ERISA-Eighth Circuit Permits An Action Under ERISA For Declaratory Judgment By A Health Plan To Determine Which Of Two Plans Has Primary Responsibility To Provide Health Benefits

In Dakotas and Western Minnesota Electrical Industry Health & Welfare Fund v. First Agency, Inc. ,  Dockets: 16-1846, 16-3319, 16-3375 (8th Cir. 2017), Jacob Plassmeyer incurred medical expenses after injuring his knee during a collegiate baseball practice in February 2014. Jacob’s college provided its student athletes insurance covering accidental injuries under a blanket policy issued by First Agency, Inc., as appointee of Guarantee Trust Life Insurance Company (collectively referred to as “FA”). Jacob’s father is also an insured participant in the Dakotas and Western Minnesota Electrical Industry Health and Welfare Fund (“Dakotas”), an employee welfare benefit plan. Jacob is covered under this ERISA plan as a dependent of his father. Jacob timely filed claims with both insurers. Though it is undisputed his baseball injuries are covered by both policies, both insurers refused to pay. FA claimed that Dakotas must pay first because FA’s policy is “excess only.” Dakotas claimed that, under the plan’s coordination of benefits (“COB”) provision, FA’s coverage is primary. Jacob’s claim remains unpaid.

 

The trustees of  Dakotas brought this declaratory judgment action against FA under § 502(a)(3) of ERISA, seeking an order enforcing the COB provisions in the Dakotas plan by declaring that FA’s policy provides primary coverage of Jacob’s claim for medical expenses already incurred. The district court  denied FA’s motion to dismiss and granted Dakotas’ motion for summary judgment, concluding that (i) § 502(a)(3) allows ERISA plan trustees to bring a declaratory judgment action to determine the extent of the plan’s liability, and (ii) under the plan’s COB provision FA has primary responsibility for Jacob’s covered medical expenses. FA appeals those rulings. Reviewing de novo, the Eighth Circuit Court of Appeals affirmed the district courts’ rulings.

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