United States District Court, D. Arizona
Apollo Education Group Incorporated, Apollo Group Health
Plan, Plaintiffs: John C West, LEAD ATTORNEY, Lewis Roca
Rothgerber LLP - Phoenix Office, Phoenix, AZ.
Nicholas Henry, father of minor: on behalf of P.H.,
Defendant: Geoffrey Mark Trachtenberg, Michael Justin Henry,
LEAD ATTORNEYS, Levenbaum Trachtenberg PLC, Phoenix, AZ.
Diane J. Humetewa, United States District Judge.
action is before the Court on Defendant's Motion to
Dismiss (Doc. 9). Plaintiffs have filed a Response (Doc. 10)
and Defendant has filed a Reply (Doc. 11). The Court has also
considered Defendant's Notice of Supplemental Authority
in Support of Motion to Dismiss (Doc. 12), Plaintiffs'
Response (Doc. 13) thereto, and Defendant's Reply (Doc.
Apollo Education Group, Inc. and Apollo Group, Inc. Health
and Welfare Plan initiated this action by filing a Complaint
against Defendant Nicholas Henry, the father of minor child
P.H., on January 27, 2015. Plaintiffs' health care plan
(the " Plan" ) provides health care benefits to its
participants and is an employee welfare benefit plan as
defined by the Employment Retirement Income Security Act of
1974 (" ERISA" ), 29 U.S.C. § 1001 et
seq. At all relevant times, Defendant Nicholas Henry was
a participant in the Plan and P.H. was a covered dependent
under the Plan.
October 12, 2013, P.H. was injured in an accident involving
an all-terrain vehicle. (Doc. 1 at 2). As of the date of the
Complaint, the Plan had paid approximately $48,000.00 for
medical expenses P.H. incurred as a result of the accident. (
Id. ). Following the accident, P.H. reached
settlements with third parties and/or their insurers totaling
at least $125,000.00 for injuries and damages resulting from
the accident. ( Id. ). Because P.H. is a minor, any
settlements are contingent upon approval by the Probate
Court. ( Id. ).
assert that the terms and conditions of the Plan are set
forth in the Master Plan Document entitled The Apollo Group,
Inc. Health and Welfare Plan. (Doc. 1 at 3). Additionally,
the Master Plan Document includes several other documents,
referred to as " Incorporated Documents." (
Id. ). Among the " Incorporated Documents"
is the " Summary Plan Description" ("
SPD" ). ( Id. ). Plaintiffs assert that "
[a]s an incorporated document, the terms and conditions of
the SPD are incorporated into the Plan and made a part
thereof." ( Id. ).
contend that a provision in the SPD requires a covered person
whose medical expenses for an injury are paid under the Plan
to reimburse the Plan if he or she receives compensation from
a third party who caused the injury. ( Id. ). On
January 10, 2014, Plaintiffs notified Defendant of their
claim for reimbursement of medical expenses paid on behalf of
P.H. for injuries sustained in the accident. ( Id.
). Plaintiffs seek reimbursement from the proceeds of the
settlement agreements between P.H. and the responsible third
parties. (Doc. 1 at 4). Plaintiffs allege that Defendant
refuses to recognize the right to reimbursement under the
Plan for the medical expenses paid on P.H.'s behalf. (
on these facts, Plaintiffs raise three causes of action. In
Count One, Plaintiffs raise a claim for equitable relief
under 29 U.S.C. § 1132(a)(3)(B) to enforce the terms of
the Plan. (Doc. 1 at 4-5). They contend that under the terms
of the Master Plan Document, Defendant promised to reimburse
the Plan if recovery was obtained from a third party.
Plaintiffs allege that based on the terms of the Plan, they
have an equitable lien by agreement for no less than
$47,930.87, which they are entitled to enforce.
Count Two, Plaintiffs seek injunctive relief pursuant to 29
U.S.C. § 1132(a)(3)(A). (Doc. 1 at 5-6). Plaintiffs
request an injunction enjoining Defendant from disbursing
settlement funds received from third parties. Plaintiffs
claim the funds should be ordered set aside and preserved to
protect their right to reimbursement under the Plan.
Count Three, Plaintiffs seek declaratory relief. (Doc. 1 at
6-7). Plaintiffs allege that a dispute exists between them
and Defendant regarding proper interpretation and application
of the Plan. Plaintiffs therefore seek a declaration of
rights, responsibilities and obligations under the Plan.
relief, Plaintiffs seek equitable relief in the form of
enforcement of their reimbursement rights under the Plan,
injunctive and declaratory relief as noted ...