No. 99-1786
In the Supreme Court of the United States
GREAT-WEST LIFE & ANNUITY INSURANCE
COMPANY, ET AL., PETITIONERS
v.
JANETTE KNUDSON AND ERIC KNUDSON
ON WRIT OF CERTIORARI
TO THE UNITED STATES COURT OF APPEALS
FOR THE NINTH CIRCUIT
BRIEF FOR THE UNITED STATES
AS AMICUS CURIAE SUPPORTING PETITIONERS
BARBARA D. UNDERWOOD
Acting Solicitor General
Counsel of Record
EDWIN S. KNEEDLER
Deputy Solicitor General
BETH S. BRINKMANN
Assistant to the Solicitor
General
Department of Justice
Washington, D.C. 20530-0001
(202) 514-2217
JUDITH E. KRAMER
Acting Solicitor of Labor
ALLEN H. FELDMAN
Associate Solicitor
NATHANIEL L. SPILLER
Deputy Assistant Solicitor
GARY K. STEARMAN
Attorney
Department of Labor
Washington, D.C. 20210
QUESTION PRESENTED
Whether a civil action brought under Section 502(a)(3) of the Employee Retirement
Income Security Act of 1974,
29 U.S.C. 1132(a)(3), to redress a violation of, or to enforce, a term of
a plan that requires a plan participant or beneficiary to reimburse the
plan for medical expenses paid by the plan if the participant or beneficiary
receives a recovery from a third-party tortfeasor, constitutes an action
for "appropriate equitable relief" authorized by Section 502(a)(3).
In the Supreme Court of the United States
No. 99-1786
GREAT-WEST LIFE & ANNUITY INSURANCE
COMPANY, ET AL., PETITIONERS
v.
JANETTE KNUDSON AND ERIC KNUDSON
ON WRIT OF CERTIORARI
TO THE UNITED STATES COURT OF APPEALS
FOR THE NINTH CIRCUIT
BRIEF FOR THE UNITED STATES
AS AMICUS CURIAE SUPPORTING PETITIONERS
INTERESTS OF THE UNITED STATES
Section 502(a)(3) of the Employee Retirement Income Security Act of 1974
(ERISA), 29 U.S.C. 1132(a)(3), authorizes an ERISA plan participant, beneficiary,
or fiduciary to bring a civil action to obtain "appropriate equitable
relief" to redress violations of, and to enforce, both the terms of
the plan and Title I of ERISA, 29 U.S.C. 1101-1169 (1994 & Supp. V 1999).
This suit was filed by an employee benefit plan, its administrator (as a
fiduciary of the plan), and its insurer to enforce a term of the plan that
requires a participant or beneficiary to reimburse the plan for medical
expenses out of any funds recovered by the participant or beneficiary from
a third-party tortfeasor. The question presented is whether the relief sought
by the plan to obtain reimbursement constitutes equitable relief within
the meaning of Section 502(a)(3).
The Secretary of Labor is authorized under Section 502(a)(5) of ERISA, 29
U.S.C. 1132(a)(5), to bring civil actions to obtain "appropriate equitable
relief" to redress violations of, and to enforce, Title I of ERISA.
Accordingly, the Court's determination of what constitutes "appropriate
equitable relief" may affect not only the scope of private civil actions
under Section 502(a)(3) to enforce Title I, which are a necessary complement
to actions by the Secretary, but also the scope of the Secretary's own authority
to enforce Title I of ERISA.
STATEMENT
1. Petitioner Health and Welfare Plan for Employees and Dependents of Earth
Systems, Inc. (the plan), is a medical and hospital benefits plan that qualifies
as an employee welfare benefit plan subject to the Employee Retirement Income
Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq. Pet. App. A2, C2. Petitioner
Earth Systems, Inc. (Earth Systems), is the sponsor and administrator of
the plan. J.A. 24-25, 89. Petitioner Great-West Life & Annuity Insurance
Company (Great-West) is the stop-loss insurer for the plan and the assignee
of the plan for purposes of obtaining reimbursement. Pet. App. A2, C2.1
Respondent Janette Knudson was seriously injured in an automobile accident
on June 10, 1992. Pet. App. A2. At the time of the accident, she was covered
by the plan as an eligible dependent because she was the spouse of respondent
Eric Knudson, who was an employee of a wholly-owned subsidiary of petitioner
Earth Systems and a participant in the plan. Id. at A2, C2.
2. The summary plan description (SPD) for the plan2 provided that, in the
event a "third party may be liable or legally responsible for expenses
incurred by a Covered Person for: an illness; or a sickness; or a bodily
injury," the plan would pay the covered expenses, but would "have
the right to recover from the Covered Person any payment for benefits paid
for treatment of such [l]oss * * * which the Covered Person is entitled
to receive from the third party." J.A. 58. The SPD further provided
that the plan would "have a first lien upon any recovery, whether by
settlement, judgment or otherwise, that the Covered Person receives"
from the third party or the third party's insurer. Ibid. The lien was not
to exceed "the amount of benefits paid" by the plan for the medical
treatment or "the amount received by the Covered Person for such medical
treatment from the third party." J.A. 59. The SPD also set forth certain
conditions pertaining to the plan's right of recovery. First, it stated
that the covered person must "cooperate fully" with the plan in
asserting its right to recover. Ibid. Second, the SPD specified that, if
the covered person received a recovery from a third party but failed to
reimburse the plan, the person would be personally liable to the extent
of the recovery from the third party up to the amount of the plan's first
lien. Ibid. Third, the SPD provided that, before the plan paid for treatment,
it "may require the Covered Person to provide all information and sign
and return all documents necessary to exercise [its] rights [of recovery]
under this provision." Ibid.
Pursuant to those terms of the plan, petitioner Great-West, on behalf of
the plan, notified respondent Eric Knudson on August 19, 1992, of the plan's
entitlement to full reimbursement for any expenses paid on Janette Knudson's
behalf, if any settlement or judgment was received from a court. J.A. 71-72.
On September 30, 1992, Great-West wrote a similar letter to Janette Knudson.
J.A. 75-76. Great-West explained that it was investigating the plan's possibilities
for recovering from third parties, and it informed Janette Knudson of the
plan's first lien right of recovery to any sums she received in settlement
or in satisfaction of a judgment as a result of the accident. J.A. 75. Great-West
also requested, in conformity with the plan, that she sign a right-of-recovery
agreement. J.A. 75-76. Great-West's letter stated that any attorney representing
Knudson should be given the correspondence and that any "[s]ettlement
of this matter in contravention" of the terms in the letter "does
not extinguish the Plan's rights in this matter or reduce its legal options."
J.A. 76.
On October 20, 1992, respondent Eric Knudson signed the right-of-recovery
agreement. See J.A. 77-78. In that agreement, he acknowledged that as a
participant in the plan he had made a claim for covered medical benefits
for his wife's injuries, and he requested that benefits be paid by the plan
at that time "without the necessity of awaiting final determination
of responsibility and with the understanding that no benefits may be payable
and that another party or insurer may be liable for like benefits for which
they will make payments." J.A. 77. Eric Knudson also agreed that the
plan may be subrogated to any rights he or his dependent may have to benefits
from the other party; agreed to transfer to the plan any right he or his
dependents may have to take legal action against the other party; and acknowledged
that, under the terms of the plan, the plan may obtain reimbursement from
him of any payment of benefits for which he or his dependents may be entitled
to recover from a third party. J.A. 77-78. Eric Knudson further acknowledged
that the plan "shall automatically have a first lien upon any recovery,
whether by settlement, judgment or otherwise"; that "[s]aid first
lien shall be for the amount of medical and hospital benefits paid by the
Plan"; and that he would be personally liable to the plan "to
the extent of such recovery up to the amount of its first lien." J.A.
78. Finally, Eric Knudson agreed "to cooperate fully with the Plan
in asserting its rights to recover." Ibid.
The plan paid benefits on behalf of Janette Knudson in the form of medical
expenses totaling $411,157.11. Pet. App. A2.
3. In 1993, respondents filed suit in state court against the manufacturer
of the automobile that Janette Knudson was driving when she was injured
and against others allegedly responsible for the accident. Pet. App. A2,
B1, C2. The parties ultimately settled the case for $650,000. By orders
dated July 23, 1997, and August 1, 1997, the state court approved the settlement
and resolved the status of various competing liens against the settlement.
Id. at A2, C3-C4.3 The settlement allocated five percent of the award, or
$13,828.70, to past medical expenses. Id. at A2, C3. Respondents tendered
a check in that amount to petitioners, who rejected the payment because
in their view the plan was entitled to payment in full of the $411,157.11
in medical expenses that it had paid on behalf of respondents. Id. at A2-A3,
C3-C4. Petitioners requested that respondents' attorney segregate the settlement
funds pending the outcome of the instant suit in federal court, but respondents'
attorney declined because the monies had gone directly from the automobile
manufacturer to a trust established for Janette Knudson. Id. at C4.
4. a. Meanwhile, on May 19, 1997, petitioner Great-West had filed the instant
action under Section 502(a)(3) of ERISA, 29 U.S.C. 1132(a)(3), to enforce
the reimbursement provision of the plan through equitable and declaratory
relief. J.A. 81-86. On July 3, 1997, Great-West, now joined by petitioners
Earth Systems and the plan, filed a first amended complaint (see J.A. 87-95)
requesting injunctive relief to prevent respondents from violating the plan
by refusing to agree to reimburse it; to enforce the terms of the plan by
requiring respondents to make reimbursement in the amount of $411,157.11
out of any proceeds recovered from third parties; and to prevent respondents
from disposing of any funds received pursuant to a settlement because respondents
had failed to honor petitioners' subrogation rights under the plan. J.A.
92-94. Petitioners also requested a declaration that respondents are required
to reimburse the plan $411,157.11 out of any proceeds they recover from
third parties, J.A. 93, a temporary restraining order to prevent respondents
from seeking state-court approval of the settlement, ibid., and "any
other relief to which [the plan] is entitled," as well as attorney's
fees. J.A. 95.4
b. On May 14, 1998, the district court, ruling on cross-motions for summary
judgment, entered judgment for respondents. Pet. App. C1-C12. The district
court held that petitioners' rights under the plan were limited to the portion
of the state-court settlement that was attributed by the state court to
past medical expenses. Id. at C10.5 The court rejected as arbitrary and
capricious the plan administrator's interpretation of the plan to allow
petitioners to be "reimbursed 100% of any third party recovery,"
because the court interpreted the plan to limit reimbursement to the lesser
of "the amount of benefits paid out" by the plan ($411,157.11)
or "the amount received from a third party for medical treatment,"
which the court understood here to be "the portion of the $650,000
[settlement] that is attributable to medical expenses." Id. at C9-C10.6
The court held that because the state court concluded that five percent
of the settlement is attributed to petitioners' lien, petitioners' right
of recovery in this action is limited to that amount.
5. a. The court of appeals affirmed the district court's judgment, but on
different grounds. Pet. App. A2-A4. The court explained that Section 502(a)(3)
of ERISA authorizes only an action for equitable relief, and that, in FMC
Medical Plan v. Owens, 122 F.3d 1258 (9th Cir. 1997), it had held that "reimbursement
of payments made to a beneficiary of an insurance plan by a third party,
which [petitioners] seek here, is not equitable relief within the meaning
of § 1132(a)(3)." Pet. App. A3-A4.7 The court of appeals rejected
petitioners' argument that Owens was wrongly decided and declined petitioners'
request for en banc review, noting that it had recently reaffirmed the Owens
holding in Reynolds Metals Co. v. Ellis, 202 F.3d 1246 (9th Cir.), cert.
dismissed, 121 S. Ct. 674 (2000). Pet. App. A4.
b. The Owens decision, which the panel in this case felt bound to follow,
held that under Mertens v. Hewitt Associates, 508 U.S. 248 (1993), the term
"equitable relief" must be given a "narrow construction"
for purposes of Section 502(a)(3) of ERISA, see 122 F.3d at 1262, and relief
is limited to "injunction, mandamus, and restitution," id. at
1260-1261. The Ninth Circuit concluded in Owens that the complaint in that
case-which sought reimbursement out of a participant's third-party recovery
for benefits paid by the plan- did not purport to seek either an injunction
or mandamus. The court also concluded that restitution was not available
because, in its view, Mertens holds that restitution consists only of the
return of "ill-gotten" assets or profits taken from a plan, id.
at 1261, and the participant in Owens had obtained the payments from the
plan pursuant to its terms, not by any fraud or wrongdoing. The court held
that, under the construction of Section 502(a)(3) it believed was "mandated
by Mertens," a claim for reimbursement is not authorized in those circumstances.
Id. at 1262. The court instead viewed the suit as a "breach of contract
claim" in which the remedy sought was "money damages for [the
participant's] alleged breach," and it held that such relief is not
available under Section 502(a)(3). Id. at 1261-1262.
For similar reasons, the Ninth Circuit in Owens rejected the contention
that a constructive trust could be imposed. The court recognized that the
Ninth Circuit had previously held that a constructive trust constitutes
an equitable remedy under ERISA. But it held that remedy was unavailable
in Owens because "a constructive trust is born from some form of ill-gotten
gain of another's property," and the participant in Owens had not obtained
the payment of medical expenses from the plan "by any form of fraud,
duress, or unconscionable behavior," or as a result of any breach of
fiduciary duty. 122 F.3d at 1261.8
SUMMARY OF ARGUMENT
A. A civil action constitutes an action for "appropriate equitable
relief" within the meaning of Section 502(a)(3) of the Employee Retirement
Income Security Act of 1974 (ERISA), 29 U.S.C. 1132(a)(3), when it seeks
to redress a violation of, or to enforce, a term of an ERISA plan that requires
a participant or beneficiary to reimburse the plan out of a recovery from
a third-party tortfeasor. The court of appeals erred in characterizing such
an action as one seeking money damages for a breach of contract, which constitute
legal relief not available under Section 502(a)(3). That characterization
disregards both the strong support in traditional equitable principles for
requiring such relief, and this Court's holding that the common law of trusts
provides a "starting point for analysis [of ERISA] . . . [unless] it
is inconsistent with the language of the statute, its structure, or its
purposes." Harris Trust & Sav. Bank v. Salomon Smith Barney Inc.,
530 U.S. 238, 250 (2000) (quoting Hughes Aircraft Co. v. Jacobson, 525 U.S.
432, 447 (1999)).
Consistent with those principles, an action to enforce a reimbursement term
of a plan is properly viewed as an action for equitable relief because it
seeks to prevent unjust enrichment of the participant or beneficiary and
because the relief is measured by the unjust gain to the defendant, not
by the loss to the plan. Such a reimbursement action is analogous to a traditional
suit in equity to enforce an agreement by a beneficiary to pay money into
a trust, or to obtain repayment from a beneficiary of an advance made from
a trust.
B. In Mertens v. Hewitt Associates, 508 U.S. 248 (1993), the Court held
that "appropriate equitable relief" under Section 502(a)(3) means
"those categories of relief that were typically available in equity
(such as injunction, mandamus, and restitution, but not compensatory damages)."
Id. at 256. Equity typically provided a variety of remedies to prevent unjust
enrichment, including restitution, constructive trust, equitable lien, subrogation,
and specific performance. A court sitting in equity has the flexibility
to choose which of those types of relief is most appropriate in the circumstances
of the particular case.
C. The Ninth Circuit is wrong in believing that Mertens limits the availability
of restitution and constructive trusts in actions under Section 502(a)(3)
to cases involving fraud or other wrongdoing. Under the court of appeals'
view, the reimbursement terms of an ERISA plan cannot be enforced under
Section 502(a)(3) because the participant or beneficiary was authorized
to receive payment from the plan as an initial matter. But the Mertens Court
referred to the availability of "restitution of ill-gotten plan assets
or profits" merely as an example of "appropriate equitable relief"
under Section 502(a)(5); the Court did not purport to limit restitution
to those circumstances. 508 U.S. at 260. Indeed, elsewhere in Mertens the
Court explained, without further limitation, that "equitable relief"
under Section 502(a)(3) means "those categories of relief that were
typically available in equity (such as injunction, mandamus, and restitution,
but not compensatory damages)." Id. at 256 (emphasis omitted). Under
well-established principles of equity, wrongdoing is not an essential element
of a claim for restitution or a constructive trust, as the Court recently
confirmed in Harris Trust, 530 U.S. at 251.
ARGUMENT
AN ACTION MAY BE BROUGHT UNDER SECTION 502(a)(3) OF ERISA TO ENFORCE OR
REDRESS A VIOLATION OF AN ERISA PLAN TERM THAT REQUIRES A PARTICIPANT OR
BENEFICIARY TO REIMBURSE THE PLAN FOR MEDICAL EXPENSES RECOVERED FROM A
THIRD PARTY
Section 502(a)(3) of ERISA provides, inter alia, that a fiduciary of a plan
governed by ERISA may bring a civil action "to enjoin any act or practice
which violates * * * the terms of the plan," and "to obtain other
appropriate equitable relief * * * to redress such violations or * * * to
enforce * * * the terms of the plan." 29 U.S.C. 1132(a)(3).9 In Mertens
v. Hewitt Associates, 508 U.S. 248 (1993), the Court held that, for purposes
of Section 502(a)(3), "equitable relief" does not mean whatever
relief could have been provided in a case by a court in equity, because
that category would include remedies that are traditionally legal, but that
an equity court could grant in certain circumstances. Id. at 256-257. Rather,
the Court held that the term "equitable relief," as used in Section
502(a)(3), means "those categories of relief that were typically available
in equity (such as injunction, mandamus, and restitution, but not compensatory
damages)." Id. at 256. The Court stated, for example, that, under Section
502(a)(3), a defendant "may be enjoined from participating in a fiduciary's
breaches, compelled to make restitution, and subjected to other equitable
decrees." Id. at 262.
In their first amended complaint, petitioners sought relief that is typically
available in equity, including an injunction to enforce the terms of the
plan that expressly provide for reimbursement, to prevent respondents from
violating those terms, to require respondents to reimburse the plan in "the
amount of $411,157.11 out of any proceeds they recovered from third parties,"
and to prevent respondents from disposing of any funds received pursuant
to settlement of their claims against third parties. J.A. 92, 94-95. They
also sought "any other relief" to which they are entitled. J.A.
95. Petitioners' suit thus comes within the plain meaning of Section 502(a)(3)
as a suit to enjoin an act that violates the terms of a plan, and to obtain
other "appropriate equitable relief" to redress such a violation
and to enforce the terms of a plan.
The Ninth Circuit's contrary conclusion was based on its view that reimbursement
of funds to a plan out of payments made to a participant or beneficiary
by a third party is not equitable relief. Pet. App. A3-A4. That conclusion
rests on two faulty premises. First, the Ninth Circuit believed that an
action to enforce a reimbursement term of a plan is a suit seeking "money
damages" for a breach of contract, a form of legal relief that is not
available under Section 502(a)(3). Owens, 122 F.3d at 1261-1262; Cement
Masons, 197 F.3d at 1006-1007. Second, the Ninth Circuit believed that equitable
relief in the form of restitution or a constructive trust is not available
in actions to enforce a reimbursement term of a plan because the plan participant
or beneficiary from whom reimbursement is sought did not obtain the plan
funds in the first instance through fraud or other wrongdoing. Ibid. Both
of those premises are contrary to this Court's precedents and must be rejected
to ensure proper enforcement of ERISA plans.
A. A Suit To Enforce A Reimbursement Term Of An ERISA Plan Constitutes An
Action For Appropriate Equitable Relief, Not Money Damages, Because It Seeks
To Prevent Unjust Enrichment
1. An action to enforce a term of an ERISA plan that requires a participant
or beneficiary to reimburse the plan for expenses recovered from a third
party is an action to prevent the participant or beneficiary from being
unjustly enriched. When a plan expressly conditions the payment of medical
benefits on subsequent reimbursement to the plan out of funds recovered
by the participant or beneficiary from a third-party tortfeasor, the participant
or beneficiary is unjustly enriched when he or she retains the amount recovered
from a third party and does not reimburse the plan. An action to enforce
such a reimbursement term is properly brought as an equitable action to
prevent unjust enrichment through that double recovery. Restatement of Restitution
§ 1, at 12-15 (1937).
The relief sought in an action to remedy unjust enrichment is measured by
the unjust gain to the defendant, not by the harm to the plaintiff. Consistent
with that theory of recovery, petitioners sought reimbursement from respondents
in "the amount of $411,157.11 out of any proceeds they recovered from
third parties." J.A. 92 (emphasis added).10 Moreover, unlike an award
of money damages, which "substitutes money for the original condition
or thing to which the plaintiff was entitled," the reimbursement sought
here would give petitioners the very thing to which they are entitled under
the terms of the plan. 1 D. Dobbs, Law of Remedies § 3.1, at 279-280
(2d ed. 1993). A judicial order requiring respondents to reimburse the plan
in accordance with the plan terms is the sort of relief that is typically
available in equity because it would compel specific performance of an obligation
to pay money. Indeed, it would compel reimbursement of payments that were
previously made by the plan on the express condition that reimbursement
would be required if the participant or beneficiary recovered from a third
party.
If a beneficiary's recovery from a third-party is less than the total expenses
paid by the plan, the plan may not obtain reimbursement in excess of the
third-party recovery. And the plan may not recover damages to compensate
the plan for the loss of the use of the funds between the time it paid the
medical benefits on behalf of the beneficiary and the latter's recovery
from the third party. Petitioners' action thus seeks merely to restore the
status quo and to prevent unjust enrichment to the extent of respondents'
recovery from the third party. Cf. Tull v. United States, 481 U.S. 412,
422 (1987). If equitable reimbursement is ordered in these circumstances,
respondents will not lose anything to which they are entitled under the
terms of the plan, and the plan will not gain anything to which it is not
entitled under the terms of the plan.
2. Petitioners' suit is not an action for contract damages, as the court
of appeals would have it. See Pet. App. A3-A4; Owens, 122 F.3d at 1262.
That characterization of the suit disregards the background of trust law
against which ERISA plans are established and instead treats the parties'
relationship as a garden-variety, arms'-length contract.11 An ERISA plan,
like an ordinary trust, is not merely one type of contract. G. Bogert &
G. Bogert, The Law of Trusts and Trustees § 17, at 215-216 (rev. 2d
ed. 1984); cf. Chauffeurs Local No. 391 v. Terry, 494 U.S. 558, 568 (1990)
("The nature of an action is in large part controlled by the nature
of the underlying relationship between the parties."). In particular,
the assumption of fiduciary duties under an ERISA plan is analogous to the
assumption of such duties under an ordinary trust, which is based not on
contract, "but rather on the effect of a conveyance" that confers
upon beneficiaries an equitable interest in the trust res. G. Bogert &
G. Bogert, supra, § 17, at 215-216.12
Some ERISA plans do not provide for a formal trust account. For example,
employee welfare benefit plans, such as the plan in this case, are exempt
from ERISA's minimum funding standards, see 29 U.S.C. 1081(a)(1), and do
not generally establish trust accounts, although if the plan receives contributions
from participants or beneficiaries, it must segregate such plan assets from
the employer's general assets, 29 C.F.R. 2510.3-102. The Court has made
clear, however, that the type of plan involved in a particular case does
not alter the analysis under ERISA where the statutory text does not distinguish
between different types of plans. See Firestone Tire & Rubber Co. v.
Bruch, 489 U.S. 101, 105, 111 (1989) (Court guided by principles of trust
law in case involving employee welfare benefit plan for which separate trust
fund had not been established); Hughes Aircraft Co. v. Jacobson, 525 U.S.
432, 443-444 (1999) (plan sponsors who alter the terms of a plan are not
fiduciaries, and "are analogous to the settlors of a trust," regardless
of whether the plan is a pension benefit plan, a welfare benefit plan, a
contributory plan, a noncontributory plan, or "any other type of plan")
(citation omitted).
This Court has repeatedly held that the common law of trusts provides a
"starting point for analysis [of ERISA] . . . [unless] it is inconsistent
with the language of the statute, its structure, or its purposes."
Harris Trust & Sav. Bank v. Salomon Smith Barney Inc., 530 U.S. 238,
250 (2000) (quoting Hughes Aircraft Co., 525 U.S. at 447); see also Firestone
Tire & Rubber Co., 489 U.S. at 110-111. Reference to the common law
of trusts in this case demonstrates the appropriateness of several equitable
remedies in a case such as this.
As beneficiaries of an ERISA plan, respondents owe various duties to the
plan, and they would owe duties to other beneficiaries under established
common-law trust principles. "Co-beneficiaries are owners of equitable
interests in the same res * * * . They are in a fiduciary relation to each
other in the sense that one beneficiary may not secretly secure for himself
a special advantage in the trust administration." G. Bogert & G.
Bogert, supra, § 191, at 478 (1979); see also Restatement (Second)
of Trusts §§ 251-255, at 633-642 (1959) (describing duties and
liabilities of beneficiary to trust); 3A A. Scott & W. Fratcher, The
Law of Trusts §§ 250-254, at 358-378 (4th ed. 1988) (same).
Moreover, suits could typically be brought in equity to enforce an agreement
by a beneficiary to pay money into a trust. 3A A. Scott & W. Fratcher,
supra, § 252, at 366; Restatement (Second) of Trusts, supra, §
252, at 635-636. An action likewise could be brought in equity against a
beneficiary for instigating a breach of trust and to restore payments improperly
made to the beneficiary from the trust. G. Bogert & G. Bogert, supra,
§ 191, at 478-485; 3A A. Scott & W. Fratcher, supra, §§
253-254.2, at 368- 378; Restatement (Second) of Trusts, supra, §§
253-254, at 636-640. And an equitable action was available against a beneficiary
for repayment of an advance made by the trust. Id. § 255, at 640-642.
See generally 3A A. Scott & W. Fratcher, supra, §§ 251, 252,
at 363, 366 (A beneficiary may be liable to the trust estate based on the
broad equitable principle that "a person entitled to participate in
a fund and also bound to contribute to the same fund cannot receive the
benefit without discharging the obligation.").
An action to enforce the reimbursement terms of an ERISA plan in order to
prevent unjust enrichment of a participant or beneficiary fits comfortably
within the scope of those traditional claims in equity. Such an action is
analogous to both an action to enforce an agreement by the beneficiary to
pay money into the trust, and an action for repayment of an advance made
from the trust. Like those actions, reimbursement pursuant to the terms
of an ERISA plan furthers the underlying trust objectives and enhances the
functioning of the plan by providing specified benefits to all employees
and their dependents, while also containing costs and preserving the plan
assets to satisfy further claims. Mertens, 508 U.S. at 262-263; Varity Corp.
v. Howe, 516 U.S. 489, 514 (1996).
B. "Equitable Relief" Includes An Order To Prevent Unjust Enrichment
Resulting From A Participant's Or Beneficiary's Failure To Abide By A Reimbursement
Term Of An ERISA Plan.
1. Petitioners' action for reimbursement seeks equitable relief within the
meaning of Section 502(a)(3) notwithstanding that it would, if successful,
result in an order for payment of money. This Court has expressly recognized
that an award of monetary relief is not necessarily legal relief. In Chauffeurs
Local No. 391, the Court explained, for example, that monetary relief is
equitable where it is "restitutionary, such as in 'action[s] for disgorgement
of improper profits,'" 494 U.S. at 570 (quoting Tull, 481 U.S. at 424),
and where it is "incidental to or intertwined with injunctive relief,"
id. at 571 (quoting Tull, 481 U.S. at 424); see also Harris Trust, 530 U.S.
at 240 (discussed at pp. 29-30, infra); Curtis v. Loether, 415 U.S. 189,
197 (1974); Porter v. Warner Holding Co., 328 U.S. 395, 402 (1946). And
the Court also has held in other circumstances that a suit for monetary
reimbursement may be considered to be one for "specific relief"
rather than "money damages." See Bowen v. Massachusetts, 487 U.S.
879, 893-896, 899-901 (1988).13
As we explain below, restitution and specific relief are but two of a number
of remedies typically available in equity that may be appropriate in an
action under Section 502(a)(3) of ERISA to enforce a term of a plan providing
for reimbursement to the plan out of a third-party recovery. Whether the
appropriate remedy in any particular case is restitution, specific relief,
or another form of equitable relief may depend on the circumstances of that
case. Flexibility in determining the nature of the relief that is appropriate
in a given case is characteristic of suits in equity. Accordingly, courts
entering an equitable judgment "may vary, qualify, restrain, and model
the remedy so as to suit it to mutual and adverse claims, controlling equities,
and the real and substantial rights of all the parties." 1 J. Story,
Equity Jurisprudence § 28, at 24 (14th ed. 1918); see, e.g., Albemarle
Paper Co. v. Moody, 422 U.S. 405, 415-417 (1975).
Moreover, because of the expansive preemption provisions of ERISA, which
supersede state laws that relate to covered employee benefit plans (29 U.S.C.
1144(a); see Egelhoff v. Egelhoff, 121 S. Ct. 1322 (2001)), a cause of action
presumably would not lie against a participant or beneficiary under state
law to enforce a reimbursement term of a plan. Compare FMC v. Holliday,
498 U.S. 52 (1980) (ERISA preempts state law precluding self-funded employee
welfare benefit plans from exercising rights under plan provisions requiring
member to reimburse plan if member recovers from third-party tortfeasor).
An action under Section 502(a)(3) therefore is likely to be the only avenue
of relief for a plan fiduciary. Thus, adoption of the Ninth Circuit's view-that
Section 502(a)(3) is not available to enforce such a reimbursement term-could
render such a plan term altogether unenforceable, contrary to the purposes
of ERISA.
2. Consistent with the principles set forth above, the courts of appeals
have recognized various types of equitable relief in actions under ERISA
plans that provide for reimbursement to the plan out of a third-party recovery,
recognizing that, whatever remedy is used to afford relief, the plan fiduciary
is "seeking an equitable remedy against [the participant or beneficiary]
to ensure her compliance with the terms of the Plan." Administrative
Comm. v. Gauf, 188 F.3d 767, 770 (7th Cir. 1999) (citing as examples the
fiduciary plaintiff's request for "'specific performance and enforcement'
of the contract and an 'order enjoining [the participant] from continuing
to violate the terms of the plan'").14 Providing appropriate equitable
relief to plan fiduciaries to enforce reimbursement terms of ERISA plans
helps to maintain plan assets for the benefit of all beneficiaries, and
furthers one of the stated purposes of ERISA-that of "providing for
appropriate remedies, sanctions, and ready access to the Federal courts."
29 U.S.C. 1001(b). See also Varity Corp., 516 U.S. at 512 (characterizing
Section 502(a)(3) as a "safety net, offering appropriate equitable
relief for injuries caused by violations that § 502 does not elsewhere
adequately remedy").
a. An action for reimbursement to prevent unjust enrichment may properly
be brought as an equitable action seeking restitution. See Restatement of
Restitution, supra, § 1, at 12-15 (restitution is an appropriate equitable
remedy to prevent unjust enrichment); 1 D. Dobbs, supra, § 4.1(1),
at 552, 556 (same). "Restitution is limited to 'restoring the status
quo and ordering the return of that which rightfully belongs to the purchaser
or tenant.'" Tull, 481 U.S. at 424 (quoting Porter, 328 U.S. at 402).
Restitution to prevent unjust enrichment, which is measured by the defendant's
gain, not the plaintiff's loss, differs in "goal or principle from
damages, which measures the remedy by the plaintiff's loss and seeks to
provide compensation for that loss." 1 D. Dobbs, supra, § 4.1(1),
at 555; Restatement of Restitution, supra, § 1, cmt. e at 14.15
In Harris Trust, this Court held that restitution is available under Section
502(a)(3) to remedy violations of Title I of ERISA. 530 U.S. at 243, 250-251,
253 (restitution available against nonfiduciary party in interest who participated
in prohibited transaction). Because Section 502(a)(3) affords the same relief
for violations of a plan as it does for violations of the Act itself, restitution
should likewise be available here to enforce a reimbursement term of the
plan. Here, of course, petitioners seek restitution from a beneficiary who
is retaining funds in contravention of the terms of the plan, even though
there was no violation of the plan when the funds were first advanced to
the beneficiary. The Seventh Circuit has specifically held that a suit for
restitution in comparable circumstances is an action for "appropriate
equitable relief" under Section 502(a)(3), see Harris Trust & Sav.
Bank v. Provident Life & Accident Ins. Co., 57 F.3d 608, 615 (1995),
and the Fourth Circuit has expressed a similar view, see Provident Life
& Accident Ins. Co. v. Waller, 906 F.2d 985, 988 n.5, cert. denied,
498 U.S. 982 (1990). Those courts articulated similar standards for establishing
an entitlement to restitution and determined that the plan's reimbursement
claim before them easily sufficed.16 As the Fourth Circuit put it, "the
facts of the instant case fit the archetypal unjust enrichment scenario.
* * * [T]he result in this case is an inequitable one; the record indicates
[the beneficiary] received a double recovery despite knowing about the plan's
reimbursement provision." Id. at 993.
b. A constructive trust is another appropriate equitable remedy in an action
under Section 502(a)(3) of ERISA seeking reimbursement out of a third-party
recovery. This Court described that remedy in Harris Trust: "Whenever
the legal title to property is obtained through means or under circumstances
'which render it unconscientious for the holder of the legal title to retain
and enjoy the beneficial interest, equity impresses a constructive trust
on the property thus acquired in favor of the one who is truly and equitably
entitled to the same, although he may never, perhaps, have had any legal
estate therein.'" 530 U.S. at 250-251 (quoting Moore v. Crawford, 130
U.S. 122, 128 (1889), and 4 J. Pomeroy, Equity Jurisprudence § 1053,
at 119-120 (5th ed. 1941)); accord, e.g., Restatement of Restitution, supra,
§ 160, at 640; 1 D. Dobbs, supra, § 4.3(1), at 587. ERISA's legislative
history specifically identifies a constructive trust as an example of "appropriate
equitable relief." S. Rep. No. 383, 93d Cong., 1st Sess. 105 (1973)
("Appropriate equitable relief may be granted in a civil action. For
example, injunctions may be granted to prevent a violation of fiduciary
duty, and a constructive trust may be imposed on the plan assets, if needed
to protect the participants and beneficiaries."). Consistent with that
congressional intent, the Seventh Circuit has correctly held that an action
by a plan administrator against a beneficiary for reimbursement of medical
benefits as called for by the plan may properly be treated as an action
to impose a constructive trust on funds the beneficiary received from a
third party, and thus constitutes an action for appropriate equitable relief
under Section 502(a)(3). Health Cost Controls of Ill., Inc. v. Washington,
187 F.3d 703, 710-711 (1999) (Posner, C.J.), cert. denied, 528 U.S. 1136
(2000).
c. Claims such as petitioners' may also properly be characterized as actions
"seeking to impose an equitable lien on the [funds received from a
third party] or seeking a mandatory injunction directing [the participant
or beneficiary] to sign over her claim to the money." Washington, 187
F.3d at 711. An equitable lien is another equitable remedy intended to prevent
unjust enrichment and may arise out of an express agreement or may be judicially
implied. 1 D. Dobbs, supra, § 4.3(3), at 601; G. Bogert & G. Bogert,
supra, § 32, at 395-401; see also Department of the Army v. Blue Fox,
Inc., 525 U.S. 255, 264-265 (1999) (recognizing propriety of imposing an
equitable lien to obtain a security interest in property that the plaintiff
may then use to satisfy a claim for unjust enrichment). An equitable lien
is imposed and operates like a constructive trust, the difference being
that the equitable lien provides a security interest in, rather than complete
title to, the property to which it attaches. 1 D. Dobbs, supra, § 4.3(3),
at 601; G. Bogert & G. Bogert, supra, § 32, at 395-401; Restatement
of Restitution, supra, § 161, at 650. In this case, no implication
of an equitable lien is necessary, because the SPD (see note 2, supra) expressly
provided that the plan would "have a first lien upon any recovery,
whether by settlement, judgment or otherwise," that a beneficiary received
from a third party. J.A. 58.17
d. Finally, another obvious equitable remedy that may be appropriate in
an action to enforce a reimbursement term of an ERISA plan is specific performance,
ordered through a mandatory injunction. A suit for an injunction to compel
performance of a plan term is plainly authorized by Section 502(a)(3), because
it is "[a] civil action * * * brought * * * to enjoin any act or practice
which violates * * * the terms of the plan, or * * * to obtain other appropriate
equitable relief * * * to enforce * * * the terms of the plan." 29
U.S.C. 1132(a)(3).
Unlike the other equitable remedies discussed above, specific performance
arises from the parties' contractual relationship. See 4 J. Pomeroy, supra,
§ 1401, at 1033; Restatement (Second) of Contracts, at 162 (1981) ("Topic
3. Enforcement by Specific Performance and Injunction, Introductory Note");
id. § 357, cmts. a, c at 163, 165. The remedy is "drawn as best
to effectuate the purposes for which the contract was made and on such terms
as justice requires." Id. § 358(1), at 166; see also id. §
358, cmt. a, c at 166, 167-168 (court, acting in equity "to do complete
justice," has considerable discretion and flexibility in molding relief);
id. § 364, at 184 (describing types of unfairness precluding specific
performance).
If adequate money damages were available here in an action at law, specific
performance relief might be foreclosed. Raton Water Works Co. v. Raton,
174 U.S. 360 (1899); Restatement (Second) of Contracts, supra, § 360,
cmt. a at 171 (specific performance not ordered where damages are adequate
to protect party's "expectation interest"). Mertens, however,
precludes the recovery of money damages against non-fiduciaries under Section
503(a)(3). Thus money damages are not available at law, and therefore an
injunction ordering specific performance of the reimbursement clause is
"appropriate equitable relief" under Section 502(a)(3). See Blue
Cross & Blue Shield v. Sanders, 138 F.3d 1347, 1352 n.5 (11th Cir. 1998);
see also 4 J. Pomeroy, supra, § 1403, at 1039 (specific performance
available where no action at law may be maintained on the contract); Restatement
(Second) of Contracts, supra, § 359(1) and (3), cmt. c at 169, 170
(specific performance will not be refused even if other remedies, such as
restitution, are available).
C. The Absence of Wrongdoing By Respondents In The Initial Receipt Of Benefits
Does Not Foreclose Equitable Relief To Require Reimbursement
The Ninth Circuit erroneously interpreted Mertens to limit the availability
of restitution and the imposition of a constructive trust in actions under
Section 502(a)(3) of ERISA to cases involving fraud or other wrongdoing
in the initial receipt of payments from the plan. Ellis, 202 F.3d at 1248,
1249; Cement Masons, 197 F.3d at 1006-1007; Owens, 122 F.3d at 1261. Under
that view, an action to enforce a plan term providing for reimbursement
to the plan of funds recovered from a third party would never support an
award of restitution or constructive trust because, by definition, the participant
or beneficiary was authorized by the terms of the plan to receive the payment
from the plan in the first instance.
A lack of wrongdoing by the participant or beneficiary in receiving the
plan's payment of benefits in the first instance does not, however, render
restitution or a constructive trust inappropriate in an action to enforce
a reimbursement provision. First, the retention of funds received from the
third-party tortfeasor by the participant or beneficiary despite his knowledge
of the reimbursement obligation constitutes the wrongful retention of the
funds, whether or not the initial receipt of the payments from the plan
was lawful. See G. Bogert & G. Bogert, supra, § 471, at 26-29 (1978)
("Wherever equity finds * * * a wrongful holding it will give relief,
whether the type of injustice is new or old. The court does not restrict
itself by describing all the specific forms of inequitable holding which
will move it to grant relief, but rather reserves freedom to apply this
remedy to whatever knavery human ingenuity can invent.").
Second, even if the refusal by a participant or beneficiary to comply with
an express reimbursement term of a plan were not viewed as wrongful holding
of the funds, restitution and imposition of a constructive trust are still
appropriate remedies under this Court's precedents. The Ninth Circuit rested
its contrary interpretation of Mertens on a statement by the Court identifying
"the return of 'ill-gotten' assets or profits taken from a plan"
as an example of "appropriate equitable relief" under Section
502(a)(5) of ERISA.18 See Owens, 122 F.3d at 1261 (quoting Mertens, 508
U.S. at 260); Cement Masons, 197 F.3d at 1006-1007. The Mertens Court, however,
did not purport to limit restitution to such circumstances. 508 U.S. at
260. Indeed, elsewhere in Mertens the Court explained, without further limitation,
that "equitable relief" under Section 502(a)(3) means "those
categories of relief that were typically available in equity (such as injunction,
mandamus, and restitution, but not compensatory damages)." Id. at 256
(emphasis omitted). Mertens thus contemplates that equitable remedies, including
restitution, may be awarded whenever it would be consistent with principles
of equity to do so.
Under established principles of equity, wrongdoing is not an essential element
of a restitution claim. 1 D. Dobbs, supra, § 4.1(2), at 559; Restatement
(Second) of Contracts, supra, § 373, at 208-209. Similarly, no showing
of wrongdoing or dishonorable conduct by the person having legal title to
the asset is required in order to recover through a constructive trust.
Indeed, restitution through imposition of a constructive trust is appropriate
even where the assets were transferred by mistake, because it is a means
of preventing unjust enrichment. 1 D. Dobbs, supra, § 4.1(2), at 559-560;
id. § 4.3(2), at 597-598; see also 5 A. Scott & W. Fratcher, Scott
on Trusts § 462.2, at 313-314 (4th ed. 1989) ("A constructive
trust may arise, however, even though the acquisition of the property was
not wrongful. It arises where the retention of the property would result
in the unjust enrichment of the person retaining it.").19 In addition,
like a constructive trust, an equitable lien is not limited to cases of
wrongdoing or dishonorable conduct. 1 D. Dobbs, supra, § 4.3(3), at
602-603.
Finally, in Harris Trust, the Court reaffirmed that restitution and imposition
of a constructive trust under Section 502(a)(3) are governed by common-law
remedial principles, not notions of wrongdoing. The Court there held that
the fact that a third party "was not 'the original wrongdoer' does
not insulate him from liability for restitution" to a plan of trust
property transferred to him in breach of a trustee's fiduciary duty. 530
U.S. at 251.20 And as the Court also noted, a constructive trust likewise
"is based on property, not wrongs." Ibid. (quoting 1 D. Dobbs,
supra, § 4.3(2), at 597); Restatement of Restitution, supra, §
160, cmt. d at 643 ("a constructive trust is imposed * * * to take
from the defendant property the retention of which * * * would result in
* * * unjust enrichment"). A court therefore may enter appropriate
equitable relief to compel reimbursement to the plan of payments made to
a participant or beneficiary when reimbursement is required by the terms
of the plan.
CONCLUSION
The judgment of the court of appeals should be vacated and the case remanded
to that court for further consideration consistent with the analysis set
forth above.
Respectfully submitted.
BARBARA D. UNDERWOOD
Acting Solicitor General
EDWIN S. KNEEDLER
Deputy Solicitor General
BETH S. BRINKMANN
Assistant to the Solicitor
General
JUDITH E. KRAMER
Acting Solicitor of Labor
ALLEN H. FELDMAN
Associate Solicitor
NATHANIEL L. SPILLER
Deputy Assistant Solicitor
GARY K. STEARMAN
Attorney
Department of Labor
MAY 2001
1 The district court explained that "[t]he Plan had a 'Stop-Loss' insurance
agreement with Great-West, whereby the Plan would pay any benefits up to
$75,000 and Great-West would pay any excess amount. Additionally, the stop-loss
allowed Great-West the right to recover first from amounts paid to the Plan
by third parties. The stop-loss limits the Plan's risk of dissipating all
of its assets for a single member." Pet. App. C2.
2 Pursuant to Sections 101(a)(1) and 102(a)(1) of ERISA, 29 U.S.C. 1021(a)(1)
and 1022(a)(1) (1994 & Supp. V 1999), a SPD must be furnished to all
participants and beneficiaries of the plan. It must include specific information
about the plan, including eligibility requirements and procedures for claim
submissions. 29 U.S.C. 1022(a)(1) (1994 & Supp. V 1999). It must be
"written in a manner calculated to be understood by the average plan
participant" and "must be sufficiently accurate and comprehensive
to reasonably apprise such participants and beneficiaries of their rights
and obligations under the plan." 29 U.S.C. 1022(a)(1) (1994 & Supp.
V 1999). See Curtiss-Wright Corp. v. Schoonejongen, 514 U.S. 73, 83-84 (1995).
3 Respondents did not make petitioners parties to the suit in state court,
Pet. App. B2, C2-C3, and petitioners did not attempt to intervene in that
action, id. at C2. Nevertheless, on April 21, 1997, petitioners removed
the state-court action to federal court before the settlement was approved
by the state court. Id. at B2, C3. On June 27, 1997, the district court
remanded the case to the state court. It held that because petitioners were
not parties to the state-court action, they had no right of removal under
28 U.S.C. 1441. Pet. App. B1-B4, C3.
4 On July 9, 1997, the district court denied petitioners' request for a
temporary restraining order. J.A. 96-99.
5 The district court rejected petitioners' argument that the state court
lacked subject matter jurisdiction to determine the plan's lien rights.
Pet. App. C5-C7. The district court held that the state court had concurrent
jurisdiction under Section 502(a)(1)(B) and (e)(1) of ERISA, 29 U.S.C. 1132(a)(1)(B)
and (e)(1), because "[t]he state court action to determine the status
of liens on Janette Knudson's recovery is an action to enforce her rights
under the terms of the * * * Plan." Pet. App. C6. If this Court reverses
the court of appeals' holding that petitioners have no cause of action under
Section 502(a)(3) of ERISA, the court of appeals may consider on remand
whether the district court correctly held that the state court had jurisdiction
to determine the plan's lien rights and whether petitioners could in any
event be bound by the state court's determination of that issue even though
they were not parties to the state-court action. See Martin v. Wilks, 490
U.S. 755, 762 & n.2 (1989) ("A judgment or decree among parties
to a lawsuit resolves issues as among them, but it does not conclude the
rights of strangers to those proceedings," except in certain limited
circumstances.).
6 The district court disregarded the right-of-recovery agreement signed
by respondent Eric Knudson because, in the court's view, that agreement
misstated the terms and obligations of the plan, lacked consideration, and
deviated from the plan without a formal plan amendment. Pet. App. C8-C9.
In particular, the court noted that although the agreement extended reimbursement
to "'any' third party recovery," id. at C8, the plan itself, in
the court's view, limited reimbursement to "the amount received from
a third party for medical treatment," id. at C10.
7 The court noted that the Owens panel had ordered dismissal for lack of
subject matter jurisdiction, while in Cement Masons Health & Welfare
Trust Fund v. Stone, 197 F.3d 1003, 1008 (9th Cir. 1999), petition for cert.
pending, No. 99-1403, the panel ordered dismissal of the same type of claim
on the merits, Pet. App. A4-i.e., for failure to state a claim on which
relief could be granted. For purposes of this case, the panel here noted,
in evaluating the substantive holding of Owens, "the dismissal could
be based either on lack of subject matter jurisdiction or on the merits."
Id. at A4 n.5.
8 The Ninth Circuit reaffirmed the substantive holding of Owens in Cement
Masons (see note 7, supra), holding that, like Owens, the case involved
a claim for contractual reimbursement, and not restitution, because the
participant did not receive the payments from the plan through fraud or
wrongdoing. 197 F.3d at 1006-1007. The court rejected the argument that
Cement Masons was distinguishable from Owens because the plan in Cement
Masons established an automatic lien on any third-party recovery. The court
held that the plan's request for declaratory and injunctive relief regarding
the propriety of enforcing the lien was nothing more than a request for
"a mechanism to enforce, or to obtain the equivalent of, a damage remedy."
Id. at 1007.
In Ellis, the Ninth Circuit again reaffirmed Owens, rejecting the Eleventh
Circuit's view that Owens was "based on an 'unduly narrow reading of
Mertens.'" 202 F.3d at 1248 (quoting Blue Cross & Blue Shield v.
Sanders, 138 F.3d 1347, 1353 n.5 (11th Cir. 1998)). The Ninth Circuit reasoned
that Owens does not conflict with Mertens because Owens does not bar all
claims for monetary relief under Section 502(a)(3) and recognizes that restitution
and constructive trusts may be appropriate, "provided some fraud or
wrong-doing is shown." Id. at 1249.
9 Section 502(a)(3) authorizes suits by "a participant, beneficiary,
or fiduciary." 29 U.S.C. 1132(a)(3). Petitioners alleged in their first
amended complaint that petitioner Earth Systems is the plan administrator
and, as such, is authorized to bring the action under Section 502(a)(3).
J.A. 89. We agree that Earth Systems, as the plan administrator, is a fiduciary
of the plan, see 29 U.S.C. 1002(21)(A), and, thus, authorized to bring an
action under Section 502(a)(3). The Court need not determine the status
of the other petitioners or their authority to sue under Section 502(a)(3).
See Health Cost Controls of Ill., Inc. v. Washington, 187 F.3d 703 (7th
Cir. 1999) (Posner, C.J.) (holding that the assignee of a plan may sue under
section 502(a)(3)), cert. denied, 528 U.S. 1136 (2000).
10 The district court concluded that the plan and the right-of-recovery
agreement differed regarding the scope of reimbursement required. See note
6, supra. The court of appeals did not address that ruling and related questions
regarding the proper interpretation of the plan, the meaning and validity
of the right-of-recovery agreement, and the effect of the state-court judgment.
Those issues may properly be considered by the court of appeals on remand.
11 Of course, for the reasons already discussed, even in the case of an
ordinary contract, an equitable action will lie to prevent unjust enrichment
and to compel specific performance of an obligation to pay money.
12 Although employers typically contribute the bulk of the funds for ERISA
health plans, the employees who participate in and are beneficiaries of
the plan often contribute substantial amounts as well. Employees of small
firms pay on average 33% of health plan premiums, while employees in large
firms pay 22%. See Pet. at 6-7, Reynolds Metals Co. v. Ellis, supra (No.
99-1787) (citing Private Health Insurance-Impact of Premium Increases on
Number of Covered Individuals Is Uncertain: Hearings Before the Subcomm.
on Employer-Employee Relations of the House Comm. on Education and the Workforce,
106th Cong., 1st Sess. (1999) (statement of William J. Scanlon, Director,
Health Financing and Public Health Issues, General Accounting Office)).
In addition, employer-funded plans can arise by virtue of collective bargaining
agreements, in which, presumably, employee-beneficiaries expressly trade
off other benefits, such as higher wages, for medical insurance. The beneficiaries
contribute in that way as well, albeit indirectly. See Central States Mot.
for Leave to File Amicus Curiae Br. in Support of Pet. 1. Indeed, benefits
under an ERISA health plan may generally be considered an example of compensation
in lieu of salary because they are part of an employee's overall compensation
package.
13 In Bowen v. Massachusetts, the Court held that the provision of the Administrative
Procedure Act that precludes actions against federal agencies seeking "money
damages" (see 5 U.S.C. 702) does not bar a district court action by
a State seeking review of a decision by the Department of Health and Human
Services denying reimbursement for certain expenditures under the State's
Medicaid program. The Court held that the State's request for monetary relief
was in the nature of an equitable action for specific relief to obtain money
to which the State allegedly was entitled under the federal Medicaid statute.
See also Department of the Army v. Blue Fox, Inc., 525 U.S. 255, 262 (1999)
("Bowen's interpretation of § 702 thus hinged on the distinction
between specific relief and substitute relief, not between equitable and
nonequitable categories of remedies."). Although Bowen and Blue Fox
addressed a distinct question concerning the meaning of "money damages"
in 5 U.S.C. 702, those cases are instructive insofar as they recognize that
some actions for monetary relief are suits for "equitable" relief.
14 ERISA plans attach different labels to the right of the plan to recover
previously-made payments out of a third-party recovery received by a participant
or beneficiary, and sometimes use differing terms interchangeably. See 16
L. Russ, Couch on Insurance § 226:1, at 226-11, § 226:4, at 226-15
to 226-17 (3d ed. 2000); see also id. § 222:2, at 222-11 to 222-12
("The right of an insurer to recover payments made pursuant to its
policy from a third party which caused the loss, or from the person to whom
the payment was made, generates considerable confusion because of overlap
between, and misuse of," the terms "subrogation," "recoupment,"
"restitution," reimbursement," and "recovery.");
id. § 222.22, at 222-13 to 222-14 (noting distinctions among subrogation,
liens, and assignments).
15 Although restitution may be viewed as a legal remedy when awarded in
an action at law, it is properly viewed as equitable relief where, as here,
it is sought in a traditional action in equity to prevent unjust enrichment.
See Reich v. Continental Cas. Co., 33 F.3d 754, 755-756 (7th Cir. 1994)
(Posner, C.J.), cert. denied, 513 U.S. 1152 (1995). See also Washington,
187 F.3d at 710.
16 Although the Fourth Circuit in Waller found a cause of action for restitution
under federal common law, and did not rest its decision on Section 502(a)(3)
(see 906 F.2d at 988 n.5, 992-994), it, like the Seventh Circuit in Harris
Trust & Savings Bank v. Provident Life & Accident Insurance Co.,
looked to the elements of restitution as described by Professor Corbin:
(1) the plaintiffs had a reasonable expectation of payment; (2) the defendants
should reasonably have expected to pay, and (3) society's reasonable expectations
of person and property would be defeated by nonpayment. See 906 F.2d at
993-994, and 57 F.3d at 615 (both citing C. Kaufman, Corbin on Contracts
§ 19A, at 50 (Supp. 1989)).
17 In addition, in this case, respondent Eric Knudson agreed in the right-of-recovery
agreement "that the plan may be subrogated to me or my dependent's
rights for any benefits from the other party." J.A. 77. Subrogation
is an equitable remedy, Restatement of Restitution, supra, § 162, at
653; 1 D. Dobbs, supra, § 4.3(4), at 605-606; G. Bogert & G. Bogert,
supra, § 33, at 401, and is "an established branch of equity jurisprudence,"
16 L. Russ, supra, § 222:24, at 222-52. At its core, subrogation is
intended to prevent unjust enrichment. The question of when an insurer is
entitled to subrogation or how much it should receive are questions of equity,
even when the subrogation is expressly delineated in an insurance policy.
Id. § 222:39, at 222-75; see also id. §§ 222:8, 222:9, at
222-30 to 222-34; id. § 222:20, at 222-47; § 222:28, at 222-61
to 222-63; see generally Restatement of Restitution, supra, § 162,
at 653.
Although subrogation and reimbursement differ procedurally-in the former,
the insurer stands in the insured's shoes against the third-party tortfeasor,
while in the latter, it proceeds against the insured and only if the insured
obtains a third-party recovery (see L. Russ, supra, § 226:1, at 226-10
to 226-12)-both have similar justifications (to prevent unjust enrichment)
and substantive effects (preventing double recovery). Cf. Stillmunkes v.
Hy-Vee Employee Benefit Plan & Trust, 127 F.3d 767, 770 (8th Cir. 1997)
(state subrogation law covers claim under plan reimbursement clause, but
is preempted by ERISA); FMC Corp. v. Holliday, supra (ERISA preempts application
of state anti-subrogation and reimbursement statute to reimbursement provision
of self-funded ERISA plan).
18 Section 502(a)(5), 29 U.S.C. 1132(a)(5), is the parallel statutory provision
that authorizes civil actions by the Secretary of Labor to redress statutory
violations. It is worded similarly to Section 502(a)(3), and this Court
has interpreted it accordingly. See Harris Trust, 530 U.S. at 248-249.
19 See also 5 A. Scott & W. Fratcher, supra, § 462.2, at 313-314
(4th ed. 1989 & Supp. 2000) (noting that, under ordinary trust law,
the historical limitation of a constructive trust as a remedy for breach
of trust by fiduciaries has been abandoned); 1 D. Dobbs, supra, § 4.3(2),
at 597. See also Washington, 187 F.3d at 711 (finding no basis "either
in ERISA or in the principles of equity" for limiting "the imposition
of a constructive trust in an ERISA case" to cases where "there
has been a breach of trust"); accord Wal-Mart Stores, Inc. Assocs.'
Health & Welfare Plan v. Wells, 213 F.3d 398, 401 (7th Cir.), cert.
denied, 121 S. Ct. 441 (2000).
20 The Court in Harris Trust emphasized that "the common law of trusts"
limits restitution from "defendants other than the principal 'wrongdoer'"
to instances in which the defendant had actual or constructive knowledge
of the prohibited nature of the transfer. 530 U.S. at 251. No comparable
concern about knowledge arises in a case such as this, because reimbursement
is sought pursuant to an express term of the plan.