The Eleventh Circuit recently concluded that Robert Montanile, a welfare plan participant, could not avoid reimbursing the National Elevator Industry Health Benefit Plan for benefits it paid on his behalf after he recovered from a third party tortfeasor. In so ruling, the Court rejected Montanile’s arguments that the plan’s reimbursement provision was not enforceable because it was not contained in the plan document and that reimbursement was not an appropriate remedy because the funds had been spent or dissipated. The Court ruled first that, in light of the fact that there was no plan document separate and apart from the summary plan description, the subrogation/reimbursement provision was an enforceable term of the SPD, and the Supreme Court’s statement in CIGNA Corp. v. Amara, 131 S.Ct. 1866 (2011) that the terms of an SPD are not part of the plan document thus had no application here. Second, applying existing precedent in the Circuit, the Court held that where, as here, a plan unambiguously gives itself a first-priority claim to third party payments an equitable lien attaches immediately upon the receipt of specifically identifiable funds, rendering it irrelevant that the funds were subsequently spent or dissipated. The case is Board of Trustees of the National Elevator Industry Health Benefit Plan v. Montanile, 2014 WL 6657049 (11th Cir. Nov. 24, 2014).
