Here is a wonderful analysis – which manages to both review its past and guess intelligently at its future – of Montanile v Board of Trustees of the National Elevator Industry Health Benefit Plan, the latest Supreme Court case to try to determine the scope of equitable remedies available under ERISA. Montanile, scheduled to be argued on November 9, is yet another case trying to establish the rules as to when a plan can recoup, out of a participant’s litigation recovery, the medical expenses it paid for the participant. Any experienced personal injury lawyer, whether plaintiff or defense side, will tell you that repaying most liens out of a recovery is a no-brainer, something that is accepted as a matter of course, but these usually involve workers compensation liens. What complicates the scenario here is, quite simply, ERISA, something which many lawyers who don’t practice in the area would insist always complicates things. More specifically and precisely, what complicates this particular case is the fact that the medical expenses were paid by an ERISA governed plan, and the recovery was spent by the participant without first repaying the expenses to the plan. ERISA complicates the question of whether the plan is entitled to repayment because, first, ERISA provides a limited group of remedies and the claim for repayment must be shoehorned into them if it is to succeed, and, second, ERISA pulls in historical concepts of equity jurisprudence for purposes of making this decision.
The fact that these two factors may alter an otherwise expected right to reimbursement is somewhat ironic here, in a what’s sauce for the goose is sauce for the gander kind of way. These elements –the limited remedies available under ERISA and the tight limitation on equitable remedies in the ERISA context – have long complicated participants’ ability to recover from plans and fiduciaries; now, here, they complicate a plan’s ability to recover from a participant.