The opinion of the court was delivered by: James B. Moran, Senior Judge, U.S. District Court
MEMORANDUM OPINION AND ORDER
Plaintiff Primax Recoveries Incorporated (Primax) brings this suit
seeking injunctive and declaratory relief to reinstate the lien on
proceeds of a lawsuit between the defendant, Neal Goss, and third party
tortfeasors. Defendant moves to dismiss the suit pursuant to Federal Rule
of Civil Procedure 12(b)(1) for lack of subject matter jurisdiction. For
the following reasons, defendant's motion is granted and plaintiff's
claim is dismissed,
The facts are taken from plaintiff's complaint. Robert Goss was an
employee of AON Corporation and a participant in AON's heath care
benefits program. As his son, defendant Neal Goss was a beneficiary under
the terms of the plan. The plan contains a reimbursement provision that
COORDINATION WITH THIRD PARTY CLAIMS
No payment will be made for expenses incurred for
injuries received in or as a result of an accident to
the extent a third party is responsible for paying
these expenses. These Injuries include expenses
arising out of, or in the course of, any employment
for wage or profit, where it is determined that the
Individual is not covered by Workers' Compensation or
similar law. If you or a covered dependent incurs
expenses for injuries received in an accident, for
which CIGNA's Claims Administrator determines a third
party may be liable, CIGNA's plan will provide its
normal benefits. However, you first must agree, in
writing, to refund at the time the amount of the third
party's responsibility is determined and satisfied,
the lessor of:
? the amount actually paid by the plan for those
? an amount equal to the payment actually
received from the third party for those expenses.
In the event you or a covered dependent subsequently
files a Workers' Compensation claim, CIGNA's Claims
Administrator shall have a lien on any amount or
settlement to the extent you have already been
reimbursed under the medical option.
On November 3, 1999, Neal was seriously injured in a sports accident.
The health care plan advanced benefits on behalf of Neal in the amount of
$491,641.78. Neal and his family filed personal injury lawsuits against
third party tortfeasors allegedly responsible for Neal's injuries.
Primax, on behalf of the plan, asserted a lien against any potential
recovery to the extent of the benefits advanced, pursuant to the above
reimbursement provision. Defendant filed a petition in the Circuit Court
of Cook County to extinguish the lien, which was granted on September 2,
2002, after plaintiff failed to appear, respond or otherwise contest the
In deciding a Rule 12(b)(1) motion to dismiss we treat all well-pleaded
factual allegations as true, drawing all reasonable inferences in favor
of the plaintiff.*fn1 Iddir v. I.N.S., 301 F.3d 492, 496 (7th Cir.
2002). To determine if we have jurisdiction, we look beyond the face of
the complaint to any evidence submitted regarding jurisdiction. Id.
Plaintiff now seeks to reinstate the lien and defendant moves to
dismiss the claim, arguing that this court lacks subject matter
jurisdiction. The health care benefits plan is governed by the Employee
Retirement Income Security Act (ERISA), 29 U.S.C. ...