By Patrick A. Malone
Stein, Mitchell & Mezines
On a rainy spring night on the shoulder of the Southwest Freeway near the U.S. Capitol, James Germany was searching in the trunk of his disabled car for tools when another car hit him from behind and crushed both of his legs. He spent four months in the hospital and ran up medical bills of nearly $200,000. He finally relearned to walk with crutches, but his career operating heavy equipment was ruined.
I was James Germany's lawyer. His case seemed to go from bad to worse. First we found out that the driver who hit him had only $50,000 insurance coverage, and Germany's own car had no additional uninsured motorist coverage. Then Germany's health insurance plan tried to grab the entire $50,000 to pay itself back for the health insurance benefits the plan owed to Germany.
The insurance plan was called the Operating Engineers Trust Fund. It was a self-insured employee benefit plan run by the local union of heavy equipment operators. The Trust Fund demanded that Germany sign over all his rights to the $50,000 auto insurance money. When Germany refused to sign, on my advice, the Fund retaliated by refusing to pay any more benefits. Germany's doctors were telling him he had to come up with some other funding source or they couldn't treat him.
I boned up on a federal law called ERISA: the Employee Retirement Income Security Act. I filed suit against the plan in federal court in Washington, D.C. I argued that the Trust Fund's "subrogation" clause, which let it piggy-back onto Germany's auto insurance claim, only gave the Fund rights to money if Germany got a windfall double recovery from his auto case. And no one claimed the $50,000 would make Germany rich. I filed a motion for summary judgment, and the Fund filed its own motion.
U.S. District Judge George Revercomb heard both sides and decided Germany was right. Germany got to keep the whole $50,000, and the Trust Fund was ordered to pay everything it owed for health insurance and retirement benefits to Germany. Because the federal law also contained a provision requiring ERISA plans to pay attorney's fees when a member sues them and wins, we also won an order for the Trust Fund to pay my fee for suing the Fund. The judge's decision is reported in the federal cases law book at 789 F. Supp. 1165 (D. D.C. 1992).
This case made me proud to be a trial lawyer. Without my help, James Germany would have been victimized twice by his auto accident. With my help, he was able to stand up to his insurance plan and make them pay what they owed, and keep some modest funds for himself.
TLA-DC Members - Do you have your own "Proud to Be a Trial Lawyer" story to contribute? If so, please email us.