Blue Cross & Blue Shield v. Woodruff

803 So. 2d 519, 2001 WL 527848
CourtSupreme Court of Alabama
DecidedMay 18, 2001
Docket1992385
StatusPublished
Cited by5 cases

This text of 803 So. 2d 519 (Blue Cross & Blue Shield v. Woodruff) is published on Counsel Stack Legal Research, covering Supreme Court of Alabama 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 v. Woodruff, 803 So. 2d 519, 2001 WL 527848 (Ala. 2001).

Opinion

803 So.2d 519 (2001)

BLUE CROSS AND BLUE SHIELD OF ALABAMA
v.
Shirley WOODRUFF, as daughter and next friend of Vera Brooks, et al.

1992385.

Supreme Court of Alabama.

May 18, 2001.

*520 W. Pemble Delashmet of Pierce, Ledyard, Latta & Wasden, P.C., Mobile; and Cavender C. Kimble, Leigh Anne Hodge, and F. Inge Johnstone of Balch & Bingham, L.L.P., Birmingham, for appellant.

Sidney W. Jackson III and Stephen L. Klimjack of Jackson, Taylor, Martino & Hedge, P.C., Mobile, for appellees.

HARWOOD, Justice.

Shirley Woodruff, as daughter and next friend of Vera Brooks,[1] and "Vera Brooks, on behalf of herself and all others similarly situated," filed this action in the Mobile Circuit Court. The plaintiffs allege that Blue Cross and Blue Shield of Alabama ("Blue Cross") issued Medicare-supplement insurance policies to Brooks and to other members of a putative class and collected premiums from them when it knew, or should have known, that the policies duplicated benefits they were entitled to receive from Medicaid. Blue Cross moved to compel arbitration and also requested *521 that the trial proceedings be stayed pending arbitration. With its motion, Blue Cross filed a supporting affidavit of Melissa Brisendine, in her capacity as "manager, marketing support" of Blue Cross. The trial court denied the motion. Blue Cross appeals.

From the information in Ms. Brisendine's affidavit, we can extract the following history of Brooks's contract with Blue Cross. Beginning April 15, 1978, Brooks was covered under a Blue Cross policy referred to as a "C Plus with PMD Medicare Supplement Contract" ("C Plus policy"), a Medicare-supplement policy regulated by federal laws. Brooks's policy was an individual policy; it was not issued pursuant to any group health-insurance coverage. On March 15, 1992, federal legislation regulating Medicare-supplement policies issued after that date, including C Plus policies, took effect. Pursuant to that federal legislation, the Alabama Department of Insurance adopted Regulation No. 71; that regulation required that Medicare-supplement policies contain a procedure for grievances and appeals and allowed for the inclusion of arbitration provisions in the policies.

Effective July 1, 1992, the C Plus policy was amended to include an arbitration provision. A newsletter entitled "C Plus Update" was mailed to all C Plus subscribers, including Brooks, in the summer of 1992; it included a copy of the "Endorsement to the C Plus with PMD contract effective July 1, 1992," which, in turn, included a section entitled "Final and Binding Nature of Arbitration Procedure." In her affidavit, Ms. Brisendine states that the newsletter informed the subscribers that their continued payment of premiums "constituted acceptance of the agreement" to submit all claims or disputes to arbitration. (The newsletter contains no such provision. That provision appears only in the policy and relates to revisions to the contract in general, not to arbitration specifically.)

In November 1993, a revised policy containing an arbitration clause was sent, along with a cover letter, to all C Plus subscribers, including Brooks; Brooks continued to pay premiums until her C Plus coverage terminated in 1997. Attached as Exhibit B to Brisendine's affidavit is a copy of Ms. Brooks's C Plus policy as it read immediately before the amendment ("the 1991 contract"). Although the date of the 1991 contract was not otherwise shown, the last page indicated that the contract had been revised in January 1991. Attached as Exhibit D to Brisendine's affidavit is a copy of the revised policy that was sent out in November 1993 ("the 1993 contract").

The 1991 contract did not contain an arbitration provision. It did contain the following provisions relating to future changes in the provisions of the contract:

"Contract Revisions:
"B. By giving 30 days written notice to you, or your group, we may change the fees you pay for coverage under this Contract or any provision of this Contract. If you pay any fees after the notice, you thereby accept the new fees or changes in the contract.
"The Contract can only be changed by written amendments, endorsements, and revisions signed by one of our officers and sent by us to you or your group. None of our officers, employees, or agents can make any oral changes, such as by telephone. Nor may anyone waive or vary any provisions of this Contract except in writing, signed by one of our officers.
"Notice:
"From us to you:
*522 "We give you notice when we mail it to you at the last address we have for you in our records...."

By deposition taken on November 2, 1999, Woodruff testified to the following circumstances involving her mother's personal history, including the condition of her eyesight and her mental condition. Woodruff and her husband moved Brooks into their home in Theodore in March or April 1995. From 1987 until that move, Brooks had lived in Greenville with Annie McCrary, a former employer and longtime friend who was two years older than Brooks and whose husband had passed away. Before she moved in with the Woodruffs, Brooks had been capable of handling her own affairs, but McCrary had handled her checkbook because Brooks suffered from macular degeneration and she could not see to read. Woodruff could not remember exactly when Brooks became unable to see well enough to read, but she estimated it was "at least 9-10 years" before her 1999 deposition. Woodruff also answered affirmatively when asked if "[t]hat would take us back to about 1985 or 1986, roughly, is when she started having problems with her vision?" Woodruff testified that before that, although Brooks had not completed high school, "she could read and write very good" and that "she loved to read." When Woodruff was gathering her mother's possessions at the home she shared with Mrs. McCrary in Greenville in preparation for her move to Theodore, Woodruff did not find any policies or other paperwork from Blue Cross, other than Brooks's Blue Cross insurance card and some explanation-of-benefit forms. Woodruff speculated that Brooks may have thrown away any other materials she might have received from Blue Cross.

By the time she moved to Theodore, Brooks was not able to keep track of her own papers and Mrs. McCrary was reading to her because Brooks's failing vision made it impossible for her to read. Woodruff could not speculate on who, as between Mrs. McCrary and Brooks, decided what documents needed to be kept and what needed to be thrown away, "because [she] wasn't there." She never asked Mrs. McCrary where any other materials relating to Blue Cross might be. Although she needed Mrs. McCrary's assistance in writing checks and reading, Brooks handled her own affairs while she lived with Mrs. McCrary. Woodruff testified that she had asked her mother if she had ever received a C Plus policy or any correspondence related to it and that "she doesn't remember anything." Brooks does not remember "how she got on C Plus" and she does not remember if she ever received a policy. Woodruff indicated that she has never asked Brooks if she had gotten any newsletters or other correspondence from Blue Cross, but that she does not believe that "right now" Brooks would remember whether she had.

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Bluebook (online)
803 So. 2d 519, 2001 WL 527848, Counsel Stack Legal Research, https://law.counselstack.com/opinion/blue-cross-blue-shield-v-woodruff-ala-2001.