West Palm Accident Complaint for Declaration of Rights & Responsibilities call 1-800-74-TRIAL

Plaintiff, ) Case No.:_______
v. ) Honorable:______
Defendant 1, Defendant 2, )
Defendant 3, and Defendant 4 )
COMPLAINT AND JURY DEMAND
Now comes Plaintiff, by and through his Attorney, and for his complaint against Defendants alleges as follows:
1. This is an action to:
a. Declare (West Palm Beach Florida car accident Plaintiff’s) right to benefits and the priority of coverage under § 502(a)(1)(B) of the Employee Retirement Income Security Act (ERISA), 29 USC § 1132 (a)(1)(B), and the Michigan No-Fault Act, MCL §§ 500.3101, et seq.;
b. Enjoin certain acts and practices, and to obtain other appropriate equitable relief under § 502(a)(1)(B) of ERISA, 29 USC § 1132 (a)(3); and
c. Obtain money damages and other appropriate relief pursuant to the Fair Debt Collection Practices Act (FDCPA), 15 USC §§ 1692 et seq.
2. This Court has jurisdiction over (West Palm Beach Florida car accident Plaintiff’s) ERISA claims pursuant to 29 USC §1132(e)(1).
3. This Court has supplemental jurisdiction over (West Palm Beach Florida car accident Plaintiff’s) claims arising under the Michigan No-Fault pursuant to 28 USC § 1367(a).
4. This Court has jurisdiction over (West Palm Beach Florida car accident Plaintiff’s) FDCPA claims pursuant to 15 USC § 1692k(d).
5. Venue is proper in this district pursuant to 29 USC § 1132(e)(2) and 28 USC § 1391(b).
Parties
6. Defendant 1 is a welfare benefits plan administered under the terms of ERISA for the benefit of [Employer] employees and their families, including beneficiaries living in Michigan.
7. Defendant 2 is a Wisconsin limited liability company and that was contracted by Defendant 1 for the purpose of pursuing collection of debts allegedly owed to Defendant 1 by its participants and beneficiaries; Defendant 2 regularly does business in Michigan.
8. Defendant 3 is a Tennessee limited liability partnership contracted by Defendant 2 for the purpose of collecting debts allegedly owed to Defendant 1; Defendant 3 regularly does business in Michigan.
9. Defendant 4 is an Illinois insurance company that provides insurance coverage to Michigan residents under policies sold throughout Michigan.
10. Plaintiff is an individual who resides in _________ County, Michigan, and he is a beneficiary of the Defendant 1 Plan and insured under a Defendant 4 policy providing coverage under the Michigan No-Fault Act.
Factual Background
11. Plaintiff was driving a motor vehicle in _________ County, Michigan on [date] when he was seriously injured in a collision caused by another driver.
12. Plaintiff suffered very serious injuries in the crash, including but not limited to: a traumatic brain injury, a mid-fracture of the right femur, liver and spleen lacerations, abdominal bleeding and acute renal failure, rib fractures, and respiratory distress.
13. Plaintiff remained hospitalized for nearly 2 months after the crash, and he underwent multiple medical procedures, including but not limited to: the removal of his spleen, multiple abdominal surgeries, and open reduction internal fixation of his femur.
14. After his hospitalization, Plaintiff underwent substantial rehabilitation and continued medical treatment for his substantial injuries.
15. At all material times, Plaintiff was entitled to health benefits provided by the Defendant 1 Plan in which Plaintiff was a participant.
16. At all material times, Plaintiff also was covered for personal protection insurance by the Defendant 4 policy, which provides for payment of all allowable expenses for (West Palm Beach Florida car accident Plaintiff’s) medical care, recovery and rehabilitation in accordance with MCL § 500.3107, and the Defendant 1 Plan was informed of the Defendant 4 coverage.
17. In accordance with the terms of the Defendant 1 Plan pertaining to coordination of benefits, the administrators of the Defendant 1 Plan determined that its coverage was primary with regard to the injuries Plaintiff suffered in the [date] crash, and that Defendant 4’s coverage was secondary in priority.
18. Consequently, Defendant 1 Plan paid numerous and substantial expenses for (West Palm Beach Florida car accident Plaintiff’s) hospitalization, surgeries, treatment, and rehabilitation necessitated by the injuries suffered in the [date] crash.
19. As a result of his injuries, Plaintiff suffered a “serious impairment of body function,” which also entitled him to recover noneconomic damages for his pain and suffering from the driver and owner of the vehicle that caused the [date] crash.
20. Under the Michigan No-Fault Act, however, Plaintiff was specifically prohibited from recovering any medical expenses from the driver or owner of the vehicle that caused the [date] crash.
21. The Defendant 1 Plan contains a provision, entitled “Reimbursing the Plan,” that states in pertinent part:
If you or one of your dependants suffers a loss or injury caused by the actions or omissions of a third party, that third party may be responsible for paying your medical and dental expenses.
***
If you receive any type of payment, reimbursement or legal recovery from the third party or insurer, you are obligated to reimburse the plan for any expenses which the plan paid to you and/or your dependants(s) and for any related legal and collection costs the plan incurred.
***
Your obligation to reimburse the plan exists for any legal recovery that relates to an injury or illness covered by your benefits (including any amounts used to pay your legal fees), even if you recover less than initially claimed (or less than your full loss) and even if the legal recovery is designated as not for medical expenses.
22. The Defendant 1 Plan also contains a provision entitled “Right of Subrogation” that states:
The plan’s right to receive any payment, reimbursement or recovery discussed above supersedes and has priority over you or your dependant’s right to receive any payment, reimbursement or recovery.
The plan expressly rejects and overrides any default rule that the plan does not have a right of subrogation until you or your dependent have been fully compensated.
23. Defendant 1 Plan does not appear to contain any provision expressly creating a “lien” with regard to any claimed overpayment of medical expenses.
24. Defendant 1 Plan contracts with outside entities to collect any monies owed to the plan under its reimbursement and subrogation provisions.
25. Upon information and belief, Defendant 1 contracted with Defendant 2 to pursue collection of any monies that may be owed to Defendant 1 by Plaintiff under the reimbursement and subrogation provisions of the plan.
26. Upon information and belief, Defendant 2 initially employed Law Firm to investigate further whether Defendant 1 Plan was entitled to any reimbursement from Plaintiff based on his potential third-party recovery from the person who caused the [date] crash.
27. On [date] a lawyer from Law Firm wrote to the lawyer handling (West Palm Beach Florida car accident Plaintiff’s) injury claim to assert a claim for reimbursement of medical expenses incurred by Defendant 1 in the amount of $197,943.
28. Recognizing that Defendant 4 would be liable to pay for any allowable medical expenses not covered by the Defendant 1 Plan, (West Palm Beach Florida car accident Plaintiff’s) Attorney promptly forwarded the letter to Defendant 4 with a request that Defendant 4 investigate the reimbursement claim.
29. Upon information and belief, Law Firm’s subsequent investigation with Defendant 4 determined that the reimbursement claim was meritless, particularly given the fact that the terms of the Defendant 1 Plan made it primary in priority over the Defendant 4 policy, which would otherwise be required to cover (West Palm Beach Florida car accident Plaintiff’s) medical expenses arising from the [date] crash, and because the Michigan No-Fault Act prohibits recovery of medical expenses in (West Palm Beach Florida car accident Plaintiff’s) third-party automobile negligence claim.
30. Defendant 2 later apparently hired Defendant 3 to investigate the same question, whether the Defendant 1 Plan was entitled to any reimbursement from Plaintiff based on his potential third-party recovery from the person who caused the [date] crash.
31. Defendant 3 has since sent numerous letters to Plaintiff on behalf of Defendant 2 and its client Defendant 1, claiming a right of reimbursement in the amount of $197,943, characterized as a “lien” on occasion.
32. At all material times, Defendant 3 knew that the terms of the Defendant 1 Plan did not create a “lien” against a Michigan No-Fault third-party recovery.
33. At all material times, Defendant 3 knew that the Defendant 1 Plan did not have a valid claim for reimbursement of medical expenses against a third-party automobile negligence settlement governed by the Michigan No-Fault Act.
34. At all material times, Defendant 3 deliberately refrained from making a claim for reimbursement from Defendant 4, apparently because the administrators of the Defendant 1 Plan had affirmatively determined that the plan was primary in priority to Defendant 4.
35. At all material times, Defendant 3 knew that the alleged reimbursement debt was not valid against any third-party recovery for (West Palm Beach Florida car accident Plaintiff’s) pain and suffering.
36. In their correspondence to (West Palm Beach Florida car accident Plaintiff’s) Attorney, the Defendant 3 lawyers expressly confirmed their awareness of “Michigan’s No-Fault laws.”
37. Nevertheless, the Defendant 3 lawyers have continually threatened to file suit on behalf of Defendant 2 for the claimed reimbursement debt.
38. Recognizing the difficulty of making Defendant 2’s claim for the reimbursement debt in the context of “Michigan’s No-Fault Laws,” Defendant 3’s correspondence stated: “However, it is our intention to seek reimbursement on behalf of the Plan where it is administered, which is in New York.”
39. The purpose of threatening to sue Plaintiff in New York was expressed as a means of escaping the jurisprudence of Michigan and the Sixth Circuit in order to take advantage of Second Circuit jurisprudence, which was described by the Defendant 3 lawyers as being more favorable to Defendant 2’s claim for the alleged reimbursement debts.
40. The implicit threat contained in the correspondence was that Plaintiff would be deprived of his Michigan lawyer and forced to hire New York counsel and travel to defend a lawsuit in the foreign venue of New York.
41. Subsequent correspondence from Defendant 3 has continued this threat to sue Plaintiff in the foreign venue of New York, and this threat has been intended to intimidate Plaintiff and coerce him to pay an invalid debt.
42. Upon information and belief, the Defendant 1 Plan has not authorized Defendant 2 or Defendant 3 to file suit against Plaintiff in New York, and Defendant 3 knew that it did not have authorization from the Defendant 1 Plan when making these threats.
43. The continuation of these threats by Defendant 3 has been willful and outrageous.
44. As a direct and proximate result of these threats, Plaintiff has suffered actual damages including but not limited to anxiety, worry for his future, impairment of his ability to freely use the proceeds of a lawsuit, and imposition of additional and unnecessary legal costs.
Count I: Declaration of Rights
Under ERISA and Michigan No-Fault
45. Plaintiff restates all of the previous allegations as incorporated herein.
46. The terms of the Defendant 1 Plan appear to be conflicting and ambiguous with respect to the duty of the Defendant 1 Plan to pay benefits in the context of a Michigan automobile accident, but resolution of the ambiguity will not result in a valid claim for reimbursement against (West Palm Beach Florida car accident Plaintiff’s) third-party recovery.
47. To the extent that there is any other source of funds against which the Defendant 1 Plan may seek subrogation or reimbursement, it is the Defendant 4 policy, which provides coverage for all medical expenses arising from the [date] crash.
48. If the “Coordination of Benefits” language of the Defendant 1 Plan is enforceable, as initially determined by the administrators of the Defendant 1 Plan, then the Defendant 1 Plan remains primary in priority, and Defendant 4 is secondary in priority.
49. If the Defendant 1 Plan provisions for “Reimbursing the Plan” take precedence, essentially nullifying the “Coordination of Benefits” terms, then the Defendant 1 Plan may have a right of reimbursement against Defendant 4.
50. To the extent that the Defendant 1 Plan has any valid claim of reimbursement of medical expenses against (West Palm Beach Florida car accident Plaintiff’s) third-party recovery, then those expenses were not really payable by the Defendant 1 Plan, and Defendant 4 must be deemed primary with respect to payment of (West Palm Beach Florida car accident Plaintiff’s) medical claims.
51. Under no circumstances is Plaintiff liable for payment of his medical expenses out of his third-party tort recovery, which is prohibited from containing compensation for medical expenses.
52. Therefore, either the Defendant 1 Plan or Defendant 4 is responsible for paying the medical expenses incurred by Plaintiff as a result of the [date] crash, and it would be appropriate for the Court to declare the respective rights of the parties in this regard.
WHEREFORE, Plaintiff requests this Honorable Court to declare the rights of the parties regarding payment of (West Palm Beach Florida car accident Plaintiff’s) benefits and the priority of coverage under the terms of the Defendant 1 Plan, the Defendant 4 policy, ERISA, and the Michigan No-Fault Act.
Count II: Injunctive Relief Under § 502(a)(3) of ERISA
53. Plaintiff restates all of the previous allegations as incorporated herein.
54. The Defendant 1 Plan does not have a valid right of reimbursement, right of subrogation, or lien of any kind against Plaintiff or his third-party tort claim arising from the [date] crash.
55. Nevertheless, Defendant 2 and Defendant 3 have persisted in their efforts to collect this alleged debt, and Plaintiff will continue to suffer harm from these collection efforts if they are not stopped permanently.
56. Plaintiff is a beneficiary of the Defendant 1 Plan, and he is entitled to seek injunctive relief under § 502 (a)(3) of ERISA to prevent any further wrongful attempts to collect the reimbursement debt allegedly owed to the Defendant 1 Plan.
57. Therefore, it would be appropriate and equitable for this Court to enjoin the Defendant 1 Plan, and its contractors and subcontractors, from making any further attempts to collect the alleged reimbursement debt from Plaintiff.
WHEREFORE, Plaintiff requests this Honorable Court to grant a permanent injunction against Defendants, prohibiting them from making any further attempts to collect the alleged reimbursement debt from Plaintiff.
Count III: Violation of Fair Debt Collection Practices Act
58. Plaintiff restates all of the previous allegations as incorporated herein.
59. The principal business of Defendant 2 is the collection of debts in Michigan and other states, and Defendant 2 regularly attempts to collect debts alleged to be due to another in Michigan.
60. The principal business of Defendant 3 is the collection of debts in Michigan and other states, and Defendant 3 regularly attempts to collect debts alleged to be due to another in Michigan.
61. Both Defendant 2 and Defendant 3 are “debt collectors” within the meaning of 15 USC § 1692a(6).
62. The alleged debt incurred by Plaintiff was incurred for personal services in the nature of medical treatment and related expenses.
63. The actions of Defendant 2 and Defendant 3 in pursuing collection of the alleged reimbursement debt against Plaintiff violated the FDCPA, including but not limited to the following violations:
a. Engaging in conduct the natural consequence of which is to harass, oppress, or abuse any person in connection with the collection of a debt in violation of 15 USC § 1692d;
b. Using false, deceptive, or misleading representations and collection means in violation of 15 USC § 1692e, including but not limited to:
• The false representation of the legal status of the alleged reimbursement of debt;
• The threat to take legal action that was not intended to be taken, or could not have been taken legally; and
• The failure to disclose that the debt collectors were attempting to collect a debt and that any information obtained would be used for that purpose;
c. Failing to provide the validation notice required by 15 USC § 1692g(a);
d. Threatening to bring a legal action to collect the alleged reimbursement debt in a judicial district other than that in which Plaintiff resides, in violation of 15 USC § 1692i(2)(B).
64. This noncompliance with the FDCPA on the part of Defendant 2 and Defendant 3 has been frequent, persistent, intentional, and extensive.
65. It would be appropriate for the Court to declare that the conduct of Defendant 2 and Defendant 3 violated the FDCPA.
66. As a direct and proximate result of one or more of their violations of the FDCPA, Defendant 2 and Defendant 3 are liable to Plaintiff under 15 USC § 1692k for actual damages, statutory damages, costs, and attorney’s fees.
WHEREFORE, Plaintiff requests this Honorable Court declare that the conduct of Defendant 2 and Defendant 3 violated the FDCPA, and to enter judgment in favor of Plaintiff and against Defendant 2 and Defendant 3 for (West Palm Beach Florida car accident Plaintiff’s) actual damages and statutory damages, together with interest, costs, and attorney fees.
Respectfully submitted,
__________________
DEMAND FOR JURY TRIAL
Now comes Plaintiff by and through his attorney, and demands a trial by jury of his peers for all of his claims for legal relief to the fullest extent permitted by the Seventh Amendment.
Respectfully submitted,
__________________