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PRIMAX RECOVERIES INCORPORATED v. GOSS

December 13, 2002

PRIMAX RECOVERIES INCORPORATED, PLAINTIFF,
V.
NEAL GOSS, A MINOR, BY AND THROUGH ROBERT M. GOSS, HIS FATHER AND NEXT FRIEND, DEFENDANT.



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,

BACKGROUND

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 provides:

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 expenses; or
? 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 petition.

DISCUSSION

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. ...


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