Danley v. State Employees Group Benefits Program

426 So. 2d 384, 1983 La. App. LEXIS 7667
CourtLouisiana Court of Appeal
DecidedJanuary 17, 1983
DocketNo. 15155-CA
StatusPublished
Cited by1 cases

This text of 426 So. 2d 384 (Danley v. State Employees Group Benefits Program) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Danley v. State Employees Group Benefits Program, 426 So. 2d 384, 1983 La. App. LEXIS 7667 (La. Ct. App. 1983).

Opinion

SEXTON, Judge.

The two defendants herein, the State of Louisiana Employees’ Group Benefits Program and the Board of Trustees of the Sheriffs’ Pension and Relief Fund, both appeal an in solido judgment in the amount of $4,770.97 rendered against them in the trial court. The plaintiffs Mr. and Mrs. Jack Danley had sued these defendants to be reimbursed certain medical expenses incurred by Mrs. Danley as a result of a colon by-pass operation. In rendering judgment for the plaintiffs, the trial court found both defendants were negligent in handling Mrs. Danley’s request to be added to her husband’s group insurance program through the defendant State of Louisiana Employees’ Group Benefits Program, (hereinafter referred to as “Employees’ Group”). Previously the trial court had overruled the decli-natory exception of improper venue filed by the defendant, Board of Trustees of the Sheriffs’ Pension and Relief Fund, (hereinafter referred to as “Sheriffs’ Fund”). Although there are several assignments of error by each defendant-appellant, they resolve themselves into two legal issues. First, did the trial court err in overruling the Sheriffs’ Fund’s venue exception? Secondly, did the trial court err in applying negligence principles to this cause and then finding each of these defendants had breached a duty to these plaintiffs? We answer both affirmatively, and accordingly reverse.

Mrs. Danley married Mr. Danley, a retired West Carroll Parish Sheriff’s deputy on July 1, 1979. At that time, Mr. Danley had medical insurance through the Employees’ Group. However, no effort was made to add Mrs. Danley to the Employees’ Group until February 20, 1980, when Mrs. Danley called the office of the Sheriffs’ Fund in Monroe, speaking to Mrs. Betty S. Griffith, an administrative assistant. Mrs. Danley inquired of Mrs. Griffith as to whether she could be added to her husband’s coverage.

Mrs. Griffith testified that she called the Baton Rouge office of the Employees’ Group and talked to an unknown party who advised her that Mrs. Danley could be covered by the filing of a certain change document. Mrs. Griffith, on that same day, prepared such a form and sent it to the Employees’ Group along with a letter inquiring whether any other action was necessary to accomplish coverage. Thereafter, still on February 20, Mrs. Griffith advised Mrs. Danley that coverage was available.

On March 3, approximately 11 days later, Mrs. Danley talked to a Minden physician concerning colon by-pass surgery and she was advised that the operation could be performed if she could present evidence of insurance. At Mrs. Danley’s request, Mrs. Griffith wrote a letter to the Minden doctor advising that coverage existed, and enclosing therewith a copy of the transmittal letter with which Mrs. Griffith transmitted the change form in attempting to secure Mrs. Danley’s coverage with the Employees’ Group. In writing the doctor Mrs. Griffith stated:

“Per the attached copy of my letter of February 20, 1980, addressed to Group Insurance Section, Baton Rouge, Louisiana, please be advised that Melba Danley has hospitalization coverage under the State of Louisiana Group Insurance Policy with CNA Insurance Company effective March 1, 1980.”

[386]*386The operation was performed on or about March 10 and thereafter the claim for the expenses attendant thereto was submitted to the Employees’ Group. It was denied.

It should be noted that the Employees’ Group is an entirely different entity from the Sheriffs’ Fund and has no agency relationship with it. The only function performed by the Sheriffs’ Fund for its members, related to Employees’ Group, is the deduction of the premiums from retirement checks and the remission of the premiums to the Employees’ Group.

The Employees’ Group, which has some 100,000 members, serving some 400 state agencies, denied receipt of Mrs. Danley’s application which Mrs. Griffith had forwarded on February 20. Employees’ Group official Mr. Baugh testified that there was no indication in the Employees’ Group computer file that the application had ever been received. Mr. Baugh, whose duties included making determinations of eligibility, stated that he had no knowledge of the application or the preceding phone call. The Sheriffs’ Fund was never invoiced by the Employees’ Group for Mrs. Danley’s coverage, although Mrs. Griffith altered the Employees’ Group invoice with respect to Mr. Danley and included a premium to the Employees’ Group for Mrs. Danley’s coverage. The record indicates that the first premium sent by Mrs. Griffith for Mrs. Danley was not received until the latter part of March, subsequent to the surgery and the incurring of the expenses attendant thereto. When the Employees’ Group realized it had received such premiums it advised the Sheriffs’ Fund to take credit for them on their next invoice.

Mr. Baugh also testified that a wife of a retired member who failed to apply for coverage within 30 days of eligibility (which occurred at the time of her marriage to the retired member) could never obtain coverage. He further testified that even if coverage were available, that she would have been required to submit evidence of insura-bility and that pre-existing conditions would not have been covered for at least one year following the date of coverage. It should be noted that Mrs. Danley, prior to her operation, weighed approximately 250 pounds and was 5'6" tall, indicating a preexisting condition which the surgery was designed to correct.

In this regard we note that the coverage policy pamphlet admitted as joint exhibit # 1 entitled “State of Louisiana Employees Uniform Group Benefits Program,” by our reading, does not require that a dependent of a retired member must apply for coverage within 30 days of obtaining that status. However, it is clear that any person who applies later than 30 days after becoming eligible is subject to a pre-existing condition limitation of at least 12 months. Also it is clear that on a late application such as that of Mrs. Danley, the applicant must file certain additional statements and there is a longer delay before coverage is effective. Thus Mrs. Danley could not have been covered before April 1.

We begin by analyzing plaintiffs’ claims against the Sheriffs’ Fund, and do not reach the substantive merits of plaintiffs’ claims against that defendant because the procedural issue of venue is dispositive here. We hold that the parish in which the plaintiffs filed their suit was a forum of improper venue for a suit against the Sheriffs’ Fund, and therefore reverse the trial court’s decision overruling the declinatory exception of improper venue.

The sole pertinent fact in our venue analysis is that plaintiffs brought suit in their domicile parish, West Carroll, while the domicile of the Sheriffs’ Fund is in East Baton Rouge. There are several statutory provisions which could serve as putative authority for the proposition that West Carroll Parish was a proper venue for the Dan-leys’ suit against the Sheriffs’ Fund. However, a careful examination of the pertinent statutory language leads us to conclude that LSA-R.S. 33:1451 is the directly controlling statutory enactment, and that only East Baton Rouge Parish is a forum of proper venue for suits against the Sheriffs’ Fund.

LSA-R.S. 33:1451 provides, in pertinent part, that the Sheriffs’ Fund:

[387]*387“shall be domiciled in the City of Baton Rouge, Louisiana, [in East Baton Rouge Parish] where all suits against it must be instituted .... ” (emphasis added).

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Bluebook (online)
426 So. 2d 384, 1983 La. App. LEXIS 7667, Counsel Stack Legal Research, https://law.counselstack.com/opinion/danley-v-state-employees-group-benefits-program-lactapp-1983.