Allen v. Pacheco

71 P.3d 375, 2003 Colo. LEXIS 484, 2003 WL 21310267
CourtSupreme Court of Colorado
DecidedJune 9, 2003
Docket01SC744
StatusPublished
Cited by84 cases

This text of 71 P.3d 375 (Allen v. Pacheco) is published on Counsel Stack Legal Research, covering Supreme Court of Colorado primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Allen v. Pacheco, 71 P.3d 375, 2003 Colo. LEXIS 484, 2003 WL 21310267 (Colo. 2003).

Opinions

Chief Justice MULLARKEY

delivered the Opinion of the Court.

I. Introduction

In this wrongful death ease, we address the question of whether the respondent Karen Pacheco is bound by an arbitration provision contained in her deceased husband’s agreement with his health maintenance organization (“HMO”). The court of appeals held that Pacheco was not bound by the arbitration agreement because the agreement does not apply to wrongful death actions filed by a [377]*377member’s non-party spouse. Pacheco v. Allen, 55 P.3d 141, 143-44 (Colo.App.2001). We affirm the court of appeals on different grounds, holding that although the arbitration provision in the HMO contract does extend to -wrongful death actions filed by a member’s non-party spouse, Pacheco is not bound by the arbitration provision because it does not comply with the Colorado Health Care Availability Act (“HCAA”), §§ 13-64-403(3) and (4), 5 C.R.S. (2002). The HCAA governs the arbitration provision in this case because the McCarran-Ferguson Act, 15 U.S.C. § 1012(b) (1997), exempts sections 13-64-403(3) and (4) of the HCAA from federal preemption by the Federal Arbitration Act (“FAA”), 9 U.S.C. § 2 (1999).

II. Facts and Procedural History

The Kaiser Foundation Health Plan of Colorado (“Kaiser”) is an HMO that provides health care services and health care insurance to its enrollees. Pacheco’s husband was a Kaiser member, but Pacheco herself never became a party to the Kaiser contract. The contract between Kaiser and Pacheco’s husband contained an arbitration clause requiring “any claim of medical malpractice” to be submitted to binding arbitration. The clause included claims for “death” asserted by “a Member’s heir or personal representative”:

Claims ... shall be submitted to binding arbitration if the claim is asserted: By a Member, or by a Member’s heir or personal representative, or by a person claiming that a duty to him or her arises from a Member’s relationship with Health Plan, Hospitals or Medical Group incident to this Agreement ... For any reason, including, but not limited to, death ... Against one or more of the following: Health Plan, Hospitals, Medical Group, Any Physician, or Any employee or agent of the foregoing,

(emphasis added).

In 1997, Pacheco’s husband died after extended hospitalization for pancreatitis. Pacheco subsequently filed a wrongful death action against Dr. Lawrence S. Allen, Dr. Timothy R. Collins, Dr. Michael K. Miller, and their employer, the Colorado Perma-nente Medical Group, P.C. (“CPMG”) (collectively, “the providers”).1 CPMG is a professional medical corporation that contracts with Kaiser to provide medical services to Kaiser members.

The trial court concluded that the arbitration clause in the contract between Kaiser and Pacheco’s husband was enforceable against Pacheco because a surviving spouse is an “heir” under the plain and ordinary meaning of the agreement. The trial court also concluded that the arbitration provision was enforceable even though the provision failed to comply with the Colorado HCAA, because the FAA federally preempted the statute. Pacheco’s case was then sent to arbitration, where the arbiter entered an award in favor of the providers. The trial court subsequently denied Pacheco’s motion to vacate the award and Pacheco appealed, arguing that the trial court erred by binding her to the arbitration agreement.

The court of appeals reversed, holding in a published opinion that the arbitration clause was not enforceable against Pacheco because (1) a contract cannot bind a non-party to an agreement; (2) Pacheco was not her husband’s “heir”; (3) a wrongful death cause of action under the Colorado Wrongful Death Act, §§ 13-21-201 to 203.7, 5 C.R.S. (2002), is a wholly separate action not covered by the terms of the Kaiser agreement; and (4) generally, the broad language of the Kaiser agreement does not extend to non-party spouses bringing wrongful death claims. Pacheco, 55 P.3d at 143-44. In so holding, the court of appeals found it unnecessary to reach the issue of federal preemption.

We granted certiorari to determine whether Pacheco is bound by the arbitration clause2 and now affirm the judgment of the [378]*378court of appeals on different grounds. We hold that although the scope of the arbitration provision does include wrongful death actions filed by a member’s non-party spouse, Pacheco nevertheless is not bound by the provision because the provision does not comply with the statutory requirements set forth in the Colorado HCAA. Sections 13-64-403(3) and (4) of the HCAA govern the arbitration provision in this case because the McCarran-Ferguson Act exempts these sections of the HCAA from federal preemption.

III. Analysis

1. The Arbitration Agreement Binds a Non-Party Spouse Asserting a Wrongful Death Claim

Before addressing the statutory preemption issues raised in this case, we first explain why the scope of the Kaiser arbitration provision includes wrongful death actions filed by a member’s non-party spouse.

An arbitration agreement is a contract, the interpretation of which is a matter of law that we review de novo. See State Farm Mut. Auto. Ins. Co. v. Stein, 940 P.2d 384, 387 (Colo.1997) (addressing insurance policies generally). To determine whether the parties have agreed to submit the issue in question to arbitration, we follow state law principles governing contract formation. City & County of Denver v. Dist. Ct., 939 P.2d 1353, 1361 (Colo.1997). We must construe the terms of the agreement in a manner that allows each party to receive the benefit of the bargain, and the scope of the agreement must faithfully reflect the reasonable expectations of the parties. Id. at 1361, 1363. In other words, we must interpret the agreement in a manner that best effectuates the intent of the parties. Id. at 1361.

We ascertain the parties’ intent by looking to the plain language of the agreement. State Farm, 940 P.2d at 387. We will enforce the agreement as written unless there is an ambiguity in the language; courts should neither rewrite the agreement nor limit its effect by a strained construction. Id. Thus, like any contract, an arbitration agreement must be given effect according to the plain and ordinary meaning of its terms. Id.

In determining whether an ambiguity exists, we must ask whether the disputed provision is reasonably susceptible on its face to more than one interpretation. Id. We also evaluate the agreement as a whole and construe the language in harmony with the plain and generally accepted meaning of the words employed, unless the intent of the parties, as expressed in the contract, indicates that an alternative interpretation is intended. Id.

If ambiguities are found in the arbitration agreement, we must afford the parties a presumption in favor of arbitration and resolve doubts about the scope of the arbitration clause in favor of arbitration.3 See City & County of Denver, 939 P.2d at 1364.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Jovel v. TeamSnap, Inc.
D. Colorado, 2025
Marinos v. Brahaj
2025 NY Slip Op 03561 (Appellate Division of the Supreme Court of New York, 2025)
King v. Home Depot, Inc.
D. Colorado, 2024
James Williams v. Smyrna Residential, LLC
Tennessee Supreme Court, 2024
First American Title v. Barron
2023 UT App 109 (Court of Appeals of Utah, 2023)
Naizgi v. HSS Inc.
D. Colorado, 2023
Antero Resources Corporation v.
2023 CO 13 (Supreme Court of Colorado, 2023)
Spencer v. TICI LLC
D. Colorado, 2023
Stonerise Healthcare, LLC v. Susan K. Oates
West Virginia Supreme Court, 2020
v. Spalding Rehabilitation
2019 COA 93 (Colorado Court of Appeals, 2019)
In re N.A. Rugby Union v. U.S. Rugby Football Union
2019 CO 56 (Supreme Court of Colorado, 2019)
Frazier v. W. Union Co.
377 F. Supp. 3d 1248 (D. Colorado, 2019)
GGNSC Admin. Servs., LLC v. Schrader
917 F.3d 20 (First Circuit, 2019)
Colorow Health Care, LLC v. Fischer
2018 CO 52 (Supreme Court of Colorado, 2018)
EnCana Oil & Gas (USA), Inc. v. Miller
2017 COA 112 (Colorado Court of Appeals, 2017)

Cite This Page — Counsel Stack

Bluebook (online)
71 P.3d 375, 2003 Colo. LEXIS 484, 2003 WL 21310267, Counsel Stack Legal Research, https://law.counselstack.com/opinion/allen-v-pacheco-colo-2003.