This appeal is before us once again, the Supreme Court having remanded it to us for further consideration in light of the Court’s decision in
Empire Healthchoice Assurance, Inc. v. McVeigh,
— U.S. -,
To provide health insurance for federal employees, the federal Office of Personnel Management contracts with insurance carriers such as Blue Cross. The contract with Blue Cross provides that an insured who having received benefits from Blue Cross recovers compensation for the same illness or injury from a third party (for example, as the result of filing a tort claim against that party) must return to Blue Cross so much of the benefits as the compensation offsets. Blue Cross reserves the right not to permit the insured to deduct any part of the attorney’s fee that he incurred in obtaining the compensation from the third party. The reason this provision appears in the contract between the government and Blue Cross is that any reimbursement received by Blue Cross must be remitted, minus a service charge, to the federal government.
Blue Cross filed this suit in federal district court against one of its insureds, Cruz (actually Cruz’s representative, but we suppress that irrelevant detail). Blue Cross had paid $4,682.20 in benefits to cover injuries that Cruz had sustained in an automobile accident. He had hired his own lawyer to bring a tort suit against the injurer, had recovered $30,000 in a -settlement, and had paid his lawyer one-third of that amount as the lawyer’s fee. Blue Cross wanted the entire $4,682.20 reimbursed to it, but Cruz argued that under Illinois’s common fund doctrine he was entitled to deduct a third as Blue Cross’s share of the attorney’s fee. In that way, each of the beneficiaries of the lawyer’s efforts — Cruz and Blue Cross — would be paying the lawyer the same fraction (one-third) of their respective benefits from his efforts.
The common fund doctrine allows a person who incurs attorney’s fees in obtaining a judgment or settlement that confers a benefit on another to deduct a portion of the fee. E.g.,
Bloomer v. Liberty Mutual Ins. Co.,
Blue Cross disagreed. It does not
want
to create the incentive that the common fund doctrine provides: It (or the Treasury) must like the tradeoff between fewer tort recoveries by insureds and a larger
Ordinarily, however, preemption is a defense, and the anticipation of a federal defense does not entitle the plaintiff to bring a suit not otherwise within federal jurisdiction in federal court,
Caterpillar Inc. v. Williams,
Under either the “complete preemption” or “unique federal interest” approach, Blue Cross’s suit would arise under federal law and thus be within the jurisdiction of the district court.
Beneficial National Bank v. Anderson,
Empire
arose from a suit by a health insurer against an insured who had recovered tort damages but refused to reimburse the insurer, on the ground that his damages did not cover the injury for which he had received benefits from the insurer. The Supreme Court, resolving an intercir-cuit conflict that the Court identified our decision as being on the wrong side of, held that the suit did not arise under federal law.
That is to read the majority opinion too narrowly, and in any event ignores the principle that jurisdictional provisions should be simple and clear so that a party is not placed in the position of filing a suit in one court only to discover after years of litigating there that it has to start over in another court because the first court lacked jurisdiction.
Budinich v. Becton Dickinson & Co.,
One reason the Court gave in
Empire
for rejecting a federal common law of federal employees’ health benefits is that a common fund defense will often involve a disagreement merely over the value to the insurer of the insured’s efforts in his third-party suit, and that is hardly an issue on which a federal rule is necessary. Our case involves the broader issue of the applicability of the common fund doctrine in light of the contract, which purports to entitle Blue Cross to reject the doctrine. Another reason the Court gave for its result in
Empire
was that the contracts between the Office of Personnel Management and the insurers allow an insurer to enforce the insured’s third-party ' claim against the third party directly, and if the insurer followed that route his right to reimbursement would depend entirely on the third party’s tort liability; no reimbursement or common fund issue would be presented, because the insurer would be paying the attorney’s fee.
The jurisdictional holding in our previous opinion was based on a belief that Congress in the Federal Employees Health Benefit Act had wanted federal employees to have the same benefits under their health plan no matter what state they were in, so that if they moved from one state to another they would not have to worry that their entitlement had changed. That was an argument for regulating the contracts between the insurers and the government by a uniform body of contract principles, and thus by a federal common law of contracts. The Supreme Court distinguished, however, between benefits and reimbursement.
The beneficiary-litigant can, it is true, be made worse off by suing, if he has a disappointing result. Suppose an insured who incurred medical expenses of $40,000 paid for by Blue Cross sued his injurer and settled with him for $50,000 and his lawyer’s fee was $20,000. In both a common fund state and a state that has no common
Thus the benefits are uniform, though the net financial position of an insured who has a potential tort claim is not but instead depends on the state liability rules applicable to his tort claim, including rules ancillary to liability such as the common fund doctrine. When “benefits” are understood to include every financial incident of an illness or injury, national uniformity is unattainable without a federal takeover of the entire tort system.
We conclude that the district court’s judgment, dismissing Blue Cross’s suit for want of federal jurisdiction, must be affirmed, and Blue Cross will have to start over in state court — where it can if it wishes plead preemption, based on the contract, as a defense to Cruz’s defensive invocation of the common fund doctrine. We shall not speculate on the outcome, but we shall try to offer some guidance to the parties. Blue Cross will be able to argue before the state court that the Federal Employees Health Benefits Act should be interpreted to bar a state from forbidding waiver of the common fund doctrine by the contracts that the Office of Personnel Management makes with health insurers, such as Blue Cross. Cf.
Administrative Committee of Wal-Mart Stores, Inc.
Associates’
Health & Welfare Plan v. Varco,
Blue Cross will also be able to argue that the rule of Illinois law that makes waivers of the state common fund doctrine unenforceable, see
Scholtens v. Schneider, supra,
These are difficult questions, so the state court, we’re afraid, will have its work cut out for it. We lack jurisdiction to try to answer them.
Affirmed.
