# Opposition Brief — Travitz v. Northeast Department ILGWU Health & Welfare Fund

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## Record

- **Collection:** Supreme Court brief
- **Document type:** Opposition Brief
- **Published:** January 1, 1994
- **Citation:** 511 U.S. 1143

## Text

- Biprems Court, US
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No. 93-1695 | MAX 9 1994

OFFICE OF THE CLER
IN THE _Srke © ie Cae |

SUPREME COURT OF THE UNITED STATES

October Term, 1993

DOROTHY E. TRAVITZ,
Petitioner,

U.

NORTHEAST DEPARTMENT ILGWU
HEALTH AND WELFARE FUND
AND
ILGWU EASTERN STATES
HEALTH AND WELFARE FUND,
Respondents.

ON PETITION FOR WRIT OF CERTIORARI TO
THE UNITED STATES COURT OF APPEALS
FOR THE THIRD CIRCUIT

BRIEF IN OPPOSITION TO PETITION FOR
WRIT OF CERTIORARI

Charles W. Johnston*

HANDLER, GERBER, JOHNSTON &
ARONSON

Suite 100, 150 Corporate Center Dr.

Post Office Box 98

Camp Hill, PA 17001-0098

(717) 975-5500

Attorneys for Respondent
“Counsel of Record

PACKARD PRESS / LEGAL DIVISION, 1617 JFK BOULEVARD, PHILA, PA 19103 (215) 563-9000

ore 5 an
.F s

5 \
\

QUESTION PRESENTED

Whether ERISA’s preemption provisions, as inter-
preted by this Court in FMC Corp. v. Holliday and
Metropolitan Life Insurance Co. v. Massachusetts, pro-
hibit states from applying state insurance regulations to
self-funded employee welfare benefit plans?

es

TABLE OF CONTENTS

Page
QUES ERIS FEIN EE 6 cc cccivcveccceseuses i
DEAE Bee MEAT osc ecisetvevceversioess 1
STATEMENT OF THE CASE ......cccccccccece 2
SUMMARY OF ARGUMENT...............-.4.-- 8
REASONS FOR DENYING THE WRIT ......... 8
CPV AADC oe cer csavees vaeeureeueetse buat 16

ll

TABLE OF AUTHORITIES

Cases: Page

Autoclub Insurance Association v. Health and Wel-
fare Plans, Inc., 961 F.2d 588 (6th Cir. 1992). 9

FMC Corp. v. Holliday, 498 U.S. 52 (1990) ... 5, 8, 9,
11, 14, 15

Fort Halifax Packing Co., Inc. v. Coyne, 482 U.S. 1
tte bas. 06 Wee cb eb eeece baeeee 11

Hampton Industries v. Sparrow, 981 F.2d 726 (4th
EES I ee eae 9

Lincoln Mutual Casualty Co. v. Lectron Products,
Inc. Employee Health Benefit Plan, 970 F.2d

ees See oc cccebuecs ances 9
Metropolitan Life Insurance Co. v. Massachusetts,
Ge Se Ee SEED 0.0 ce eccccececss 8, 9, 10, 12

PM Group Life Insurance v. Western Growers As-
surance Trust, 953 F.2d 543 (9th Cir. 1992).. 9

Provident Life and Accident Insurance Co. v. Lin-
thicum, 930 F.2d 14 (8th Cir. 1991) ......... 9

Shaw v. Delta Airlines, Inc., 463 U.S. 85 (1983). 10, 12

Thompson v. Talquin Building Products Co., 928
eee OEY COUT Gs BED ccc cccccccccceccces 9

ili

No. 93-1695

IN THE

SUPREME COURT OF THE UNITED STATES

October Term, 1993

DOROTHY E. TRAVITZ,
Petitioner,

Vv.

NORTHEAST DEPARTMENT ILGWU
HEALTH AND WELFARE FUND
AND
ILGWU EASTERN STATES
HEALTH AND WELFARE FUND,
Respondents.

BRIEF IN OPPOSITION TO PETITION FOR
WRIT OF CERTIORARI

STATUTES INVOLVED

In addition to the statute cited in the Petition for
Writ of Certiorari, Section 1719(b) of the Pennsylvania
Motor Vehicle Financial Responsibility Law (“Pa. Law”)
provides:

“(b) Definition.—As used in this section
the term ‘program, group contract or other
arrangement’ includes, but is not limited to,
benefits payable by a hospital plan corporation
or a professional health service corporation
subject to 40 Pa.C.S. Ch. 61 (relating to hospi-
tal plan corporations) or 63 (relating to profes-
sional health services plan corporations).”

1

=F

2

STATEMENT OF THE CASE

Prior to January 1, 1990, the Fund was known as the
Northeast Department ILGWU Health and Welfare
Fund. As of January 1, 1990, the Northeast Department
Fund was merged into the ILGWU Eastern States
Health and Welfare Fund (hereinafter collectively “the
Fund”). The Fund is an employee welfare benefit plan
existing for the purpose of providing hospital, medical/
surgical, major medical, weekly disability, dues-made-
good, preventative health care, eyeglass, and vacation
benefits to employees of contributing employers covered
by collective bargaining agreements. Benefits distrib-
uted by the Fund are funded by employer contributions
and by investment income earned on employer contri-
butions.

The Fund is a self-insured, multiemployer plan to
which thousands of employers, primarily in the ladies’
apparel industry, make contributions pursuant to collec-
tive bargaining agreements between such employers
and the International Ladies’ Garment Workers’ Union.
Dorothy E. Travitz was, on or about October 18, 1990, a
participant of the Fund.

The fiscal integrity of the Fund is maintained
through, among other ways, excluding from coverage
certain types of claims for benefits. The Fund contains
various exclusions from coverage including, among
others, an exclusion pertaining to conditions for which
costs of treatment or losses are recoverable through legal
action or claims settlement from another party or insur-
ance company.

The Fund provides as follows:

“General Exclusions and Limitations

“The information in this section applies to
all of the benefits that the Fund offers. It is not
repeated in each specific section, but it applies
anyway.

Exclusions”

* * *

3

“(S) You can not receive benefits/coverage
for a condition if the costs of treating that
condition are recoverable through legal action
or claim settlement from another party or in-
surance company.”

The Fund further provides for a temporary advance
of benefits pending litigation or claims settlement with
respect to injuries or illnesses otherwise excluded from
coverage under the Fund, in order to assist the partici-
pant during delays in recovering the payment for those
excluded conditions from a third party. The Fund terms
require that in the event of recovery from a third party,
the Fund must be reimbursed to the full extent of
advanced benefits, without a deduction for attorneys’
fees incurred by the participant in third-party litigation
related to the excluded conditions.

The Fund provided as follows:

“Advance of Benefits

“If you have a right to recover payment for
an injury or illness from another source, there
may be delays because of the time it takes to
process the claim or because of lawsuits. If this
happens, the Fund may be able to help you
temporarily by paying benefits in advance. If
this is done, you must sign a legal document
stating that the Fund will be repaid in full, from
any settlement you receive. The Fund must be
repaid to the full extent (without any deduction

of attorney fees, court costs, or arbitration
costs) of the benefits it provided. The Fund
may also require legal assurances that the party
which is liable to you will honor your claim and
that the money due to you will be repaid
directly to the Fund. In all cases, only the
Trustees of the Fund can decide whether an

4

advance of benefits is appropriate. Each case
will be decided on its own merits.

“If you are denied benefits from the Fund
because the Fund or its agents believe that
payment is recoverable from another source,
you may appeal that decision directly to the
Board of Trustees. See page 49 for information
on the procedure for this type of appeal.”

Subsequent to October 18, 1990, the Fund received
numerous claims for benefits from Dorothy Travitz
relating to treatment or services for injuries resulting
from the use of a motor vehicle on October 18, 1990.

The Fund initially began to process the payment of
claims submitted by Travitz pursuant to the Advance of
Benefits provisions of the Plan. The Fund paid a total of
$2,924.78 of benefits for Travitz relating to the treat-
ment or services for in juries resulting from the October
18, 1990 motor vehicle accident.

pet re to October 18, 1990, the Fund sought
assurances from Travitz and her attorney that, if the
Fund was to advance benefits, the participant and
counsel would recognize and protect the Fund’s interest
in the benefits advanced to participant. By letter dated
April 12, 1991, counsel for the Fund wrote to counsel for
Travitz advising him of the Fund’s position and request-
ing that Travitz execute an Assignment of Claim form
enclosed in the letter. Despite the request by Fund and
Fund’s counsel for participant to execute the Assign-
ment of Claim, participant refused to executed the form.
Subsequent to October 18, 1990, Travitz submitted to
the Fund bills for treatment or services resulting from
injuries sustained by her in the October 18, 1990 motor
vehicle accident requesting that the bills be paid by the
Fund. In view of Travitz’s refusal to execute the Assign-
ment of Claim, the Fund ceased advancing benefits and
did not pay any additional bills submitted by Travitz.

Subsequent to October 18, 1990, Travitz asserted
tort claims against certain tortfeasors alleging that the

5

motor vehicle accident occurring on October 18, 1990,
and the resulting physical and personal injuries to
Travitz, arose out of certain negligent acts or omissions
of the tortfeasors.

By letters dated April 12, 1991, June 3, 1992, June
17, 1992, and July 10, 1992, counsel for the Fund wrote
to counsel for Travitz detailing the Fund’s position with
respect to: (1) the Fund’s exclusionary provisions relat-
ing to treatment or services for injuries resulting from
recoveries through legal action or claim settlement from
another party or insurance company; (2) the Fund’s
advance of benefits provisions; (3) the Fund’s federal
common law right of subrogation; and (4) that the
Employee Retirement Income Security Act preempts
the application of the Pennsylvania Motor Vehicle Fi-
nancial Responsibility Law to the Fund, since it is a
self-insured employee welfare benefit plan, as held by
this Court in FMC Corp. v. Holliday, 498 U.S. 52 (1990).

Prior to the settlement of Travitz’s tort claim, the
June 3, 1992 letter detailed at length the position of the
Fund with respect to the Fund’s interpretation and
application of the Fund’s exclusion provisions. Counsel
for Travitz was advised as follows:

“The Fund is a self-insured employee wel-
fare benefit fund which does not purchase an
insurance policy from any insurance company
in order to satisfy its obligations to its partici-
pants. In FMC Corporation v. Holliday, __
U.S. ___, 111 S.Ct. 403, 107 L.Ed. 2d 356
(1990), the Supreme Court held that ERISA
preempts the application of Pennsylvania state
law to self-funded employee benefit plans. Al-
though state laws directly regulating insurance
are not preempted under ERISA, the Act also
provides that self-funded employee benefit
plans may not be deemed to be insurance
companies or engaged in the business of insur-
ance for purposes of such state laws. Thus the

6

Fund, being self-insured, is not subject to the
Pennsylvania automobile insurance laws.

“Accordingly, since Pennsylvania insur-
ance law is preempted by ERISA with respect
to the Fund, the rules under the Fund’s plan
take primary effect. A copy of the general
exclusions and limitations language found in
the Fund’s Summary Plan Description is en-
closed for your review. Paragraph 3 excludes all
Fund benefits ‘for treatment or services for
injuries resulting from the maintenance or use
of a motor vehicle if such treatment or service is
paid under a plan or policy of motor vehicle
insurance.’ Therefore, the Fund is not respon-
sible for paying benefits that would be payable
to Mrs. Travitz under the auto insurance
coverage.

“Moreover — and more importantly — under
Paragraph 5, Mrs. Travitz ‘cannot receive be-
nefits/coverage for a condition if the costs of
treating the condition are recoverable through
legal action or claim settlement from another
party or insurance company. Thus, benefits
are not payable to your client for medical treat-
ment arising out of the automobile accident on
October 18, 1990.”

On June 17, 1992, Travitz entered into a Settlement
Agreement and Release with the tortfeasors and their
insurer. By virtue of the Release, Travitz received the
following payments, or will receive the following pay-
ments:

2. Payments

In consideration of the release set forth
above, the Insurer on behalf of the Defendants
agrees to pay to the individual(s) named below
(“Payee(s)”) the sums outlined below:

(A) Immediate cash: $125,000.00

7

(B) The Periodic Payments shall be
deemed paid when mailed by First Class Mail
on the dates specified as follows:

— $1,030 per month for life with 15 years
guaranteed, compounding 3% annually,
commencing 4-20-1992.

— $10,000 payable on 4-20-1997, guaranteed.

— $15,000 payable on 4-20-2002, guaranteed.

— $20,000 payable on 4-20-2007, guaranteed.

— $30,000 payable on 4-20-2013, guaranteed.

Notwithstanding the significant recovery of settlement
proceeds by Travitz, the Fund was never notified of the
recovery. Furthermore, no portion of the advanced ben-
efits were reimbursed to the Fund.

Subsequent to June 17, 1992, Travitz initiated suit
against the Fund in the United States District Court for
the Middle District of Pennsylvania seeking payment of
all medical bills that she incurred arising out of the
October 18, 1990 automobile accident. Travitz asserted
that Section 1722 of the Pa. Law precluded her from
recovering the cost of the medical benefits from the
tortfeasor since the benefits were payable by the Fund,
regardless of the coverage exclusion of the Fund. The
Fund responded by arguing that Exclusion 5 was appli-
cable to Travitz, since Section 1722 of the Pa. Law was
preempted by ERISA, and that Travitz therefore should
have sought recovery from the tortfeasor for the medical
bills.

Both Travitz and the Fund moved for summary
judgment. The District Court found that there were no
disputed material facts, granted the Fund’s Motion, and
denied Travitz’s Motion. The Court of Appeals affirmed
the District Court’s decision, holding that the application
of Section 1722 of the Pa. Law to the Fund was
preempted by ERISA since Section 1722 attempts to
shift liability for medical and health care benefits to the
Fund.

8

SUMMARY OF ARGUMENT

In enacting ERISA’s expansive preemption provi-
sion Congress intended to preempt all state laws which
relate to self-funded employee benefit plans. Section
1722 of the Pa. Law relates to the Fund since it has a
direct economic impact upon the Fund by effectively
mandating that the Fund must pay all of Travitz’s
medical benefits despite the explicit exclusionary lan-
guage in Exclusion 5. If the Fund was required to follow
the provisions of Section 1722 of the Pa. Law in Penn-
sylvania, it would be subject to potentially inconsistent
participant coverage requirements. This Court, in FMC
Corp., found that in enacting the preemption provisions
Congress did not intend to have self-insured employee
benefit plans subject to a “patchwork scheme of regula-
tion” on a state-to-state basis.

REASONS FOR DENYING THE WRIT

There are no special and important reasons
for granting the Writ, since the decision of
the Court of Appeals for the Third Circuit is
consistent with the Court’s opinions in FMC
Corp. and Metropolitan Life Insurance Co.,
and therefore does not conflict with a deci-
sion of another court of appeals or conflict
with a decision of this Court.

The decision of the Court of Appeals for the Third
Circuit, affirming that of the United States District
Court for the Middle District of Pennsylvania, is consis-
tent with this Court’s decision in FMC Corp. v. Holliday,
498 U.S. 52 (1990) and Metropolitan Life Insurance Co.
v. Massachusetts, 471 U.S. 724 (1985). There is no
conflict or any other basis for further review of the issues
raised below and herein by this Court.

Moreover, Travitz fails to articulate what substantial
question she is seeking to have this Court review. Rule
11 of this Court addresses the consideration governing

9

the grant or denial of certiorari. The Rule emphasizes
the necessity of a substantial question before certiorari
will be granted. The Rule sets forth a list of reasons
which clearly indicate the character of the reasons that
it will consider in whether to grant certiorari. The issues
that Travitz raises in her Petition do not establish that
the decision of the Court of Appeals conflicts with any
decisions of other circuits or raises an important ques-
tion of federal law which has not been settled by this
Court.! The issues raised by the Petition had been
addressed and settled by the Court in FMC Corp., 498
U.S. 52 (1990) and Metropolitan Life Insurance Co.,
471 U.S. 724 (1985).

This case is therefore not appropriate for the Su-
preme Court to review, and therefore the subject Peti-
tion for Writ of Certiorari should be denied.

Despite this Court’s decisions in FMC Corp., which
reaffirmed and reinforced its decision in Metropolitan
Life that the application of the Pennsylvania law to a
self-insured employee welfare benefit plan was pre-
empted by ERISA, Travitz suggests that this holding
should be revisited herein.

In Metropolitan Life, this Court held that ERISA
preempts the application of state insurance laws to
uninsured, or self-funded employee welfare benefit
plans. In so doing, this Court gave life to the distinction
between insured and self-insured plans which Congress

1. Since FMC Corp., the courts have uniformly found that
ERISA preempts any attempt to regulate self-insured employee
benefit plans. Hampton Industries v. Sparrow, 981 F.2d 726 (4th
Cir. 1992); Lincoln Mutual Casualty Co. v. Lectron Products, Inc.
Employee Health Benefit Plan, 970 F.2d 206 (6th Cir. 1992);
Autoclub Insurance Association v. Health and Welfare Plans, Inc.,
961 F.2d 588 (6th Cir. 1992); PM Group Life Insurance v. Western
Growers Assurance Trust, 953 F.2d 543 (9th Cir. 1992); Provident
Life and Accident Insurance Co. v. Linthicum, 930 F.2d 14 (8th Cir.
1991); Thompson v. Talquin Building Products Co., 928 F.2d 649
(4th Cir. 1991).

10

created in the so-called “deemer clause” of ERISA,
Section 514(b)(2)(B).

In Metropolitan Life, this Court employed a three-
part analysis following the structure of Section 514 in
considering whether state regulation of self-insured
benefit plans is preempted by ERISA. First, Section
514(a), ERISA’s broad preemption provision, provides
that ERISA shall preempt “any and all state laws insofar
as they may now or hereafter relate to any employee
benefit plan.” 29 U.S.C. §1144(a). “The phrase ‘relate to’
was given its broad common-sense meaning, such that a
State law ‘relate[s] to’ a benefit plan ‘in the normal sense
of the phrase, if it has a connection with or reference to
such plan.’ ” Metropolitan Life, 471 U.S. at 739 quoting
Shaw v. Delta Airlines, Inc., 463 U.S. 85, 97 (1983).

Second, Section 514(b)(2)(A), the so-called insur-
ance savings clause, provides that ERISA does not
preempt any state law “which regulates insurance,
banking or securities law.” 29 U.S.C. §1144(b)(2)(A). A
state law “regulates insurance” if it meets the common-
sense requirement that it is specifically directed towards
some aspect of the insurance irdustry or if it falls within
the reference in the McCarran-Ferguson Act, 15 U.S.C.
§1011, et seq., to the “business of insurance.” Metropol-
itan Life, 471 U.S. at 742-43.

Third, Section 514(b)(2)(B), ERISA’s deemer
clause, limits the reach of the insurance savings clause,
providing “neither an employee benefit plan nor any
trust established under such a plan, shall be deemed
to be an insurance company. . . for the purposes of
any law of any state purporting to regulate insurance
companies for] insurance contracts.” 29 U.S.C.
§1144(b)(2)(B). Thus, this Court’s analysis in Metropol-
itan Life established a bright line test relating to pre-
emption as between insured and self-insured employee
benefit funds. As the Court stated,

“Our decision results in a distinction between
insured and uninsured plans, leaving the

11

former open to indirect regulation while the

latter are not. By so doing, we merely give life to

the distinction Congress is aware of and one it

has chosen not to alter.”

Id. at 474 (footnote omitted).

By so concluding, this Court recognized that Con-
gress established benefit plan regulation as exclusively a
federal concern to minimize the need for interstate
self-insured funds such as the Fund to administer their
plans differently in each state in which they have
participants. This recognized the administrative realities
of self-insured, multi-state employee benefit plans, and
sought to promote a fund’s capacity to provide benefits to
participants scattered throughout many states in the
most efficient manner—i.e., through a single employee
benefit plan. As this Court stated in Fort Halifax Pack-
ing Co., Inc. v. Coyne, 482 U.S. 1, 11 (1987):

“It is thus clear that ERISA’s preemption pro-
vision was prompted by recognition that em-
ployers establishing and maintaining employee
benefit plans are faced with the task of coordi-
nating complex administrative activities. A
patchwork scheme of regulation would intro-
duce considerable inefficiencies and benefit
program operation, which might lead these
employers with existing plans to reduce bene-
fits, and those without such plans to refrain
from adopting them. Preemption ensures that
the administrative practices of a benefit plan
will be governed by only a single set of regula-
tions.”

In FMC Corp., this Court was called upon to revisit
the issue of whether the ERISA deemer clause protects
selfinsured employee benefit plans from all state insur-
ance regulation. In FMC Corp., this Court considered
whether ERISA preempted Section 1720 of the Pa.
Law —i.e., anti-subrogation provision—which specifi-
cally prohibited an insurer from collecting funds from a

12

plaintiff in satisfaction of its subrogation interest when
the plaintiff had been injured and obtained recovery in
an action arising out of the maintenance or use of a
motor vehicle. Following its three-step analysis set forth
in Metropolitan Life, this Court concluded that Section
1720 “‘relate[s] to’ an employee benefit plan” since
Section 1720, as does Section 1722 herein, has a “ref-
erence” to employee benefit plans, as does Section 1722,
and a “connection” to employee benefit plans, as does
Section 1722. Travitz is asserting that while this Court
found that ERISA preempted Section 1720 of the Pa.
Law, the preemption provisions of ERISA do not pre-
empt the application of Section 1722 of the Pa. Law to
the Fund, despite the Pa. Law’s specific reference to
employee welfare benefit plans in Section 1722 of the
Law.

Travitz acknowledges and concedes in the Petition
that Section 1722 of the Pa. Law contains a “reference
to” an employee welfare benefit plan. Despite conceding
that Section 1722 of the Pa. Law makes “reference to,”
and thus “relates to” the Fund and is therefore pre-
empted by Section 514(a) of ERISA, Travitz goes on to
argue that there is no “connection with” the Fund.
Under the Court’s test in Shaw v. Delta Airlines, Inc.,
Travitz’s queries and arguments relating to Section
514(a) of ERISA should have stopped at that point. The
court below, in concluding that Section 1722 of the Pa.
Law not only made “reference to” but was “connected
with” the Fund, found that:

Section 1722, which precludes the recovery of
benefits from a tortfeasor where a person is
eligible to receive those benefits under another
program, group contract or arrangement, as
defined in Section 1719, has ‘reference’ to
benefit plans governed by ERISA... .”

* * *

“In addition, Section 1722 has a ‘connec-
tion’ to ERISA benefit plans. The Court has

13

held that state laws have a ‘connection’ to an
ERISA plan when the laws risk subjecting plan
administrators to conflicting state regulations.
. . . Section 1722 has that very effect.”

ere is a Clear “connection with” the Fund that is
not “too tenuous, remote or peripheral,” since one of the
objects of Section 1722 of the Pa. Law when there are
injuries to an individual and there are resulting medical
charges is to dictate the order of coverage/recovery
under various policies of insurance, i.e., first-party ben-
efits mandated by Subchapter B of the Pa. Law, workers’
compensation and benefits paid by a program, group
contract, or other arrangement. Section 1719, Coordina-
tion of Benefits, says that the first-party benefits man-
dated by Subchapter B shall be primary with respect to
all other policies of insurance except workers’ compen-
sation, which shall always be primary over the first-party
benefits. Section 1719 goes on to say that all other
policies of insurance covering the individual, i.e., “pro-
grams, group contracts or other arrangements,” shall be
deemed to contain a provision in the policy of insurance
that its benefits shall be in excess of the first-party
benefits.

In Section 1720, Subrogation, and 1722, Preclusion
of Recovering Required Benefits of the Law, the Penn-
sylvania legislature went on to dictate that in situations
where there is litigation arising out of the maintenance
or use of a motor vehicle and the individual incurs
medical bills, the individual or a program, group contract
or other arrangement may not recover medical benefits
paid or payable because of injuries sustained by the
individual.

The ultimate object of Sections 1720 and 1722 is to
shift the responsibility for the payment of medical bills to
either the workers’ compensation carrier or to some
third-party carrier, i.e., a program, a group contract, or
an other arrangement —the Fund as asserted by Travitz.

14

By enacting these provisions, the Pennsylvania legisla-
ture is dictating the structure and the terms of coverage
of employee benefit plans.

What this Court said in FMC Corp., is that Section
512 of ERISA prohibits this shifting by the Pa. Law of
responsibility for the payment of medical bills to self-
insured employee welfare benefit plans or the waiver of
federal common law subrogation rights of self-insured
employee welfare benefit plans. This Court concluded
that Section 512 prohibited the Pennsylvania legislature
from attempting to mandate plan design and coverage
for self-insured employee welfare benefit plans.

The ultimate object of the self-insured employee
welfare benefit plan in FMC Corp., and the Fund herein,
was to avoid being ultimately responsible for the pay-
ment medical charges where there has been or may be a
recovery from a party ultimately responsible for the
injuries. The fund in FMC Corp. chose not to exclude
from coverage the costs of treating the injuries sustained
in an automobile accident, as did the Fund herein. The
FMC Corp. fund took the approach of agreeing to cover
these charges, and if there was a recovery from a third
party they would be subrogated to that recovery. Since
the benefits were covered, subrogation was the control-
ling theory in FMC Corp. Here, the benefits were not
covered. The advance of benefits provision, unlike su-
brogation provision is directed solely at excluded bene-
fits advanced under that unique provision. The Fund
here took a different approach to ultimately achieve the
same result and excluded coverage for treatment from
injuries arising out of automobile accidents if the costs
of treating the injury were recoverable through legal
action or claims settlement. In addition, the Fund also
provided that in certain circumstances where certain
benefits were excluded it would advance benefits to the
participant and the participant would repay the Fund
from any settlement or recovery against a third party.

15

The result achieved by both approaches was the same,
and neither approach is subject to the application of the
Law.

This case is a mirror image of the FMC Corp. case.
The Courts below recognized this fact and correctly
concluded that Section 1722 of the Pa. Law was pre-
empted by ERISA.

16

CONCLUSION

The Writ of Certiorari should not be granted in this
case since there is no important question of federal law
or any conflict with any other court of appeal to be
settled by this Court.

Respectfully submitted,

Charles W. Johnston, Esquire

HANDLER, GERBER, JOHNSTON &
ARONSON

Suite 100, 150 Corporate Center Dr.

Post Office Box 98

Camp Hill, PA 17001-0098

(717) 975-5500

Attorneys for Respondents

Dated: May 9, 1994

---

Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/brief%3Amicro_IA40386005_1551%3A2. Public record. Not legal advice.
