Blue Cross & Blue Shield of Massachusetts, Inc. v. Trull

3 Mass. L. Rptr. 599
CourtMassachusetts Superior Court
DecidedMarch 31, 1995
DocketNo. 9302026
StatusPublished

This text of 3 Mass. L. Rptr. 599 (Blue Cross & Blue Shield of Massachusetts, Inc. v. Trull) is published on Counsel Stack Legal Research, covering Massachusetts Superior Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Blue Cross & Blue Shield of Massachusetts, Inc. v. Trull, 3 Mass. L. Rptr. 599 (Mass. Ct. App. 1995).

Opinion

Tierney, J.

This matter is before the court on the plaintiff Blue Cross and Blue Shield of Massachusetts, Inc.’s (plaintiff) motion for summary judgment pursuant to Mass.R.Civ. P. 56(c). The plaintiff brought this action against the Trull family2 (Trulls), seeking reimbursement pursuant to the subrogation clause in the Trulls’ subscriber certificates for payments made for the medical care of various members of the family following an automobile accident on February 19, 1991. The Trulls have brought a counterclaim alleging breach of contract, violation of G.L.c. 93A and seeking a declaration of the parties’ rights. The plaintiff moves for summary judgment, alleging that it is entitled to reimbursement from funds the Trulls have already received from Mr. Trull’s automobile insurance policy as a result of the accident. In addition, the plaintiff seeks a declaration that the subrogation provisions of the Trulls’ subscriber certificates require the Trulls to further reimburse the plaintiff from any funds received from any or all of three pending actions. For the following reasons, the plaintiffs motion is allowed in part.

BACKGROUND

On February 19, 1991, the Trulls were involved in an automobile accident in Conway, New Hampshire in which all four family members were injured. At the time of the accident, David Trull was driving the family car in which his wife, Elizabeth, and sons, Nathaniel and Benjamin, were passengers. Benjamin Trull ultimately died from his injuries.

During all times relevant to this action, the Trulls were covered by a Blue Cross Blue Shield Master Health Plus and/or Vital Insurance Protection plan. As of September 8, 1994, the plaintiff had paid out the following benefits to the Trulls for injuries suffered in the accident: $9,903.59 for services rendered to David Trull; $223,965.18 for services rendered to Elizabeth Trull; $50,720.83 for services rendered to Nathaniel Trull; and $1,788.17 for services rendered to Benjamin Trull. Additional services may still be required by several members of the family.

Part 5, Section 3 of the Trulls’ Master Health Plus policy, which addresses the issue of subrogation, reads as follows:

If you are injured by an act or omission of another person, the benefits under this contract will be subrogated. This means that Blue Cross and Blue Shield may use your right to recover money from the person who caused your injury. If you recover the money, you must pay Blue Cross and Blue Shield up to the amount of the benefit payments we have made. Our right to repayment comes first even if you are not paid for all of your claims against the other person or if the payment you receive is described as payment for other than health care expenses . . . (Emphasis in original.)

The language in Part 6, Section 8(c) of the Vital Insurance Protection plan is virtually identical.

In 1992, the plaintiff sought to impose a lien pursuant to G. L. c. 111, §70A on any recovery by the Trulls from a third party. At this time, the plaintiff discovered that the claims of Elizabeth, Nathaniel and Benjamin Trull against David Trull had been settled by Hanover Insurance for $200,000.00. Of this amount, $100,000.00 was allocated for Elizabeth, $85,000.00 for Nathaniel and $15,000.00 for Benjamin. The monies received were not designated as covering any particular expenses or damages incurred by the Trulls. The plaintiff sought to recover at least part of these proceeds from the defendants pursuant to the subrogation clauses. The Trulls have refused to make any such payments to the plaintiff.

Currently pending in the New Hampshire state and federal court systems are three actions brought by the Trulls as a result of the accident. The plaintiff has sought to assert liens pursuant to G.L.c. Ill, §70A against any recovery obtained by any of the Trulls in the New Hampshire actions. Both the Trulls and the attorneys in the New Hampshire actions have refused to acknowledge these liens.

DISCUSSION

Summary judgment shall be granted where there are no genuine issues as to any material fact and where the moving party is entitled to judgment as a matter of law. Cassessov. Commissioner of Correction, 390 Mass. 419, 422 (1983); Community Nat’l Bank v. Dawes, 369 Mass. 550, 553 (1976); Mass.R.Civ. P. 56(c). The moving party bears the burden of affirmatively demonstrating the absence of a triable issue, “and [further] that the moving party is entitled to judgment as a matter of law.” Pederson v. Time Inc., 404 Mass. 14, 16-17 (1989). A party moving for summary judgment who does not have the burden of proof at trial may demonstrate the absence of a triable issue [600]*600either by submitting affirmative evidence that negates an essential element of the opponent’s case or “by demonstrating that proof of that element is unlikely to be forthcoming at trial.” Flesner v. Technical Communications Corp., 410 Mass. 805, 809 (1991); accord, Kourouvacilis v. General Motors Corp., 410 Mass. 706, 716 (1991). “If the moving party establishes the absence of a triable issue, the party opposing the motion must respond and allege specific facts which would establish the existence of a genuine issue of material fact in order to defeat [the] motion.” Pederson, supra, 404 Mass, at 17. “(T]he opposing party cannot rest on his or her pleadings and mere assertions of disputed facts to defeat the motion for summary judgment.” LaLonde v. Eissner, 405 Mass. 207, 209 (1989).

A. Subrogation

“Subrogation is an equitable adjustment of rights that operates when a creditor or victim of loss is entitled to recover from two sources, one of which bears a primary legal responsibility.” Frost v. Porter Leasing Corp., 386 Mass. 425, 426-27 (1982). “The doctrine of subrogation applies, within limits ... to payments under policies of insurance” and such a right may be either express or implied. Id. at 427. Once an insurer has paid out benefits, the insurer is entitled to share the proceeds of any rights of recovery which the insured may have against a third party for the same loss covered by the insurance. Id.; see also Travelers Insurance Co. v. Graye, 358 Mass. 238, 240-41 (1970); General Exchange Insurance Corp. v. Driscoll, 315 Mass. 360, 364 (1944).

In the present action, the plaintiff claims that, in accordance with the express subrogation clause in the Trulls’ subscriber certificates, it is entitled to recover from the Trulls any and all judgment or settlement proceeds the Trulls receive from third parties as a result of the accident, up to the amount that the plaintiff has paid out to the Trulls as a result of the accident.

This issue is one of first impression in Massachusetts, as the court is called upon to decide that which previous courts have specifically declined to address. See Blue Cross of Massachusetts Inc. v. Travaline, 398 Mass. 582, 590 (1986) (court declines to express any opinion as to validity of any claim insurer may bring directly against insured pursuant to subrogation clause in insurance certificate); Frost v. Porter Leasing Corp., 386 Mass. 425, 527 (1982) (where insurer’s claim is one of implied subrogation, court expresses no opinion on parties’ ability to define their rights by contract).

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Related

Pederson v. Time, Inc.
532 N.E.2d 1211 (Massachusetts Supreme Judicial Court, 1989)
LaLonde v. Eissner
539 N.E.2d 538 (Massachusetts Supreme Judicial Court, 1989)
Brown v. Leighton
434 N.E.2d 176 (Massachusetts Supreme Judicial Court, 1982)
Frost v. Porter Leasing Corp.
436 N.E.2d 387 (Massachusetts Supreme Judicial Court, 1982)
Commonwealth v. Bastarache
414 N.E.2d 984 (Massachusetts Supreme Judicial Court, 1980)
Community National Bank v. Dawes
340 N.E.2d 877 (Massachusetts Supreme Judicial Court, 1976)
Kourouvacilis v. General Motors Corp.
575 N.E.2d 734 (Massachusetts Supreme Judicial Court, 1991)
Flesner v. Technical Communications Corp.
575 N.E.2d 1107 (Massachusetts Supreme Judicial Court, 1991)
Cassesso v. Commissioner of Correction
456 N.E.2d 1123 (Massachusetts Supreme Judicial Court, 1983)
Travelers Insurance Co. v. Graye
263 N.E.2d 442 (Massachusetts Supreme Judicial Court, 1970)
Blue Cross of Massachusetts, Inc. v. Travaline
499 N.E.2d 1195 (Massachusetts Supreme Judicial Court, 1986)
General Exchange Insurance v. Driscoll
52 N.E.2d 970 (Massachusetts Supreme Judicial Court, 1944)
Creswell v. Medical West Community Health Plan, Inc.
644 N.E.2d 970 (Massachusetts Supreme Judicial Court, 1995)

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Bluebook (online)
3 Mass. L. Rptr. 599, Counsel Stack Legal Research, https://law.counselstack.com/opinion/blue-cross-blue-shield-of-massachusetts-inc-v-trull-masssuperct-1995.