LAURA L. PATTERSON, et al. v. AMERICAN FAMILY INSURANCE COMPANY, et al.
C.A. No. 20CA0075-M, 20CA0078-M
IN THE COURT OF APPEALS NINTH JUDICIAL DISTRICT
September 30, 2021
2021-Ohio-3449
HENSAL, Presiding Judge.
STATE OF OHIO, COUNTY OF MEDINA. APPEAL FROM JUDGMENT ENTERED IN THE COURT OF COMMON PLEAS COUNTY OF MEDINA, OHIO CASE No. 2017-CV-0585
HENSAL, Presiding Judge.
{1} Swagelok Associates Welfare Benefit Plan (“Swagelok“) has appealed a judgment of the Medina County Court of Common Pleas that granted summary judgment to Eric and Laura Patterson on their declaratory judgment claim and declared that Swagelok does not have a right to subrogation. The Pattersons have cross-appealed the denial of their motion for sanctions. For the following reasons, this Court affirms.
I.
{2} The underlying facts of this case are not in material dispute. Mr. Patterson enrolled in a health benefits plan that was offered by his employer, the Swagelok Company. Following his enrollment, Mrs. Patterson was injured in a motor vehicle collision, which she alleges was caused by another driver. Swagelok paid benefits towards Mrs. Patterson‘s treatment and believes it is entitled to be reimbursed from any sums the Pattersons recover from the other driver. The Pattersons filed a complaint against the other driver and included a claim against Swagelok, seeking a declaration that Swagelok has no right to subrogation. Swagelok counterclaimed, seeking subrogation. After the Pattersons amended their complaint and discovery ended, both parties moved for summary judgment. The trial court granted judgment to the Pattersons and declared that Swagelok does not have a contractual right to subrogation. The court, however, denied the Pattersons’ motion for attorney fees. Swagelok has appealed the court‘s judgment, assigning four errors. The Pattersons have cross-appealed the denial of their motion for attorney fees, assigning two errors. We will address Swagelok‘s first three assignments of error together because they each concern the trial court‘s jurisdiction over the Pattersons’ claims against Swagelok.
II.
ASSIGNMENT OF ERROR I
THE TRIAL COURT ERRED BY FINDING SWAGELOK PLAN
ASSIGNMENT OF ERROR II
THE TRIAL COURT ERRED BY NOT FINDING THE PATTERSONS’ ACTION SEEKING TO “ENJOIN“, “BAR” OR “PREVENT” AN ERISA PLAN‘S PRACTICE OF SEEKING REPAYMENT AS AN ERISA CLAIM UNDER
ASSIGNMENT OF ERROR III
THE TRIAL COURT ERRED IN FINDING THE PATTERSONS’ COMPLAINT WAS AN ACTION UNDER
{3} In each of its first three assignments of error, Swagelok argues that the trial court did not have jurisdiction to consider the Pattersons’ declaratory judgment claim because such claims have been pre-empted by the Employee Retirement Income Security Act of 1974, commonly known as ERISA. Under
[n]o genuine issue as to any material fact remains to be litigated; (2) the moving party is entitled to judgment as a matter of law; and (3) it appears from the evidence that reasonable minds can come to but one conclusion, and viewing such evidence most strongly in favor of the party against whom the motion for summary judgment is made, that conclusion is adverse to that party.
Temple v. Wean United, Inc., 50 Ohio St.2d 317, 327 (1977). To succeed on a motion for summary judgment, the party moving for summary judgment must first be able to point to evidentiary materials that demonstrate there is no genuine issue as to any material fact, and that it is entitled to judgment as a matter of law. Dresher v. Burt, 75 Ohio St.3d 280, 292 (1996). If the movant satisfies this burden, the nonmoving party “must set forth specific facts showing that there is a genuine issue for trial.” Id. at 293, quoting
{4} In its first assignment of error, Swagelok focuses on the trial court‘s determination that it waived its preemption argument by not raising it as an affirmative defense in its answer to the Pattersons’ amended complaint. According to Swagelok, its preemption defense directly challenged the subject-matter jurisdiction of the trial court, which was not subject to waiver.
{5}
{6} The Ohio Supreme Court has recognized that “[t]he controlling language of
{7} Regarding whether the Pattersons’ claim was preempted, Swagelok argues in its second assignment of error that the Pattersons’ declaratory judgment claim must be characterized as a claim under
{8} In relevant part,
{9} “In determining the scope of its jurisdiction under a federal statute, a state court of general subject-matter jurisdiction possesses a ‘deeply rooted presumption in favor of concurrent’ state and federal jurisdiction.” Girard v. Youngstown Belt Ry. Co., 134 Ohio St.3d 79, 2012-Ohio-5370, ¶ 16, quoting Mims v. Arrow Fin. Servs., L.L.C., 565 U.S. 368, 378 (2012).
{10} In their amended complaint, the Pattersons demanded that the trial court
{11} Multiple courts have held that a declaratory judgment action seeking a declaration of rights, status, or other legal relations is an action “to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan” under
{12} The Pattersons’ claim against Swagelok sought a declaration that Swagelok does not have a contractual right to subrogation and, relatedly, sought to bar Swagelok from exercising any claimed right to subrogation. Although their request can be construed as a civil action to enforce the terms of the plan under
ASSIGNMENT OF ERROR IV
THE TRIAL COURT COMMITTED REVERSIBLE ERROR BY HOLDING ERISA LAW PROHIBITS ENFORCEMENT OF THE SPD AS PART OF THE ACTUAL “PLAN“.
{13} In its fourth assignment of error, Swagelok argues that the trial court incorrectly determined that it is not entitled to subrogation under the terms of the plan. According to Swagelok, the subrogation term is contained within the health benefits Summary Plan Description (“SPD“) that is incorporated by reference into the “wrap” plan document that concerns
{14} As Swagelok notes, its benefits program contains different documents. One is titled “Plan Document” and describes all the various benefits available to employees, including health care, dependent care and flexible spending accounts, life insurance, long-term disability, dental care, vision, accidental death, and others. See
{15} The Plan Document thus refers to two other documents: the Governing Documents and the SPD. It clarifies that language in the Governing Documents controls over the Plan Document, but the language of the Plan Document controls over the SPD.
{16} The Governing Documents for the medical benefits program were not provided to the trial court. The SPD for the program, however, was provided. The SPD indicates that it describes the health benefits available to employees and their families and includes summaries of who is eligible, what services are covered and not covered, how benefits are paid, and the employee‘s rights and responsibilities. See
{17} Swagelok argues that the Plan Document and SPD are the only two documents that detail the parameters of the health benefits program and that there are no separate “Governing Documents.” According to Swagelok, the SPD is the “Governing Documents” and its terms are incorporated into the Plan Document, supplementing that document and adding the subrogation provision. The trial court rejected Swagelok‘s arguments, noting that the SPD indicates that it is only providing summaries and that the Plan Document does not contain source information about the particulars of the health benefit program. The court reasoned that the Governing Documents must therefore be the benefits contracts that Swagelok has entered with the companies administering the health benefits program. It noted that the Plan Document‘s definition of benefit contracts provides that the terms of those contracts are incorporated into the Plan Document, supplementing its provisions. The court also noted that a Swagelok representative testified that Swagelok has a contract with an insurance company that indicates what specific health benefits will be covered.
{18} Addressing the relationship between a benefit plan and its summary, the United States Supreme Court has been clear that “summary documents, important as they are, provide communication with beneficiaries about the plan, but * * * their statements do not themselves constitute the terms of the plan * * *.” CIGNA Corp. v. Amara, 563 U.S. 421, 438 (2011); McCutchen, 569 U.S. at 92, fn.1. In Amara, the Supreme Court noted that a plan is developed by its sponsor, who creates the basic terms and conditions, including a procedure for amending the plan. Amara at 437. The summary, on the other hand, is provided by the plan‘s administrator. Id.;
{19} Swagelok argues that, in some circumstances, a summary document has been deemed part of the plan, such as in Board of Trustees v. Moore, 800 F.3d 214 (6th Cir.2015). In Moore, however, there was a trust document that authorized the Board to develop a welfare benefits plan, administer the plan, and act as fiduciary to the plan. Instead of drafting a welfare benefits plan, the Board “went straight to [the] creation of a summary plan description[.]” Id. at 219. Under those circumstances, because there was no separate plan document and the summary was specifically approved by the Board, the Sixth Circuit construed the summary as the controlling ERISA plan. Id. at 220; see also, e.g., Alday v. Container Corp. of America, 906 F.2d 660, 665 (11th Cir.1990) (explaining that the summary document “clearly functioned as the plan document required by ERISA.“); Rhea v. Alan Ritchey, Incorporated Welfare Benefit Plan, 858 F.3d 340, 344 (5th Cir.2017) (explaining that “SPD was functioning as both an SPD and written instrument.“).
{20} In this case, the Plan Document contains all the features required of an employee benefit plan.
{21} Upon review of the record, we conclude that the trial court correctly determined that the SPD could not add a subrogation and reimbursement provision to the Plan Document. Because the Plan Document does not contain such provisions and Swagelok did not produce any evidence that the Governing Documents include such provisions, we conclude that the trial court also correctly determined that Swagelok does not have a contractual right to subrogation or reimbursement. Accordingly, the trial court correctly granted summary judgment to the Pattersons. Swagelok‘s fourth assignment of error is overruled.
CROSS-APPEAL ASSIGNMENT OF ERROR I
THE TRIAL COURT ABUSED ITS DISCRETION BY FINDING THAT SWAGELOK AND/OR ITS COUNSEL DID NOT VIOLATE R.C. 2323.51 FOR FAILING TO PRODUCE THE PLAN DOCUMENT REQUESTED AND MAKING FALSE STATEMENTS REGARDING ITS EXISTENCE AND THE NATURE OF THE SPDS RELIED ON.
{22} In their first assignment of error, the Pattersons argue that the trial court should have sanctioned Swagelok under
{24} Following a hearing on the Pattersons’ motion for sanctions, a magistrate found that the Pattersons sent Swagelok initial discovery requests that sought the Plan Document required by
{25} The magistrate found that Swagelok considered the SPD to be both the controlling plan document and the summary document required by ERISA. Because there is conflicting case law about that issue, he found that Swagelok‘s failure to produce the Plan Document in October 2017 was not conclusively frivolous conduct. He also found that Swagelok provided the Plan Document voluntarily in February 2018, which was still a month before the deposition of the plan administrator. The magistrate also found that the Pattersons failed to prove that they were adversely affected by the delay in receiving the Plan Document, noting that they did not identify what specific additional expenses they incurred from the delay. The magistrate also noted that one of Swagelok‘s primary defenses was whether the Pattersons could even file their action in state court, which was unrelated to the language of the Plan Document or SPD. He found that Swagelok‘s defense that the court did not have jurisdiction was also not frivolous considering the conflicting case law on the issue. The Pattersons objected to the magistrate‘s decision, but the trial court overruled their objections. The court determined that Swagelok‘s initial failure to disclose the Plan Document did not rise to the level of frivolous conduct under the specific facts of this case. It also determined that the legal arguments Swagelok made throughout the case and in its motion for sanctions did not violate
{26} The Pattersons argue that the trial court incorrectly found that they did not request the Plan Document in their initial discovery requests. They also argue that it was not reasonable for Swagelok to believe that it complied with their discovery requests by producing only the SPD. Notably, the Pattersons argue that it was unreasonable for Swagelok‘s counsel to accept Swagelok‘s representation that the SPD was the only document pertaining to
{27} Although arguing that Swagelok‘s conduct was frivolous, the Pattersons do not explain which part of the definition of
{28} According to Swagelok‘s benefit program manager, she understood that the SPD was part of a larger and greater document that they referred to as “the Wrap plan.” She described the Wrap plan as something that consolidated all of Swagelok‘s various benefit plans, but she also asserted that amendments to each individual plan might be in the SPD for health benefits, the SPD for vision benefits, and so forth.
{29} The trial court found credible that Swagelok considered the SPD to be the controlling document regarding Swagelok‘s subrogation and reimbursement rights. In support of its finding, the court noted the case law that holds that a SPD can be the controlling plan document under ERISA. The court also noted that the Pattersons did not ask the benefit program manager why Swagelok did not provide the Plan Document with its initial discovery response.
{30} Upon review of the record, we conclude that the Pattersons have not established that Swagelok‘s failure to produce the Plan Document initially “obviously serve[d] merely to harass or maliciously injure” the Pattersons.
{31} Any misstatements in the magistrate‘s decision that were adopted by the trial court were harmless. Because the Pattersons did not establish that Swagelok engaged in frivolous conduct, any incorrect statements by the trial court regarding the amount that the Pattersons may recover for such conduct were also harmless. We conclude that the trial court did not err when it determined that Swagelok did not violate
CROSS-APPEAL ASSIGNMENT OF ERROR II
THE TRIAL COURT ABUSED ITS DISCRETION BY FAILING TO ADDRESS WHETHER SWAGELOK AND ITS COUNSEL VIOLATED R.C. 2323.51 FOR FILING THEIR MOTION FOR SANCTIONS.
{32} In their second assignment of error, the Pattersons argue that the trial court failed to address whether the motion for sanctions that Swagelok filed against them was frivolous. The Pattersons note that Swagelok requested that the trial court award it attorney fees because they allegedly continued seeking contracts, financial records, and depositions even though it had provided all the documentation it possessed concerning its right to subrogation. Swagelok argued that the Pattersons were needlessly attempting to drive up the cost of the litigation by continuing to seek copious amounts of discovery. According to the Pattersons, Swagelok‘s motion was frivolous because all their requests were within the bounds of discovery and Swagelok only ever produced the Plan Document because of their additional discovery requests.
{33} In its ruling on the Pattersons’ motion for attorney fees, the court first considered whether Swagelok engaged in frivolous conduct when it initially failed to disclose the Plan Document. It determined that Swagelok‘s conduct did not rise to the level of frivolous conduct. The court then wrote: “[n]or can the Court find the legal arguments made by Swagelok during the case or Swagelok‘s motion for sanctions against the Plaintiffs violates
III.
{34} Swagelok‘s assignments of error are overruled. The Pattersons’ assignments of error are also overruled. The judgment of the Medina County Court of Common Pleas is affirmed.
Judgment affirmed.
There were reasonable grounds for this appeal.
We order that a special mandate issue out of this Court, directing the Court of Common Pleas, County of Medina, State of Ohio, to carry this judgment into execution. A certified copy of this journal entry shall constitute the mandate, pursuant to App.R. 27.
Immediately upon the filing hereof, this document shall constitute the journal entry of judgment, and it shall be file stamped by the Clerk of the Court of Appeals at which time the period for review shall begin to run. App.R. 22(C). The Clerk of the Court of Appeals is instructed to mail a notice of entry of this judgment to the parties and to make a notation of the mailing in the docket, pursuant to App.R. 30.
Costs taxed equally to both parties.
JENNIFER HENSAL
FOR THE COURT
CARR, J.
TEODOSIO, J.
CONCUR.
APPEARANCES:
SHAUN D. BYROADS and DARAN KIEFER, Attorneys at Law, for Appellant/Cross-Appellee.
BENJAMIN P. PFOUTS, Attorney at Law, for Appellees/Cross-Appellants.
