Connecticut Podiatric Medical Ass'n v. Health Net of Connecticut, Inc.

28 A.3d 958, 302 Conn. 464, 2011 Conn. LEXIS 419
CourtSupreme Court of Connecticut
DecidedOctober 18, 2011
DocketSC 18267
StatusPublished
Cited by24 cases

This text of 28 A.3d 958 (Connecticut Podiatric Medical Ass'n v. Health Net of Connecticut, Inc.) is published on Counsel Stack Legal Research, covering Supreme Court of Connecticut primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Connecticut Podiatric Medical Ass'n v. Health Net of Connecticut, Inc., 28 A.3d 958, 302 Conn. 464, 2011 Conn. LEXIS 419 (Colo. 2011).

Opinions

Opinion

McLACHLAN, J.

The plaintiff podiatrists, Jeffrey F. Yale, Anthony R. lorio, and R. Daniel Davis (individual podiatrists), and the named plaintiff, the Connecticut Podiatric Medical Association (association), appeal1 from the grant of summary judgment in favor of the defendant, Health Net of Connecticut, Inc. The plaintiffs argue that the trial court improperly concluded that, as a matter of law, the defendant’s practice of reimbursing the individual podiatrists at a lower rate than medical doctors for the same procedures does not constitute “unfair discrimination” in violation of the Connecticut Unfair Insurance Practices Act (CUIPA), General Statutes § 38a-815 et seq., and the Connecticut Unfair Trade Practices Act (CUTPA), General Statutes § 42-110a et seq.2 The defendant contends that the judgment of the trial court may be affirmed on the alternate ground that the individual podiatrists do not have standing to pursue damages.3 Because we conclude that the protection against “unfair discrimination” in General Statutes [467]*467§ 38a-816 (10)4 is limited to denials of reimbursement, we affirm the judgment of the trial court.

The trial court set forth the following relevant facts in its memorandum of decision rendering summary judgment in favor of the defendant. The defendant issues health care insurance policies to provide coverage for medical services and enters into contracts with practitioners of the healing arts to provide those services. The individual podiatrists are licensed to practice in the state of Connecticut and are network providers of services pursuant to provider agreements with the defendant. Pursuant to those agreements, the individual podiatrists administer podiatric care to patients who are members of a health care insurance plan that is issued or administered by the defendant. The defendant has entered into agreements with its insureds to provide health insurance coverage for a variety of medical services, and for each service, the defendant has designated a specific current procedural terminology code (code). In order to receive payment for services that they provide to the defendant’s insureds, the individual podiatrists inform the defendant of the type of service provided by using the code that has been assigned to that particular service. Pursuant to its provider agreements with the individual podiatrists, the defendant reimburses them for the services that they have provided by paying a set amount for each code.

[468]*468The defendant also enters into-provider agreements with medical doctors who are licensed to practice in Connecticut. Pursuant to those agreements, the medical doctors axe network providers of medical services to patients who participate in a health plan issued or administered by the defendant. Some of the medical doctors administer health care for the foot. Like the individual podiatrists, medical doctors who contract with the defendant inform the defendant of the services provided by submitting the designated codes. In some instances, the individual podiatrists and medical doctors administer the same services using the same codes, but the defendant pays the medical doctors more than it pays the individual podiatrists for the identical service, designated by the identical code.

The plaintiffs brought the present action, alleging that the defendant’s practice of reimbursing the individual podiatrists at a lower rate than medical doctors for the same service, designated by the identical code, constitutes an unfair trade practice in violation of CUTPA and CUIPA. The plaintiffs sought both monetary and injunctive relief. The trial court granted the defendant’s motion to dismiss the association’s claims for monetary relief, concluding that it lacked representational standing because the claim for monetary damages would require the participation of the individual podiatrists.5 Subsequently, the court granted the defendant’s motion for summary judgment, concluding that § 38a-816 (10) does not require insurance providers to reimburse podiatrists at the same rate that it reimburses medical doctors for the same services. Because the court resolved the issue in favor of the defendant on the merits, it concluded that it was unnecessary to consider the defendant’s claim that the individual podiatrists lacked standing. This appeal followed.

[469]*469Because it implicates subject matter jurisdiction, we first address the defendant’s claim that the trial court’s judgment may be affirmed on the alternate ground that the individual podiatrists lack standing to pursue damages. The defendant claims that because it reimburses the individual podiatrists’ practice groups, any injury suffered by the individual podiatrists is too remote. We disagree.

“[Notwithstanding the broad language and remedial purpose of CUTPA, we have applied traditional common-law principles of remoteness and proximate causation to determine whether a party has standing to bring an action under CUTPA.” Vacco v. Microsoft Corp., 260 Conn. 59, 88, 793 A.2d 1048 (2002). “It is axiomatic that a party must have standing to assert a claim in order for the court to have subject matter jurisdiction over the claim. . . . Our standing jurisprudence consistently has embodied the notion that there must be a colorable claim of a direct injury to the plaintiff, in an individual or representative capacity. . . . The requirement of directness between the injuries claimed by the plaintiff and the conduct of the defendant also is expressed, in our standing jurisprudence, by the focus on whether the plaintiff is the proper party to assert the claim at issue. . . . Thus, to state these basic propositions another way, if the injuries claimed by the plaintiff are remote, indirect or derivative with respect to the defendant’s conduct, the plaintiff is not the proper party to assert them and lacks standing to do so. [When], for example, the harms asserted to have been suffered directly by a plaintiff are in reality derivative of injuries to a third party, the injuries are not direct but are indirect, and the plaintiff has no standing to assert them.” (Citations omitted.) Ganim v. Smith & Wesson Corp., 258 Conn. 313, 346-48, 780 A.2d 98 (2001).

We employ “a three part policy analysis ... [in applying] the general principle that plaintiffs with indi[470]*470rect injuries lack standing to sue .... First, the more indirect an injury is, the more difficult it becomes to determine the amount of [the] plaintiffs damages attributable to the wrongdoing as opposed to other, independent factors. Second, recognizing claims by the indirectly injured would require courts to adopt complicated rules apportioning damages among plaintiffs removed at different levels of injury from the violative acts, in order to avoid the risk of multiple recoveries. Third, struggling with the first two problems is unnecessary [when] there are directly injured parties who can remedy the harm without these attendant problems.” (Internal quotation marks omitted.) Vacco v. Microsoft Corp., supra, 260 Conn. 89.

The right to reimbursement is derived from the provider agreements. The individual podiatrists, not their practice groups, are the parties to the provider agreements.

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Bluebook (online)
28 A.3d 958, 302 Conn. 464, 2011 Conn. LEXIS 419, Counsel Stack Legal Research, https://law.counselstack.com/opinion/connecticut-podiatric-medical-assn-v-health-net-of-connecticut-inc-conn-2011.