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Pactiv Corp. v. Sanchez

United States District Court, N.D. Illinois, Eastern Division

July 23, 2015

JOSE SANCHEZ, Defendant.


ROBERT M. DOW, Jr., District Judge.

Plaintiff Pactiv Corporation ("Pactiv") brings a one-count declaratory judgment action pursuant to the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1132(a)(3). Pactiv seeks a declaration that it is entitled to set off the amount of a benefit payment that it made for Defendant Jose Sanchez's medical care against a judgement that it has been ordered to pay in a related workers' compensation proceeding. Before the Court are Pactiv's motion for summary judgment [50] and Sanchez's motion to dismiss and motion for summary judgment [59, 73]. For the reasons that follow, the Court grants in part Pactiv's motion for summary judgment [50] and concludes that Pactiv is entitled to set off $95, 431.96 against the judgement arising from the workers' compensation proceeding. The Court denies Pactiv's motion to the extent that Pactiv seeks attorneys' fees and costs under 29 U.S.C. §1132(g)(1). The Court denies Sanchez's motion to dismiss [59] and cross-motion for summary judgment [73]. The Clerk will enter a Rule 58 final judgment thereby closing the case.

I. Background

The Court has taken the relevant facts from Pactiv's amended complaint [49] and from the parties' Local Rule ("L.R.") 56.1 Statements, which include Pactiv's Rule 56.1 Statement [52], Sanchez's Statement of Facts and Response to Pactiv's Statement of Facts [74], and Pactiv's Response to Sanchez's Statement of Facts [75]. Rule 56.1 requires a party moving for summary judgment to submit a statement of material facts as to which the movant contends there is no genuine issue and which entitles the movant to judgment as a matter of law. As the Seventh Circuit has stressed, facts are to be set forth in Rule 56.1 statements, and it is not the role of the Court to parse the parties' exhibits to construct the facts. Judges are not "like pigs, hunting for truffles buried in briefs." United States v. Dunkel, 927 F.2d 955, 956 (7th Cir. 1991). It simply is not the Court's job to sift through the record to find evidence to support a party's claim. Davis v. Carter, 452 F.3d 686, 692 (7th Cir. 2006). Rather, it is "[a]n advocate's job * * * to make it easy for the court to rule in [his] client's favor[.]" Dal Pozzo v. Basic Machinery Co., 463 F.3d 609, 613 (7th Cir. 2006).

The Court carefully reviews the parties' statements of material facts and eliminates from consideration any argument, conclusions, and assertions that are unsupported by the documented evidence of record offered in support. See, e.g., Sullivan v. Henry Smid Plumbing & Heating Co., Inc., 2006 WL 980740, at *2 n.2 (N.D. Ill. Apr. 10, 2006); Tibbetts v. RadioShack Corp., 2004 WL 2203418, at *16 (N.D. Ill. Sept. 29, 2004). Merely including facts in a responsive memorandum is insufficient to put issues before the Court. Midwest Imports, Ltd. v. Coval, 71 F.3d 1311, 1313 (7th Cir. 1995); Malec v. Sanford, 191 F.R.D. 581, 594 (N.D. Ill. 2000). Rule 56.1 also requires that statements of facts contain allegations of material fact and that factual allegations be supported by admissible record evidence. See L.R. 56.1; Malec, 191 F.R.D. at 583-85. Where a party improperly denies a statement of fact by failing to provide support for the denial, the Court deems that statement of fact to be admitted.

The facts giving rise to the parties' dispute are largely uncontested. Plaintiff Pactiv Corporation brings suit as a fiduciary of the Pactiv Corporation Master Health and Welfare Plan ("the Plan"). The Plan is an employer funded group benefit plan that provides certain medical benefits to its participants. [74], Def.'s Fact Stmt. ¶ 3; [52], Pl.'s Fact Stmt. ¶ 1. Defendant Jose Sanchez participated in the Plan from January 2001 to December 2006. [52], Pl.'s Fact Stmt. ¶ 1. Under the relevant coverage schedule, medical care "for which benefits are available under workers' compensation laws" is excluded and not covered by the Plan. Id. at ¶ 3. The Plan also obligates participants to reimburse Pactiv if another party is liable for a participant's medical expenses. Id. Pactiv's vice president and chief human resources officer are responsible for "final interpretation" of the provisions of the Plan. See id. at ¶ 4. A participant's entitlement to benefits also is decided in the sole discretion of the Plan administrator. Id. Blue Cross Blue Shield ("Blue Cross") administered the Plan's medical program during the relevant time period. See id. at ¶ 5.

In April of 2003, Sanchez received medical care for a work-related shoulder injury. [52], Pl.'s Fact Stmt. ¶ 8. He submitted claims for medical benefits to Blue Cross in connection with the injury, and Pactiv fully reimbursed Blue Cross for the claims. See id. at ¶¶ 8, 10. On April 29, 2003, Sanchez filed a claim with the Illinois Workers' Compensation Commission (the "Commission") against Pactiv in its capacity as Sanchez's employer (the "Workers' Compensation Proceeding"). Sanchez sought workers' compensation benefits, including medical expenses, arising from the same shoulder injury, for the same benefit payments that Blue Cross made on Pactiv's behalf. Id. at ¶¶ 11, 17. Pactiv states that the medical expenses presented to the Commission were identical to the claims submitted to Blue Cross, id. at ¶ 17, whereas Sanchez only admits that there is "an identity between [them], " [74], Def.'s Fact Stmt. ¶ 17. Regardless, Sanchez does not appear to contest that the medical expenses that he submitted in the Workers' Compensation Proceeding arose from the medical care that he received for his shoulder injury. See id. Sanchez further admits that the funds for which Pactiv could have requested a credit in the Workers' Compensation Proceeding are "identical to the funds" for which Pactiv seeks reimbursement in this action. [72], Def.'s Mem. at 15.

In the Workers' Compensation Proceeding, Pactiv failed to assert its right to a credit for medical expenses paid by the Plan under Section 8(j) of the Illinois Workers' Compensation Act. [75], Pl.'s Resp. to Def.'s Fact Stmt. ¶ 2. That section states:

In the event the injured employee receives benefits, including medical, surgical or hospital benefits under any group plan covering non-occupational disabilities contributed to wholly or partially by the employer, which benefits should not have been payable if any rights of recovery existed under this Act, then such amounts so paid to the employee * * * shall be credited to or against any compensation payment * * * under this Act.

820 ILCS 305/8(j). On February 26, 2010, the Commission issued a corrected decision that awarded Sanchez workers' compensation benefits, including $113, 059.31 for medical expenses, which was affirmed by the Circuit Court of Cook County and the Illinois Appellate Court. [52], Pl.'s Fact Stmt. ¶ 12. The decision included a partial permanent disability award of 80 percent loss of use of Sanchez's right arm. [74], Def.'s Fact Stmt. ¶ 1.

After the award was affirmed by the Illinois Appellate Court, Pactiv paid Sanchez $77, 496.91, which included only $15, 205.65 in medical expenses. See [52], Pl.'s Fact Stmt. ¶ 13. Sanchez subsequently filed an action in the Circuit Court of Cook County for the outstanding balance of the award. See id. at ¶ 14. On July 23, 2013, the Circuit Court of Cook County entered judgment against Pactiv in the amount of $110, 682.28 ("the State Court Judgment"), which included a medical expense award of $97, 620.64, interest in the amount of $12, 664.75, and costs in the amount of $397.00. Id. at ¶ 15; see also [52-4], Exh. 8, Order, Sanchez v. Pactiv Corp., 2012 L 10446 (Ill. Cir. Ct. July, 23, 2013). The Circuit Court found that "no stipulation for a credit for medical expenses purportedly paid by group insurance pursuant to Section 8(j) of the Worker's Compensation Act exists in the record before the Worker's Compensation Commission and no such set off was asserted by [Pactiv] in the record before the Commission." [74], Def.'s Fact Stmt. ¶ 8 (quoting Order). The Circuit Court's Order recently was affirmed by the Illinois Appellate Court. See Order, Sanchez v. Pactiv, LLC, 2015 IL App. (1st) 132570-U (1st Dist. June 26, 2015). In its motion for summary judgment, Pactiv requests that this Court declare that it is entitled to set off the benefit payments that it already paid on Sanchez's behalf against the State Court Judgment, pursuant to the terms of the Plan, so that Sanchez does not receive duplicative benefits, or a "double recovery, " for his medical expenses.

II. Legal Standards

The parties have filed cross-motions for summary judgment, and Sanchez also has filed a motion to dismiss the amended complaint. The legal ...

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