Carra Penegar v. Liberty Mutual Insurance Company

CourtCourt of Appeals for the Fourth Circuit
DecidedAugust 19, 2024
Docket22-1940
StatusPublished

This text of Carra Penegar v. Liberty Mutual Insurance Company (Carra Penegar v. Liberty Mutual Insurance Company) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fourth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Carra Penegar v. Liberty Mutual Insurance Company, (4th Cir. 2024).

Opinion

USCA4 Appeal: 22-1940 Doc: 41 Filed: 08/19/2024 Pg: 1 of 15

PUBLISHED

UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT

No. 22-1940

CARRA JANE PENEGAR, Executrix of the Estate of Johnny Ray Penegar, Jr., individually and on behalf of others similarly situated,

Plaintiff – Appellant,

v.

LIBERTY MUTUAL INSURANCE COMPANY; LIBERTY MUTUAL FIRE INSURANCE COMPANY,

Defendants – Appellees.

Appeal from the United States District Court for the Western District of North Carolina, at Charlotte. Robert J. Conrad, Jr., District Judge. (3:20−cv−00585−RJC−DCK)

Argued: December 5, 2023 Decided: August 19, 2024

Before GREGORY, RICHARDSON, and RUSHING, Circuit Judges

Affirmed by published opinion. Judge Richardson wrote the opinion, in which Judge Gregory and Judge Rushing joined.

ARGUED: Vernon Rollins Sumwalt, THE SUMWALT GROUP, Charlotte, North Carolina, for Appellant. Mihaela Cabulea, BUTLER WEIHMULLER KATZ CRAIG, LLP, Tampa, Florida, for Appellees. ON BRIEF: John Hughes, Mona Lisa Wallace, William Graham, Ed Pauley, WALLACE & GRAHAM, PA, Salisbury, North Carolina, for Appellant. Matthew J. Lavisky, BUTLER WEIHMULLER KATZ CRAIG LLP, Tampa, Florida, for Appellees. USCA4 Appeal: 22-1940 Doc: 41 Filed: 08/19/2024 Pg: 2 of 15

RICHARDSON, Circuit Judge:

Carra Penegar appeals the district court’s dismissal of her suit for lack of Article

III standing. She argues on appeal that the district court erred by failing to recognize

several injuries she sustained that establish her standing to sue. But we find that Penegar

has not suffered a cognizable injury in fact that existed when she filed suit. We therefore

affirm the district court’s order.

I. Background

A. The Medicare Secondary Payer Act

We begin with the Act under which Penegar’s claim arises. Medicare is a federal

health-insurance program that provides benefits to individuals who are sixty-five or older,

are disabled, or have end-stage renal disease. See 42 U.S.C. § 1395c. Before 1980,

Congress paid for a Medicare beneficiary’s medical services, even if she was already

covered by a primary health plan. Netro v. Greater Balt. Med. Cen., Inc., 891 F.3d 522,

524 (4th Cir. 2018). But that changed with the passage of the Medicare Secondary Payer

Act (“MSP Act”). See 42 U.S.C. § 1395y(b). 1 The MSP Act “inverted that system” by

making Medicare the secondary payer for a beneficiary’s medical services when payment

is available from her primary plan. Netro, 891 F.3d at 524 (quoting Humana Med. Plan,

Inc. v. W. Heritage Ins., 832 F.3d 1229, 1234 (11th Cir. 2016)). Only if the Government

1 Technically, the secondary-payer provisions of § 1395y(b) arose through a series of amendments beginning in 1980. See Omnibus Budget Reconciliation Act of 1980, Pub. L. No. 96-499, § 953, 94 Stat. 2599, 2647; United States v. Blue Cross and Blue Shield of Mich., 726 F. Supp. 1517, 1519–20 (S.D. Mich. 1989) (explaining the development of the statute). It has become customary, however, to refer to the resulting statute as the “Medicare Secondary Payer Act.” We follow that custom here. 2 USCA4 Appeal: 22-1940 Doc: 41 Filed: 08/19/2024 Pg: 3 of 15

determines that a primary plan has not paid or will not promptly pay will it conditionally

pay a beneficiary up front for medical services. § 1395y(b)(2)(B)(i). 2 But if the primary

plan is later determined to be responsible for paying, the MSP Act requires the plan, or the

entity to whom the primary plan has already paid the funds, to reimburse the Government

for its expenditures. § 1395y(b)(2)(B)(ii). 3

The MSP Act provides two mechanisms for enforcing a primary plan’s recoupment

obligation. First, the United States may sue to recover the amount from the primary plan

or from the individual or entity to whom the primary plan has paid the funds.

§ 1395y(b)(2)(B)(iii). Second, and pertinent to our case, private parties may sue to recover

double damages from a primary plan that has failed to provide for primary payment in

accordance with the MSP Act. § 1395y(b)(3)(A). 4 The ostensible purpose of this latter

2 Payment must also be unavailable from workers’ compensation, liability insurance, and no-fault insurance. See § 1395y(b)(2)(A)(ii). 3 The MSP Act also provides that “[t]he United States shall be subrogated (to the extent of payment made under this subchapter for such an item or service) to any right under this subsection of an individual or any other entity to payment with respect to such item or service under a primary plan.” § 1395y(b)(2)(B)(iv). 4 The precise scope of this cause of action is tricky. Section 1395y(b)(3)(A) allows a litigant to recover damages “double the amount otherwise provided” when “a primary plan . . . fails to provide for primary payment (or appropriate reimbursement) in accordance with paragraphs (1) and (2)(A).” See Bio-Med. Applications of Tenn., Inc. v. Cent. States S.E. and S.W. Areas Health and Welfare Fund, 656 F.3d 277, 285 (6th Cir. 2011) (“Paragraph (1) . . . essentially lays out a system of rules instructing when group health plans must pay for medical items and services. . . . Paragraph (2) . . . instructs when Medicare may or may not pay for medical items and services.”) The statute’s use of a conjunctive—requiring a failure to comply with paragraphs (1) and (2)(A)—has caused understandable confusion about when a provider is liable under its terms. Compare id. at 286–87 (holding that the cause of action only authorizes private suits when Medicare (Continued) 3 USCA4 Appeal: 22-1940 Doc: 41 Filed: 08/19/2024 Pg: 4 of 15

provision, we have found, is “to help the government recover conditional payments from

insurers or other primary payers.” Netro, 891 F.3d at 524 (quoting Stalley v. Cath. Health

Initiatives, 509 F.3d 517, 524 (8th Cir. 2007)).

B. Facts

In 2013, Johnny Ray Penegar, Jr., was diagnosed with mesothelioma. He received

extensive treatment for the condition, which was paid for in part by Medicare. Meanwhile,

in 2014, he filed a workers’ compensation claim (“life claim”) against his employer, UPS,

and its insurance carrier, Liberty Mutual Insurance Company (“Liberty Mutual”), before

the North Carolina Industrial Commission (“NCIC”). But before the completion of his

suit, he passed away, and his wife, Carra Jane Penegar (hereinafter “Penegar”), was

appointed executrix of his estate. Penegar subsequently added a claim for death benefits

(“death claim”).

On April 15, 2016, the NCIC concluded that Liberty Mutual was liable for both

claims. As part of Penegar’s award, the NCIC ordered that “Defendants SHALL pay for

all the medical treatment that Plaintiff received for his compensable mesothelioma,

including but not limited to imaging, therapy, surgery, hospitalization, prescriptions, and

mileage.” J.A. 93. It further provided that, “[t]o the extent that deceased Plaintiff/deceased

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