Allstate Insurance v. Tricare Management Activity

662 F. Supp. 2d 883, 2009 U.S. Dist. LEXIS 90840, 2009 WL 3234142
CourtDistrict Court, W.D. Michigan
DecidedSeptember 30, 2009
DocketCase 1:07-CV-874
StatusPublished
Cited by2 cases

This text of 662 F. Supp. 2d 883 (Allstate Insurance v. Tricare Management Activity) is published on Counsel Stack Legal Research, covering District Court, W.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Allstate Insurance v. Tricare Management Activity, 662 F. Supp. 2d 883, 2009 U.S. Dist. LEXIS 90840, 2009 WL 3234142 (W.D. Mich. 2009).

Opinion

OPINION

ROBERT J. JONKER, District Judge.

INTRODUCTION

Allstate Insurance Company (“Allstate”) seeks reimbursement of Michigan no-fault benefits that it claims it overpaid to Defendants Tricare Management Activity and the Department of the Air Force (collectively “Tricare” or “the Government”), and to Defendants Brian Keith Menefee, John D. Tallman, and John D. Tallman PLC (collectively, the “Tallman Defendants”). After plenary discovery, all parties filed dispositive motions. Allstate moves for summary judgment on all counts (docket # 81). Tricare moves for dismissal or summary judgment (docket # 83). The Tallman Defendants move for dismissal (docket # 85) or for summary judgment (docket # 86), and they also seek sanctions (docket # 113).

FACTS

This action revolves around approximately $151,000 in medical bills incurred by Brian Menefee at Spectrum Health (“Spectrum”) in the month following a motorcycle accident that left him with permanent, debilitating injuries. At the time of the accident, September 2, 2002, Mr. Menefee was home on leave from the United States Air Force. (Tallman Ds’ Br. in Support of Mots, to Dismiss and for Summ. J., docket ## 87-2, 91, 92-2, at 1.) Allstate was Mr. Menefee’s putative no fault carrier, but Allstate initially denied coverage and refused to pay the Spectrum Health bills. (Id. at 2.) Tricare stepped in as Mr. Menefee’s carrier of last resort, paid the bills at roughly 50% of the billed amount, 1 consistent with its contract with Spectrum Health, and provided ongoing coverage to Mr. Menefee pending the outcome of Mr. Menefee’s coverage lawsuit against Allstate. (Id.)

Mr. Menefee and his legal guardian hired Attorney Tallman to handle the coverage dispute with Allstate. The state trial court ruled in Mr. Menefee’s favor on the coverage question, and on January 16, 2004 entered a “partial judgment” against Allstate in an amount equal to the original Spectrum bills (approximately $151,586), 2 plus penalty attorney fees of $30,800. (Id. *886 at 4.) The Court of Appeals dismissed Allstate’s appeal from the partial judgment as premature in the absence of a final order. (Id. at 5.) Nevertheless, Mr. Menefee collected on the partial judgment after garnishing Allstate’s bank account with Bank of America. (Id. at 5-6.) The cashier’s checks resolving the garnishment were drawn payable to the order of Mr. Menefee and his attorney, Mr. Tallman. (Id. at 6.) Allstate and Mr. Menefee ultimately compromised all then remaining issues in the litigation. (See id. at 5-6.) Mr. Menefee filed a Satisfaction of Judgment. Allstate did not file an appeal or any motion for relief from the final judgment. Rather, the parties notified the state court that they had reached a settlement in lieu of Allstate’s appeal. (Id. at 7.)

Allstate now says that the $151,586 included in the partial judgment was at least implicitly earmarked by all parties and the court for payment to Spectrum Health. (Br. in Support of Pl.’s Mot. for Summ. J., docket # 82, at 6, 9, 11.) Spectrum had already received payment from Tricare for the same bills, as all parties knew at the time, but Tricare was not the proper payor and was entitled to reimbursement. (See id. at 5-7.) Moreover, because of Spectrum’s contract with Tricare, Spectrum was able to collect on its invoices at only about a 50% realization rate from Tricare, without any right to pursue Mr. Menefee for the balance. 3 In contrast, it would be able to collect at or near 100% from Allstate, the party properly obligated to pay the bill as Mr. Menefee’s no-fault carrier under the state court ruling. (Id., Ex. 16.) Allstate says that Mr. Menefee and his counsel should have satisfied the Spectrum Health bill, thus allowing Spectrum to refund the original Tricare payment. (Id. at 12-13.) This would have left all parties whole: (1) Spectrum would have received full payment for its services; (2) Mr. Menefee would have been fully covered for his medical and other no-fault benefits; (3) Mr. Tallman would have been compensated by the court’s attorney fee award of $30,800, and possibly any additional amount he was able to negotiate with Spectrum; (4) and Allstate would have properly paid the $151,586 in incurred medical expenses. (Id.)

Things did not work out that way. Mr. Menefee and his attorney received their payments under the partial judgment on May 7, 2004. (Id. at 9.) The very same day, Mr. Tallman disbursed to himself the $30,800 awarded in attorney fees by the court, and an additional approximately $30,000, representing litigation costs and an additional attorney fee. (See id.) Mr. Tallman held the remaining amount in his trust account over the weekend, and then disbursed the balance to his client on Monday, May 10. (Id.) He did all of this before contacting Spectrum. In fact, he waited over three weeks, until June 2, to contact Spectrum. (Id., Ex. 16, at 2.)

By letter of June 2, 2004, Mr. Tallman notified Spectrum that “Allstate has paid outstanding first-party benefits to Mr. Menefee, including $151,586.37 identified as ‘the Spectrum bill’ in the order of January 16, 2004.” (Id.) Mr. Tallman added that he understood “that Spectrum has agreed to accept the amount paid by the United States Mr Force as payment in full,” and requested that Spectrum’s counsel “call to confirm [Spectrum’s] position.” (Id.) Upon receiving Mr. Tallman’s letter and learning *887 that Allstate had paid off the partial judgment, Spectrum immediately notified Mr. Tallman that he was mistaken. (Id. at 3.) Spectrum explained that it “has always maintained, and continues to maintain, its entitlement to full payment of the incurred medical charges from Allstate,” and added that “[i]n fact, Spectrum is obligated to obtain these funds and refund the [Tricare] payments per the terms of its government contracts.” (Id.) Spectrum requested payment of “the Spectrum charges of $151,586.37” as soon as possible. (Id.) Spectrum also informed Mr. Tallman that it would not claim any no-fault penalties on Allstate’s late payment of the claims and that it would allow Mr. Tallman “to keep all penalty interest and penalty attorney fees awarded by the Court ... provided the paid funds are promptly paid over to the hospital.” (Id.)

Mr. Tallman and his client did not pay Spectrum as requested. (Id., Ex. 17, at ¶ 12.) On June 23, 2004, Spectrum’s counsel contacted Mr. Tallman, seeking assurance that he would hold the funds in trust until a court could hear any disputes concerning the funds. (Id. at ¶ 13.) No assurance was forthcoming because Mr. Tall-man had already disbursed the funds to himself and his client, though neither Spectrum nor Allstate knew that at the time. On July 2, Spectrum went into the state court seeking a TRO to prevent Mr.

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Bluebook (online)
662 F. Supp. 2d 883, 2009 U.S. Dist. LEXIS 90840, 2009 WL 3234142, Counsel Stack Legal Research, https://law.counselstack.com/opinion/allstate-insurance-v-tricare-management-activity-miwd-2009.