Filed: Aug. 06, 2019
Latest Update: Mar. 03, 2020
Summary: NOT PRECEDENTIAL UNITED STATES COURT OF APPEALS FOR THE THIRD CIRCUIT _ No. 18-2224 _ KRISTINE GUARIGLIA, Appellant v. UNITED FOOD & COMMERICAL WORKERS LOCAL 464A UNION WELFARE SERVICE BENEFIT FUND _ Appeal from the United States District Court for the District of New Jersey (D.C. Civil Action No. 2-18-cv-00002) District Judge: Honorable Susan D. Wigenton _ Argued January 15, 2019 Before: AMBRO, HARDIMAN, and FUENTES, Circuit Judges (Opinion filed: August 6, 2019) _ OPINION* _ * This disposition
Summary: NOT PRECEDENTIAL UNITED STATES COURT OF APPEALS FOR THE THIRD CIRCUIT _ No. 18-2224 _ KRISTINE GUARIGLIA, Appellant v. UNITED FOOD & COMMERICAL WORKERS LOCAL 464A UNION WELFARE SERVICE BENEFIT FUND _ Appeal from the United States District Court for the District of New Jersey (D.C. Civil Action No. 2-18-cv-00002) District Judge: Honorable Susan D. Wigenton _ Argued January 15, 2019 Before: AMBRO, HARDIMAN, and FUENTES, Circuit Judges (Opinion filed: August 6, 2019) _ OPINION* _ * This disposition ..
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NOT PRECEDENTIAL
UNITED STATES COURT OF APPEALS
FOR THE THIRD CIRCUIT
________________
No. 18-2224
________________
KRISTINE GUARIGLIA,
Appellant
v.
UNITED FOOD & COMMERICAL WORKERS LOCAL 464A UNION
WELFARE SERVICE BENEFIT FUND
________________
Appeal from the United States District Court
for the District of New Jersey
(D.C. Civil Action No. 2-18-cv-00002)
District Judge: Honorable Susan D. Wigenton
________________
Argued January 15, 2019
Before: AMBRO, HARDIMAN, and FUENTES, Circuit Judges
(Opinion filed: August 6, 2019)
________________
OPINION*
________________
*
This disposition is not an opinion of the full Court and pursuant to I.O.P. 5.7 does not
constitute binding precedent.
Steve L. Kessel, Esquire (Argued)
Drazin & Warshaw
25 Reckless Place
P.O. Box 8909
Red Bank, NJ 07701
Counsel for Appellant
Mark Hanna, Esquire (Argued)
Murphy Anderson
1401 K Street, N.W.
Suite 300
Washington, DC 20005
Counsel for Appellee
AMBRO, Circuit Judge
We review the District Court’s dismissal of a claim under the Employee
Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq., seeking to
compel an employer-sponsored healthcare plan to pay medical expenses. The Court held
the claim was barred by res judicata stemming from its dismissal of a similar claim in a
prior case with the same parties. We need not assess whether that application of res
judicata was correct because, on a separate ground, we conclude the District Court was
correct to dismiss the complaint. We thus affirm.
I. Background
Kristine Guariglia is a participant in an employer-sponsored healthcare plan (the
“Plan”) administered by defendant-appellee Local 464A United Food and Commercial
Workers Union Welfare Service Benefit Fund (the “Fund”). The Plan is an employee
welfare benefit plan under ERISA. It is “not a primary plan or a secondary plan but
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rather a tertiary plan and payer of last resort.” (App. 025a.) In other words, the Fund will
pay benefits only when payments from other sources are unavailable. (See, e.g., App.
025a.) It extends this payer-of-last-resort concept to medical expenses in particular,
reiterating that it “does not cover healthcare expenses for which a third party is
responsible to pay.” (App. 026a.)
In April 2012 Guariglia was injured when she tripped due to a pothole. She filed
that year a lawsuit in New Jersey state court (the “Liability Action”) alleging that
numerous third parties were liable for her injuries. She also filed a claim for
reimbursement of medical expenses under the Plan, but the Fund denied that claim.
Dissatisfied with the Fund’s decision, Guariglia filed in 2013 an action in the District
Court (“Guariglia I”) seeking to compel the Fund to pay her medical expenses. She
argued, among other things, that it must pay them irrespective whether she signed a
reimbursement agreement or did not pursue medical expenses as a form of damages in
the Liability Action.
The District Court disposed of Guariglia I by granting a motion to dismiss filed by
the Fund. Guariglia v. Local 464A United Food & Commercial Workers Union Welfare
Serv. Ben. Fund,
2013 WL 6188510 (D.N.J. Nov. 25, 2013). The Court held that (1) the
Fund’s demand for a reimbursement agreement as a condition for advancing medical
expenses did not violate ERISA, and (2) under the Plan the Fund was not required to
advance or reimburse Guariglia’s medical expenses at that time.
Id. at *5.
In the wake of Guariglia I, Guariglia continued to pursue her claims against third
parties in the Liability Action, but she did not amend that action to include medical
3
expenses, apparently because of a tactical decision made by her counsel based on a belief
that to seek medical expenses would create a conflict of interest. See Guariglia I,
2013
WL 6188510, at *4. Moreover, she did not include those expenses notwithstanding
having signed a reimbursement agreement with the Fund in which she promised to do so.
(App. 037a–038a.)
In May 2017 a jury entered a verdict in favor of the defendants in the Liability
Action. Within a few weeks after the verdict, Guariglia’s attorney sent a letter to the
Fund asserting that “[s]ince Ms. Guariglia’s medical expenses are not recoverable from a
third-party, by virtue of the jury’s verdict, those bills should now properly be paid under
the terms of your plan.” (App. 061a.) The Fund denied that claim (App. 063a–065a), so
Guariglia filed this second action in the District Court. It granted the Fund’s motion to
dismiss the complaint, holding her claim was barred by res judicata based on the Court’s
order dismissing the complaint in Guariglia I. Guariglia appeals to us.
II. Discussion1
The District Court dismissed Guariglia’s claim as barred by res judicata, and the
parties devoted most of their briefing to that issue. However, we may affirm dismissal of
a complaint on any ground presented by the record. See Munroe v. Central Bucks Sch.
Dist.,
805 F.3d 454, 469 (3d Cir. 2015). We perceive one such ground here. Indeed, it
almost jumps from the record: as a condition to receiving a reimbursement of medical
1
The District Court had jurisdiction under 29 U.S.C. § 1132(e)(1) and 28 U.S.C. § 1331.
We have jurisdiction under 28 U.S.C. § 1291 and review de novo dismissal of the
Complaint. Vorchheimer v. Phila. Owners Ass’n,
903 F.3d 100, 105 (3d Cir. 2018).
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expenses from the Fund, Guariglia signed an agreement promising first to seek those
expenses from third parties who may be liable for them. (App. 037a–038a.) But then,
notwithstanding that agreement, she chose not to expand the Liability Action to seek
those medical expenses at any point in the ensuing five years. (See Transcript of Oral
Argument at 14.) In other words, by her own admission, she did not fulfill her promises
under the reimbursement agreement and, accordingly, was not entitled to receive payer-
of-last-resort benefits under the Plan. In these circumstances, the Fund was clearly
within its discretion to deny her claim. See Fleisher v. Standard Ins. Co.,
679 F.3d 116,
120–21 (3d Cir. 2012).
* * * * *
We affirm the District Court’s dismissal of the complaint.
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