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Swire Pacific Holdings Inc v. Jones

United States District Court, W.D. Washington, Seattle

January 7, 2020

SWIRE PACIFIC HOLDINGS, INC., and THE EMPLOYEE HEALTH CARE PLAN FOR THE BOTTLING EMPLOYEES OF SWIIRE PACIFIC HOLDINGS, INC. and ITS AFFILIATES, Plaintiffs,
v.
JAMES JONES, and JEFFREY R. CAFFEE LEGAL, PLLC d/b/a THE LAW OFFICES OF JEFFREY R. CAFFEE, Defendants.

          ORDER DENYING DEFENDANTS' SECOND MOTION TO DISMISS

          RICARDO S. MARTINEZ CHIEF UNITED STATES DISTRICT JUDGE.

         I. INTRODUCTION

         This matter comes before the Court on Defendants' Second Motion to Dismiss under Rule 12(b)(6). Dkt. #29. Plaintiffs oppose. For the reasons stated below, the Court DENIES Defendants' Motion.

         II. BACKGROUND

         For purposes of this Motion to Dismiss, the Court will accept all facts in the Amended Complaint as true. The Court will briefly summarize these facts as necessary for ruling on this Motion.

         Plaintiffs are The Employee Health Care Plan for the Bottling Employees of Swire Pacific Holdings, Inc. and its' Affiliates (“Plan”) and Swire Pacific Holdings, Inc., d/b/a Swire Coca-Cola, USA (“Swire”). Swire alleges it is the Plan Sponsor and Plan Administrator for the Plan.

         Defendant James Jones worked for Swire and was a covered person and beneficiary of the self-funded ERISA plan at issue in this case. On or about July 11, 2018, Jones was injured in a serious car accident, the details of which are not at issue. The Plan paid medical benefits on his behalf, at least $407, 622.76.

         Benefits provided under the Plan are fully funded by Swire and not through an insurance carrier, although the plan is administered by Regence BlueCross BlueShield of Utah.

         Plaintiffs allege that the applicable Summary Plan Description (“SPD”), effective from January 1, 2018, to December 31, 2018, is the controlling document for the Plan, and that “there is no separate or additional master plan document for the Plan.” Dkt. #28 at 3.

         The SPD/Plan contains a “Subrogation and Right of Recovery” provision, setting forth the self-funded ERISA Plan's rights of reimbursement and subrogation. See Dkt. #28-1 (“Summary Plan Description” or “SPD”) at 53-54 (“If You receive any payment as a result of an Injury, Illness or condition, You agree to reimburse the Plan first from such payment for all amounts the Plan has paid and will pay as a result of that Injury, Illness or condition, up to and including the full amount of Your recovery.”).

         Defendant Jones settled his claims related to the Accident for $150, 000. However, he has refused to reimburse the Plan. The other Defendant in this case, his counsel Jeffrey R. Caffee Legal, PLLC, has “dominion and control over all of part of the Disputed Funds…” Dkt. #28 at 6.

         Plaintiffs bring claims under 29 U.S.C. § 1132(a)(3) to impose an equitable lien or constructive trust with respect to the disputed funds. They seek an Order enforcing the terms of the Plan and requiring Defendants to turn over the full amount of the disputed funds, as well as attorneys' fees.

         III. DISCUSSION

         A. Legal Standard ...


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