Boman v. City of Gadsden

220 So. 3d 298, 2016 Ala. LEXIS 102, 2016 WL 4585731
CourtSupreme Court of Alabama
DecidedSeptember 2, 2016
Docket1150987
StatusPublished

This text of 220 So. 3d 298 (Boman v. City of Gadsden) 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
Boman v. City of Gadsden, 220 So. 3d 298, 2016 Ala. LEXIS 102, 2016 WL 4585731 (Ala. 2016).

Opinion

MAIN, Justice.

John Boman appeals from a summary-judgment entered by the Etowah Circuit Court in favor of the City of Gadsden. For the reasons stated below, we affirm.

I. Facts and Procedural History

This is the third time this case has been before us. See City of Gadsden v. Boman, 104 So.3d 882 (Ala.2012) (“Boman I ”), and City of Gadsden v. Boman, 143 So.3d 695 (Ala.2013) (“Boman II ”). Rather than restating all the facts and procedural history surrounding this case, we limit our discussion to those facts directly relevant to the issues now on appeal. A more complete factual and procedural background of this case is set forth in Boman I and Boman II.

Boman worked as a Gadsden police officer from 1965 until he retired in 1991. During his employment with Gadsden, police officers operated under various versions of the “City of Gadsden Employee Handbook: Police Department.” The employee handbook applied to uniformed and sworn police officers employed by Gadsden and was periodically revised. At the time of Boman’s retirement, the employee handbook applicable to police officers was the “City of Gadsden Employee Handbook: Police Department (ed. 1989-1992)” (“the handbook”). Section 26 of the handbook, entitled “Employee Benefit Plan,” noted changes to the prior employee-benefit plan. According to the handbook, police-department employees’ then current health-care plan included “Major Medical benefits — 80% UCR [usual, customary, and reasonable charges] for the first $10,000 with 100% of covered expenses ... each year after $2,000 annual out-of-pocket per person.” The employee-benefit plan was issued and administered by Blue Cross and Blue Shield of Alabama (“Blue Cross”). Nothing in the handbook indicates the police-department employee health benefits extended to retirees.

Following his retirement, Boman elected to pay for retiree health coverage through a group plan offered by Gadsden to retired employees. This retired-employee-benefit plan was also administered by Blue Cross and provided substantially similar benefits to those Boman received as an active employee. In 2000, however, Gadsden elected to join an employee-health-insurance-benefit plan (“the plan”) administered by the State Employees’ Insurance Board (“the SEIB”). We explained in Boman I:

“In 2000, Gadsden elected to join the ‘Local Government Health Insurance Plan’ (‘the plan’), a ‘self-insurance health benefit plan administered by the State Employees’ Insurance Board’ (‘the Board’). The claims administrator for the plan was Blue Cross. The plan stated, in pertinent part:
“ ‘Retired Employees
‘Health benefits mil be modified when you or your dependent becomes entitled to Medicare. Coverage under this plan will be reduced by those benefits payable under Medicare, Parts A and B....
“ ‘The [plan] remains primary for retirees until the retiree is entitled to Medicare. Upon Medicare entitlement, the member’s coverage under the [plan] will complement his/her Medicare Parts A and B coverages. Medicare will be the primary payer and the [plan] will be the secondary payer. A Medicare retiree and/or Medicare dependent should have both Medicare Parts A and B to have adequate coverage with the [plan].’
“(Some emphasis added; some emphasis omitted.)
“When Boman turned 65 in 2011, he was receiving medical care for ‘congestive heart failure’ and ‘severe osteoar[301]*301thritis of the spine.’ After his 65th birthday, Blue Cross began denying his claims for medical treatment based on the failure to provide Blue Cross with a ‘record of the Medicare payment.’ However, Boman had no Medicare credits. ... Boman was hired before March 31, 1986, and, although Gadsden did begin participation in the Medicare program in 2006, Boman’s employee group had not opted to obtain Medicare coverage before Boman retired. Consequently, Boman never paid Medicare taxes and does not claim to have Medicare coverage.”

Boman I, 104 So.3d at 883-84. In the ensuing coverage dispute, the SEIB took the position that, despite the fact that Bo-man had no Medicare credits entitling him to premium-free Medicare coverage, he was still entitled to participate in Medicare by enrolling and paying the applicable premium. Thus, the SEIB determined that the plan was the secondary payer to Medicare.

Boman sued Gadsden, asserting that it had broken an agreement, made upon his employment, to provide him with lifetime health benefits upon his retirement. Bo-man also sued the members of the SEIB charged with administering the plan, challenging the SEIB’s interpretation of the plan.1

Boman’s claims against Gadsden were ultimately set forth in his 14th amended complaint, count II of which alleged that Gadsden owed him medical-insurance benefits. Boman contended that he had entered into an employment contract with Gadsden requiring Gadsden to provide him lifetime health-care benefits upon his retirement, that those benefits had vested upon Boman’s reaching 20 years of service as a Gadsden police officer, and that Gadsden had breached that agreement once the plan was deemed secondary to Medicare. Count III alleged that Gadsden committed the tort of outrage by failing to provide Boman primary health insurance. Count IV alleged that Gadsden was guilty of the tort of bad faith by wrongfully denying Boman retirement health benefits.

As to his claims against the SEIB members, Boman requested a judgment declaring that he was not “entitled to Medicare” as that term is defined in the plan and that, therefore, he was entitled to primary coverage under the plan. As more fully explained in Boman II, the trial court initially entered a summary judgment in favor of Boman and ordered the SEIB “to provide medical benefits to John Boman as primary insurance because John Boman is not ‘Medicare eligible.’ ” 143 So.3d at 701. The trial court also granted Boman injunc-tive relief against Gadsden, ordering Gadsden to be responsible for providing medical-benefit coverage to Boman in the event this Court overturned its ruling as to the SEIB. In Boman II, this Court reversed the trial court’s judgment, reasoning that, even though Boman was not entitled to participate in premium-free Medicare coverage, he was nevertheless entitled to participate in Medicare simply by enrolling and paying the applicable premium once he had turned 65 years old. Thus, he was “entitled” to Medicare as that term was used in the plan, and the plan was secondary. We also reversed the order granting injunctive relief against Gadsden because Boman had not provided the mandatory security required by Rule 65(c), Ala. R. Civ. P.

On remand following Boman II, Bowman and Gadsden filed cross-motions for a summary judgment as to Boman’s claims [302]*302against Gadsden alleging breach of contract, the tort of outrage, and bad faith. The trial court concluded that there was no. employment contract between Boman and Gadsden. The trial court also concluded that the evidence submitted did not establish a viable claim of the tort of outrage or bad faith. Accordingly, the trial court entered a summary judgment in favor of Gadsden and against Boman as to his claims of breach of contract, the tort of outrage, and bad faith. The trial court certified its judgment as final pursuant to Rule 54(b), Ala. R. Civ. P.

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Bluebook (online)
220 So. 3d 298, 2016 Ala. LEXIS 102, 2016 WL 4585731, Counsel Stack Legal Research, https://law.counselstack.com/opinion/boman-v-city-of-gadsden-ala-2016.