robert Hoch, 929 F.3d 506

Hoch, an MBI plan beneficiary, received $68,210.38 in medical benefits from a self-funded ERISA plan after an accident and later recovered a tort settlement.
MBI sued for reimbursement of plan benefits, ultimately reducing its claim by one-third to $45,473.59 to account for Hoch’s attorneys’ fees.
The only documents evidencing plan benefits were an Administrative Services Agreement (ASA) and a document labeled “Summary Plan Description” (SPD) attached as Exhibit A to the ASA.
The SPD contained a “Rights of Subrogation, Reimbursement and Assignment” clause requiring reimbursement to the claims administrator up to the amount of the recovery.
Hoch argued the SPD could not constitute the plan and that MBI lacked authority to seek reimbursement; he also asserted a counterclaim based on MBI’s initial demand for the larger amount.
The district court granted summary judgment to MBI, denied Hoch’s partial summary judgment, and dismissed his counterclaims; the Eighth Circuit affirmed.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether the SPD constitutes the written plan instrument	Hoch: SPD is only a summary and therefore cannot be the plan	MBI: SPD is the only document providing benefits and thus is the plan	SPD is the plan because it is the only document that provides benefits (Gamboa control)
Whether the SPD’s reimbursement provision is enforceable	Hoch: Reimbursement term in SPD is not binding because it’s not a formal plan document; Amara bars treating SPDs as plan terms	MBI: SPD’s terms are enforceable here because no other plan document exists and ASA incorporates the SPD	Reimbursement provision is enforceable; Gamboa allows SPD to serve as plan where no other benefit-providing document exists; Amara does not displace Gamboa in these circumstances
Whether Hoch’s counterclaim (harm from MBI’s initial larger demand) survives dismissal	Hoch: Initial demand for $68,210.38 unlawfully deprived him of use of $22,736.79; seeks interest and equitable relief	MBI: Hoch was never entitled to the disputed funds; district court properly dismissed counterclaim	Affirmed dismissal; Hoch failed to adequately present alternative theory below and on appeal, so court declines to consider it

Admin. Comm. of Wal-Mart Stores, Inc. Assocs.’ Health & Welfare Plan v. Gamboa, 479 F.3d 538 (8th Cir. 2007) (SPD may serve as the plan when no other plan document provides benefits)
CIGNA Corp. v. Amara, 563 U.S. 421 (2011) (SPDs generally are explanatory and not themselves plan terms; warns against treating SPDs as binding when a formal plan exists)
Jobe v. Med. Life Ins. Co., 598 F.3d 478 (8th Cir. 2010) (provisions appearing only in an SPD do not confer administrator discretion when the formal plan differs)
Moyle v. Anderson, 571 F.3d 814 (8th Cir. 2009) (standard of review for summary judgment)