Buatte v. Gencare Health Systems, Inc.

939 S.W.2d 440, 1996 Mo. App. LEXIS 2048, 1996 WL 720684
CourtMissouri Court of Appeals
DecidedDecember 17, 1996
Docket69962
StatusPublished
Cited by9 cases

This text of 939 S.W.2d 440 (Buatte v. Gencare Health Systems, Inc.) is published on Counsel Stack Legal Research, covering Missouri Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Buatte v. Gencare Health Systems, Inc., 939 S.W.2d 440, 1996 Mo. App. LEXIS 2048, 1996 WL 720684 (Mo. Ct. App. 1996).

Opinion

*441 RHODES RUSSELL, Presiding Judge.

Gencare Health Systems, Inc. (“Gencare”) appeals from the entry of summary judgment in favor of Lonnie and Theresa Buatte in their declaratory judgment action seeking interpretation of a subrogation provision of an insurance policy. The trial court found that state law governed and based the grant of summary judgment, in part, on Gencare’s waiver of its right of subrogation. We find that federal law permitting subrogation preempted state law and that Gencare did not waive its right to subrogation. We reverse and remand.

In 1987 Lonnie and Theresa Buatte enrolled in the Sanus Health Benefit Plan (“Plan”) 1 through Mr. Buatte’s employment with the federal government. In 1990, while still enrolled in the Plan, Theresa Buatte was injured in a ear accident involving a railroad company. As a result of the accident, she incurred $71,640.00 in medical expenses which were paid by Gencare.

The Buattes filed a personal injury action in the Circuit Court of the City of St. Louis against the railroad company. Gencare was informed about the suit and filed a petition to intervene in the action, however, it later withdrew its petition. The railroad settled the suit by paying $400,000 to the Buattes. Gencare requested that the Buattes reimburse it for the money it had spent on Theresa Buatte’s medical expenses pursuant to the subrogation/reimbursement provisions of the Plan.

The Plan stated, in a section titled “Third Party Actions,”:

If a covered person is injured through the act or omission of another, the Plan requires that it be reimbursed for the benefits provided, in an amount not to exceed the amount of the recovery or that it be subrogated to the person’s rights to the extent of the benefits received under this' Plan, including the right to bring suit in the person’s name.

The Buattes refused to reimburse Gencare and filed a declaratory judgment action in the Circuit Court of the City of St. Louis seeking an interpretation of the Plan’s subro-gation provision. Gencare removed the action to the United States District Court. The district court remanded the case back to the state court stating that the action did not arise under federal law.

The Buattes filed a motion for summary judgment listing four grounds. First, they argued that Gencare had waived its right to subrogation by failing to intervene in the action against the railroad that was now settled. Second, they contended that their settlement with the railroad did not preclude Gencare from pursuing indemnification directly from the railroad. Third, they stated that there was no proof before the court that they were subject to any subrogation provision in the policy that covered them. Finally, they argued that the Plan’s provision granting Gencare subrogation rights was contrary to the public policy of Missouri and void.

The trial court granted the motion for summary judgment based upon the Buattes’ first three grounds and specifically found that Missouri law governed. Gencare now appeals the grant of summary judgment.

The standard of review for summary judgment cases is governed by ITT Commercial Finance Corp. v. Mid-America Marine Supply Corp. 854 S.W.2d 371 (Mo.banc 1993). When considering appeals from summary judgment, we review the record in the light most favorable to the party against whom judgment was entered. Id. The propriety of summary judgment is purely an issue of law. Our review is essentially de novo. Id. Summary judgments should only be maintained where facts are not in dispute, so that the prevailing party can be determined as a matter of law. Id.

In its first point on appeal, Gencare contends that the trial court erred in applying Missouri law, as the Federal Employees Health Benefits Act (FEHBA), 5 U.S.C.A. §§ 8901-8914, preempts state law where the provisions are inconsistent.

Missouri law, as a matter of public policy, does not allow an insurer to acquire part of the insured’s rights against a tortfea- *442 sor through the payment of medical expense, either by assignment or subrogation. Wage v. Bankers Multiple Line Ins. Co., 796 S.W.2d 660 (Mo.App.1990). Insurance policies which attempt to do so are, therefore, invalid under state law.

The FEHBA, however, permits subrogation by providing:

The provisions of any contract under this chapter which relate to the nature or extent of coverage or benefits (including payment with respect to benefits) shall supersede and preempt any State or local law, or any regulation issued thereunder, which relates to health insurance or plans to the extent that such law or regulation is inconsistent with such contractual provisions.

5 U.S.C. § 8902(m)(l).

Although no Missouri cases have addressed the FEHBA’s preemption of inconsistent state law, the FEHBA has been found to preempt state law in other jurisdictions. Those courts have enforced subrogation and reimbursement clauses of health plans where state law would not have permitted the same. In NALC Health Benefit Plan v. Lunsford, 879 F.Supp. 760 (E.D.Mich.1995), a U.S. District Court in Michigan upheld a requirement that enrollees reimburse the plan from any third party proceeds they collected, even though under Michigan law such reimbursement would not have been permissible.

Similarly, in Medcenters Health Care v. Ochs, 854 F.Supp. 589 (D.Minn.1993), the insurer sought reimbursement from the insured after the insured had settled with a third party tortfeasor. The Minnesota District Court found that the provisions of the plan permitting such recovery preempted Minnesota state law which would not permit reimbursement unless the insured had received a full recovery.

We likewise find that Missouri state law prohibiting subrogation is preempted by the FEHBA. The FEHBA requires preemption of state law if it would differ the “nature or extent of coverage or benefits” offered under the FEHBA authorized plan. In the present case, prohibiting Geneare from seeking reimbursement from its insured would clearly differ the extent of coverage or benefits.

The Buattes do not dispute on appeal that Missouri’s law was preempted by the FEHBA to the extent that there was an inconsistency between state, law and the Plan’s provisions. They claim that their motion for summary judgment, and the court’s granting thereof, was premised upon Gen-care’s waiver of subrogation by failing to intervene in their earlier action with the railroad. Since the Plan was silent as to whether subrogation was waived by failing to intervene, they argue that no inconsistency exists between the plan and state law, and thus Missouri law on waiver would still apply.

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939 S.W.2d 440, 1996 Mo. App. LEXIS 2048, 1996 WL 720684, Counsel Stack Legal Research, https://law.counselstack.com/opinion/buatte-v-gencare-health-systems-inc-moctapp-1996.