Lead Opinion
T1 The dispositive issues presented in these consolidated proceedings are: (1) Do Oklahoma courts have subject matter jurisdiction over an ERISA fiduciary's claim for damages for breach of the subrogation/reim-bursement provision of an ERISA-regulated employee benefit plan? and if so, (2) Was plaintiff entitled to summary relief? We answer the first question in the affirmative and the second in the negative.
I
ANATOMY OF LITIGATION
T2 Phillip M. Reeds (Phillip) was injured in August 1999 in an automobile accident that
T3 Phillip and his parents/guardians, William S. Reeds and Elien O. Reeds (collectively "defendants" or "the Reeds"), sued the tortfeasor and their own automobile insurer. They settled with their own insurer for $2,250,000.00.
NAICO brought this action against defendants in the district court, Carter County, alleging breach of contract. Both sides moved for summary judgment. After consideration of the submitted materials, the trial court granted judgment to NAL-CO, ordering defendants to pay damages in the amount of $454,407.94. Plaintiff's motion for prejudgment interest and costs was granted and defendants were ordered to pay the additional sum of $146,607.81. Defendants' postjudgment motion for a new trial
T5 Defendants appealed. The appeal, designated as Cause No. 101,678, was assigned to the Court of Civil Appeals in Oklahoma City. While the appeal was pending, defendants filed an application in this court, designated as Cause No. 101,994, invoking the court's original cognizance to direct the trial court not to implement or enforce the judgment and to dismiss the action for lack of subject matter jurisdiction. We agreed to assume original cognizance, withdrew the appeal's earlier assignment to the Court of Civil Appeals, and consolidated the two proceedings for disposition by a single opinion under surviving Cause No. 101,994.
T6 Defendants argue in this consolidated proceeding that Oklahoma courts do not have subject matter jurisdiction over this action because federal law requires us to treat plaintiff's lawsuit as a federal ERISA claim over which the federal courts assert exclusive subject matter jurisdiction. They argue in
T7 For the reasons to be explained below, we hold that Oklahoma courts have jurisdiction over this action, but that summary judgment was not plaintiffs due. We hence reverse the judgment and remand the cause with instructions to proceed in a manner consistent with this opinion.
II
STANDARD OF REVIEW
$8 Summary process-a special pretrial procedural track pursued with the aid of acceptable probative substitutes
19 Summary relief issues stand before us for de novo review."
III
OKLAHOMA COURTS HAVE JURISDICTION OVER AN ERISA FIDUCIARY'S CLAIM FOR DAMAGES FOR BREACH OF AN ERISA-REGULAT-ED HEALTH INSURANCE CONTRACT
110 Our initial task today calls for an inquiry into whether Oklahoma courts stand ousted by federal law of jurisdiction over a state-law contract action brought by an ERISA fiduciary against an ERISA beneficiary over the interpretation and application of an ERISA plan provision. When there are no contested jurisdictional facts,
111 The state judiciary's subject matter jurisdiction is derived from the State Constitution which gives Oklahoma courts unlimited original jurisdiction over all justiciable matters unless otherwise provided by law.
€12 Because they are courts of limited jurisdiction, federal courts presume jurisdiction is lacking absent an adequate showing by the party invoking it.
113 The United States Supreme Court has recognized a narrow exception to the well-pleaded complaint rule. That exception, known as the complete preemption doctrine, provides that a strictly state-law claim presents a federal question if Congress intended for a specific federal statute to provide the exclusive cause of action, procedures, and remedies for that claim."
114 Complete preemption is a rule of federal jurisdiction.
115 Defendants did not attempt to remove NAICO's claim to federal court based on the complete preemption doctrine. Rather, they argue that the state-court judgment is a nullity because complete preemption ousts the state court of subject matter jurisdiction over NAICO's state-law claim.
T16 The causes of action available under ERISA are set out in nine civil enforcement provisions found at § 502(a), 29 U.S.C. § 1132(a). These provisions specify who may bring an action under ERISA and what relief is available to enforce, or obtain redress for violations of, ERISA or of benefit plans covered by ERISA. A plan fiduciary is authorized by ERISA to bring a civil action only under the provisions of $ 502(a)(8), which state:
"A civil action may be brought ... by a ... fiduciary (A) to enjoin any act or practice which violates any provision of this subchapter or the terms of the plan, or (B) to obtain other appropriate equitable relief () to redress such violations or (i) to en-foree any provisions of this subchapter or the terms of the plan; ..."35
Under the terms of § 502(e)(1), any claim brought under the provisions of § 502(a)(3) comes within the exclusive jurisdiction of the federal courts.
¶ 17 In Metropolitan Life Insurance Company v. Taylor," the United States Supreme Court applied the complete preemption doe-trine to ERISA.
118 These cases provide little in the way of evidence to support this conclusion beyond Metropolitan Life's expansive language. Complete preemption alters the well-established division of jurisdiction between the state and federal courts. Hence, only when Congress has shown an intent, not merely to preempt state law, but to transfer jurisdiction over a state-law claim to the federal courts does complete preemption apply. In Metropolitan Life, the Court found evidence of the requisite Congressional intent in large part in the legislative history of ERISA.
¶19 Fortunately, we need not decide whether state-law actions that come within the scope of § 502(a)(8) are or are not completely preempted because, even if they are, it does not follow that NAICO's claim comes within that provision's scope. By its express terms, § 502(a)(8) authorizes suits for equitable relief only.
1 20 It would be easy to Jump directly from the words "not authorized" in Knud-son to the conclusion that the Court intended to negate federal subject matter jurisdiction over claims seeking legal relief that would, but for the prayer for legal relief, fall within the seope of 502(a)(8). Indeed, a claim which seeks relief that is "not authorized" by ERISA's civil enforcement scheme may stand outside the jurisdiction of the federal courts, but that is not the only possible legal consequence of Knudson's holding. It is also possible that such a claim stands within the federal courts' jurisdiction, but fails to state a claim under federal law for which relief may be granted. Each of these interpretations of Enudson has its judicial adherents.
¶ 21 We are not unmindful of federal jurisprudence declaring the preeminence of federal authority in the area of employee benefit plan regulation. The United States Supreme Court has spoken of the centrality of the federal interest in ERISA,
DEFENDANTS' UM CARRIER IS A THIRD PARTY UNDER THE PLAN
123 We are asked on appeal to construe the language of the subrogation/reim-bursement provision to determine whether NAICO may be reimbursed from proceeds obtained by its insured from the insured's own UM carrier.
Right to Subrogation
When We pay benefits under the Plan and it is determined that a third party is liable for the same expenses, We have the right to subrogate from the monies payable from the third party equal to the amount We have paid for such benefits. You must reimburse Us from any monies recovered form (sic) a third party as a result of a judgment against or settlement with or otherwise paid by the third party. You must take action against the third party, furnish all the information and provide assistance to Us regarding the action taken, and execute and deliver all documents and information necessary for Us to enforce Our rights of subrogation. (emphasis added)60
¶24 Defendants argue that the words "third party" in the quoted provision do not include an injured insured's UM carrier. We disagree. The plain and ordinary meaning of the term "third party" is simply someone who is not a party to the health insurance contract. A UM carrier's "first party" status vis a vis its insured does not alter its third party status vis a vis the health insurance contract. Defendants would have us limit the words "third party" to the tortfeasor or
¶ 25 The Plan provides not only that the person or entity from whom reimbursement is sought must be a "third party," but that it must be a third party who is "Hable for the same expenses, ..." We hold that the defendants' UM carrier is a "third party liable for the same expenses." UM coverage is typically described as indemnity insurance because it pays the person who pays for the policy, but the UM insurer's obligation to pay anything at all depends on the liability of the uninsured or underinsured tortfeasor. Under our UM statute, once a vehicle is determined to be uninsured, the UM carrier becomes legally responsible-Lie. legally liable-to pay the insured for the same expenses the tortfeasor or the tortfeasor's liability insurer would be liable to pay were the tortfeasor not uninsured or underinsured.
y
THE PLAN DOES NOT CONTAIN A PRIORITY OF PAYMENTS PROVISION THAT OVERRIDES THE OKLAHOMA MAKE-WHOLE RULE
126 Defendants argue that even if their UM benefits are subject to the Plan's subrogation/reimbursement provision, the judgment must be reversed because the trial court erred in finding that the Plan contains a priority of payments provision that overrides the Oklahoma make-whole rule. They contend that in the absence of such a provision, NAICO may only obtain reimbursement if Phillip has been fully compensated for his damages. In light of this rule, defendants assert that summary judgment was inappropriate because plaintiff's evidentiary materials did not indisputably establish that Phillip has been fully compensated. We agree.
¶ 27 In Equity Fire and Casualty Company v. Youngblood,
¶28 The plan language interpreted in Youngblood stated:
11.2 Reimbursement. When any Plan benefits are paid or provided for charges incurred by a Plan Member as a result of an Accidental Injury or Iliness and thot Plan Member makes a recovery (whether by settlement or judgment or otherwise) from any individual or organization equally or financially responsible for such Accidental Injury or Iliness, then the Plan shall have a lien upon any such recovery, and the Plan Member shall reimburse the Plan to the extent that benefits were paid hereunder; provided, however, that the Committee, at its sole discretion, may permit the Plan Member to reimburse the Plan less than the full recovery amount received from such individual or organization. Nevertheless, in no event shall the*115 Plan Member be required to make a reimbursement in an amount exceeding the recovery made by the Plan Member against such individual or organization.64 (emphasis added)
We held that this provision did not establish a priority of payments or otherwise give the insurer a right to subrogation or reimbursement before the beneficiary was made whole.
¶ 29 We have found only a few cases containing "genuinely unambiguous" reimbursement provisions.
SUBROGATION RIGHTS
If you or your dependent sustain an injury caused by a third party, the Plan will pay for the injury, subject to (1) the Plan being subrogated to any recovery or any right of recovery you or your dependent has against that third party, including the right to bring suit in your name; (2) your not taking any action which would prejudice the Plan's subrogation right; and (8) your cooperating in doing what is reasonably necessary to assist the Plan in any recovery. The Plan will be subrogated only to the extent of Plan benefits paid because of the injury. (emphasis added)69
We viewed this language as inadequate to establish the right of the insurer to recoup its payments before the insured was made whole.
T30 Some courts have held that the word "any" or the words "any and all" are sufficient to give the insurer payment priority.
131 Plaintiff argues that its policy contains an adequate expression of its reimbursement priority. Plaintiff cites the following clause in the Plan: "You must reimburse Us from any monies recovered...." We do not regard this as an adequate statement to override the protection afforded an injured insured by the Oklahoma make-whole rule. Following the reasoning in Young-blood, we hold that an insurance contract stands subject to the make-whole rule unless it contains an unequivocal, express statement that the insured does not have to be made whole before the insurer is entitled to recoup its payments.
VI
AN AWARD OF PREJUDGMENT INTEREST AND COSTS RESTS UPON THE VIABILITY OF THE UNDERLYING JUDGMENT AND MUST BE VACATED UPON THE REVERSAL OF THAT JUDGMENT
133 Ancillary orders that are dependent upon the viability of an underlying judgment are nullified or affirmed on appeal by the disposition of the judgment on which they rest.
VII
SUMMARY
¶ 34 We decline to apply the complete preemption doctrine to recast today's claim as one' arising under federal law. The law-equity dichotomy expressed in the text of § 502(a)(8) of ERISA as well as inconclusive U.S. Supreme Court jurisprudence leaves us in grave doubt that plaintiffs claim, which seeks a type of relief not authorized by ERISA, comes "within the scope" of an ERISA cause of action. We will not abdicate our own cognizance over a well-pled state-law claim without a clear directive from the U.S. Supreme Court that federal jurisdiction ousts our own. We nevertheless reverse the trial court's summary judgment for plaintiff because the trial judge erred in concluding as a matter of law that the health insurance contract contained a provision that clearly and unambiguously overrides the Oklahoma make-whole rule. The cause is remanded for further proceedings consistent with this opinion.
¶ 35 ORIGINAL JURISDICTION IS ASSUMED; WRIT OF MANDAMUS IS DENIED; THE TRIAL COURTS SUMMARY JUDGMENT IS REVERSED AND THE CAUSE IS REMANDED FOR FURTHER PROCEEDINGS TO BE CONSISTENT WITH THIS OPINION.
Notes
. Defendants entered into a separate settlement with the tortfeasor and his liability insurer for $10,000.00.
. Although summary judgment, which is a determination that there shall be no trial at all, is perhaps semantically inconsistent with the notion of a "new trial," it is nevertheless authorized by our statutory scheme for postjudgment relief as a motion for reconsideration of the judgment. The provisions of 12 0.$.2001 § 651 define a new trial as "a reexamination in the same court, of an issue of fact or of law or both, after a verdict by a jury, the approval of the report of a referee, or a decision by the court." (emphasis added) CF. Lovejoy v. Stutsman,
. Postjudgment relief may not be secured by means of a motion to dismiss the judgment or order. This is so because by its adjudication a claim is transformed into an obligation called a "judgment," which, unlike a claim, cannot be "dismissed," but must be vacated. Oklahoma's nisi prius practice and procedure authorize post-judgment relief by way of a motion for a new trial, see 12 0.S.2001 §§ 651-655, or by way of a motion to modify or vacate a judgment, see 12 ©.S.2001 §§ 1031-1033. The dismissal motion in the instant case seeks in its concluding paragraph to procure the vacation of the judgment. A motion seeking reconsideration, re-examination, rehearing or vacation of a judgment or final order, which is filed within 10 days of the day such decision was rendered, may be regarded as the functional equivalent of a new trial motion, no matter what its title. Horizons, Inc. v. Keo Leasing Co.,
. " 'Acceptable probative substitutes' are those which may be used as 'evidentiary materials' in the summary process of adjudication." Jackson v. Okla. Memorial Hosp.,
. The focus in summary process is not on the facts which might be proven at trial, but rather on whether the evidentiary material in the record tendered in support of summary adjudication reveals only undisputed material facts supporting but a single inference that favors the movant's quest for reliel. Polymer Fabricating, Inc. v. Employers Workers' Compensation Ass'n,
. To that end, the court may consider, in addition to the pleadings, items such as depositions, affidavits, admissions, answers to interrogatories, as well as other evidentiary materials which are offered in acceptable form without objection from other parties or are admiited over the challenging exception. Polymer, supra note 6, at 18, al 113; Seitsinger supra note 5 at M 16-17, at 1080-81.
. Russell v. Bd. of County Comm'rs,
. An order that grants summary relief, in whole or in part, disposes solely of law questions. It is reviewable by a de novo standard. Brown v. Nicholson,
. Carmichael v. Beller,
. Spirgis v. Circle K Stores, Inc.,
. It is not the purpose of summary process to substitute a trial by affidavit for one by jury. Rather, it is to afford a method of summarily terminating a case (or eliminating from trial some of its issues) when only questions of law remain. State ex rel. Fent v. State ex rel. Okla. Water Resources Bd.,
. Head v. McCracken,
. McCracken, supra note 13; Evers v. FSF Over-lake Associates,
. Christian v. Gray,
. Although the petition in this case does not allege facts that demonstrate federal jurisdiction, plaintiff admits that it is a fiduciary under the Plan. See 29 U.S.C. § 1002(21)(A). Plaintiff also admits that the insurance contract pursuant to which Phillip received benefits is governed by ERISA. Although jurisdictional facts cannot be removed entirely from judicial scrutiny, see Prizevoits v. Indiana Bell Telephone Co.,
. Booth v. McKnight,
. The pertinent terms of the Oxca. Const. Art. 7 § 7(a) are:
"* * * 'The District Court shall have unlimited original jurisdiction of all justiciable matters, except as otherwise provided in this Article, * * *" (emphasis added).
See Holleyman v. Holleyman,
. Yellow Freight System, Inc. v. Donnelly, 494 U.S. $20, 823,
. Id.
. U.S. Const. Art. HHI, § 1. Kontrick v. Ryan,
. The provisions of 28 U.S.C. § 1331 state:
''The district courts shall have original jurisdiction of all civil actions arising under the Constitution, laws, or treaties of the United States."
. U.S. ex rel. Hafter D.O. v. Spectrum Emergency Care, Inc.,
. Metropolitan Life Ins. Co. v. Taylor,
. Franchise Tax Bd. v. Construction Laborers Vacation Trust,
. Both original and removal jurisdiction are governed by the well-pleaded complaint rule. Phillips Petroleum Co. v. Texaco, Inc.,
. Caterpillar Inc. v. Williams,
. Beneficial Nat'l Bank v. Anderson,
. Box Tree South, Ltd. v. Bitterman,
. Lister v. Stark,
. Beneficial Nat'l Bank v. Anderson, supra note 28 at 9,
. See 12 0.$.2001 § 2008(C); DIRECTV, Inc. v. Barrett,
. Caterpillar Inc. v. Williams, supra note 27 at 393,
. Although the complete preemption doctrine is ordinarily invoked to support removal of an action to federal court, Biondo v. Life Ins. Co. of North America,
. See the provisions of 29 U.S.C. § 1132(a)(3).
. The provisions of 29 U.S.C. § 1132(e)(1) state:
"Except for actions under subsection (a)(1)(B) of this section, the district courts of the United States shall have exclusive jurisdiction of civil actions under this subchapter brought by the Secretary or by a participant, beneficiary, fiduciary, or any person referred to in section 1021(0(1) of this title. State courts of competent jurisdiction and district courts of the United States shall have concurrent jurisdiction of actions under paragraphs (1)(B) and (7) of subsection (a) of this section."
. Supra note 24.
. Id. at 66,
. The provisions of § 502(a)(1)(B), 29 U.S.C. § 1132(a)(1)(B), state:
(a) Persons empowered to bring a civil action A civil action may be brought-(1) by a participant or beneficiary-wore ok ue ok
(B) to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan; a
. See e.g. Rutledge v. Seyfarth, Shaw, Fairweather & Geraldson,
. See Metropolitan Life, supra note 24 at 65-66,
. Id., citing H.R. Conf. Rep. No. 93-1280, p. 327, 1974 U.S.C.CA.N. 5038, 5107,
. Metropolitan Life, supra note 24 at 66,
. Id.
. See the terms of § 502(a)(3), supra at text at note 35. See also Mertens v. Hewitt Associates,
.
. Id. at 221,
. Mertens, supra note 45 at 255,
. Holding that a claim, otherwise within the scope of § 502(a)(3) but for its quest for legal relief, stands outside the jurisdiction of the federal courts: Hamrick's Inc. v. Roy, 115 S...W.3d 468 (Tenn.App.2002); Bauhaus USA, Inc. v. Copeland,
. Arnold v. Intervet, Inc.,
. We note that neither party attempts to invoke the ordinary federal preemption provisions under ERISA in § 514(a) and (b), which were dealt with in Hollaway, M.D. v. UNUM Life Insurance Company,
. See eg. Alessi v. Raybestos-Manhattan, Inc.,
. Aetna Health Inc. v. Davila,
. Mertens, supra note 45, at 254,
. of § 502(B, 55. The provisions 29 U.S.C. § 1132(f), state:
''The district courts of the United States shall have jurisdiction, without respect to the amount in controversy or the citizenship of the parties, to grant the relief provided for in subsection (a) of this section in any action." (emphasis added)
. Aetna Health Inc. v. Davila, supra note 53.
. The pertinent terms of § 502(a)(1)(B), 29 U.S.C. § 1132(a)(1)(B), provide:
"A civil action may be brought-(1) by a participant or beneficiary-ok ok
(B) to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan;
. Davila supra note 53 at 214-16,
"Nor can the mere fact that the state cause of action attempts to authorize remedies beyond those authorized by ERISA § 502(a) put the cause of action outside the scope of the ERISA civil enforcement mechanism.... Congress' intent to make the ERISA civil enforcement mechanism exclusive would be undermined if state causes of action that supplement the ERISA § 502(a) remedies were permilted, ..." (emphasis added)
. Although the Plan pursuant to which Phillip received benefits is an ERISA-regulated employee benefit plan, defendants did not interpose ERISA's ordinary preemption provision as an affirmative defense to plaintiff's claim. Under the provisions of ERISA § 514(a) 29 U.S.C. § 1144(a), with but a few exceptions, any state law relating to an ERISA plan is preempted (in the "choice of law" sense). Section 514(a) provides:
"Except as provided in subsection (b) of this section, the provisions of this subchapter and subchapter III of this chapter shall supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan described in section 1003(a) of this title and not exempt under section 1003(b) of this title. ...".
Federal preemption is an affirmative defense. Saks v. Franklin Covey Co.,
. Approximately three months after the accident, NAICO sent a letter to Phillip's father, asking that a "Subrogation Data Form"" be executed. The first page states in part that Phillip "acknowledges the rights of subrogation in favor » of National American Insurance Company ..., and that he "voluntarily agrees to payment from first dollars by third parties in favor of and to National American under said rights of subrogation." The Reeds signed the document. Although both plaintiff and defendants refer to this instrument as a contract and rely on it in support of their respective interpretations of the subrogation/reimbursement provision, we do not consider it admissible evidence of the contract's meaning. Parties to an insurance policy stand in a contractual relationship to one another. Silver v. Slusher,
.
.
. Id. at 1 15, 576-77 (adopting "the make whole rule in contract subrogation and reimbursement cases where (1) the subrogation or reimbursement contract neither expressly sets priorities for the repayment of benefits, nor otherwise gives a - right to subrogation or reimbursement before any funds are paid to the beneficiary, nor vests the plan manager's (sic) discretionary authority to interpret ambiguous provisions of the plan; and (2) the compensation received by the beneficiary from settlement with or judgment against a third party represents less than full compensation. Under such circumstances, the subrogation and reimbursement terms of the contract will be unenforceable.").
. Id. at T3, at 574.
. Id. at % 17, at 577.
. Id. at % 10, at 575.
. See e.g. Hershey v. Physicians Health Plan,
.
. Youngblood, supra note 62 at 19, n. 3, at 575, n. 3.
. See eg. Great-West Life & Annuity Ins. Co. v. Clingenpeel,
. King v. Pan American Life Ins. Co.,
. See Rules for the District Courts of Oklahoma, Rule 13(a), 12 O.S. Supp.2002 Ch. 2., App.; Wynn v. Avemeo Ins. Co.,
. See Rules for the District Courts of Oklahoma, Rule 13(b), 12 O.S. Supp.2002 Ch. 2: Avermco, supra note 72.
. Harkrider v. Posey,
Dissenting Opinion
dissenting.
I respectfully dissent for the reason that the language, meaning and intent of the reimbursement terms of this insurance contract are clear and unambiguous. The trial court was correct in its decision.