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Text of Sixth Circuit Opinion: Subrogation Provision in SPD Is Enforceable; Finding of Liability Not Required for Subrogation to Apply (PDF)
U.S. Court of Appeals for the Sixth Circuit
Aug. 26, 2015
"Moore claims that the grant of summary judgment should be reversed because genuine issues of material fact exist as to three issues: [1] whether the SPD is a controlling plan document, making the subrogation provision enforceable; [2] whether the settlement funds were wholly 'excess and separate' from the medical costs the Board seeks to recover and therefore exempt from subrogation; and [3] whether subrogation applies in the absence of a judicial finding or admission of liability by the third party. Because each of these issues poses a legal question rather than a factual dispute, and because the district court's resolution of the legal issues was correct ... the court properly granted summary judgment in the NEI Board's favor." [Nat. Elevator Inc. Health Benefit Plan v. Moore, No.14-04048 (6th Cir. Aug. 25, 2015)]
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