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ERISA: Subrogation, Sereboff, and the “Make Whole” Doctrine: The D.C. Circuit Defines Ambiguity in ERISA Subrogation Clauses—Moore v. Capital Care, Inc.

On August 29, 2006, the United States Court of Appeals for the District of Columbia Circuit held that an injured ERISA plan beneficiary need not be “made whole” by any injury-related recovery from a third party in order for her ERISA plan to assert subrogation or reimbursement rights if the plan's terms either 1) “unambiguously establish a plan priority” to any funds a beneficiary recovers from a third party, or 2) are reasonably interpreted to establish such a priority by an ERISA plan fiduciary clearly authorized to do so. In 1991, appellants William and Judith Moore (the Moores) purchased an ERISA health insurance policy (the plan) from Blue Cross Blue Shield of the National Capital Area and its wholly-owned subsidiary CapitalCare (CC/BCBS). On September 10, 1992, the Moores’ daughter Alistaire, a plan beneficiary, was seriously injured in an automobile accident.