Funderburk v. Oklahoma State & Education Employees Group Insurance Board

2011 OK CIV APP 123, 268 P.3d 556, 2011 Okla. Civ. App. LEXIS 109
CourtCourt of Civil Appeals of Oklahoma
DecidedNovember 18, 2011
DocketNo. 107,685
StatusPublished

This text of 2011 OK CIV APP 123 (Funderburk v. Oklahoma State & Education Employees Group Insurance Board) is published on Counsel Stack Legal Research, covering Court of Civil Appeals of Oklahoma primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Funderburk v. Oklahoma State & Education Employees Group Insurance Board, 2011 OK CIV APP 123, 268 P.3d 556, 2011 Okla. Civ. App. LEXIS 109 (Okla. Ct. App. 2011).

Opinion

WM. C. HETHERINGTON, JR., Presiding Judge.

T1 The sole issue in this appeal brought from a district court order affirming a final order of the Oklahoma State Employee and Education Group Insurance Board (Board) is whether the Board is required to comply with the rule-making process under Article I of the Administrative Procedures Act (APA), 75 0.8.2001 § 250 et seq.,1 when fulfilling its statutory duty to "compile a comprehensive Schedule of Benefits." The Board found it did not. We agree. The district court's order is AFFIRMED.

STANDARD OF REVIEW

12 It is undisputed that the Board is subject to the APA. Under Article II of the APA, the district court, the Court of Civil Appeals, and the Supreme Court apply the same review standard. City of Tulsa v. State ex rel. Public Employees Relations Board, 1998 OK 92, ¶ 12, 967 P.2d 1214, 1219. As raised here, statutory interpretation by an agency presents a question of law which we review under a de novo standard. Stipe v. State ex rel. Bd. of Trustees of Oklahoma [558]*558Public Employees Retirement System, 2008 OK 52, ¶ 7, 188 P.3d 120, 122. Such review is plenary, independent, and non-deferential. State ex rel. Protective Health Services State Dept. of Health v. Vaughn, 2009 OK 61, ¶ 9, 222 P.3d 1058, 1064.

FACTS

T3 Cassandra Funderbunk (Appellant) was insured by HealthChoice (Insurer), a group health insurance plan administered by the Board, at the time she had medical procedures performed by out-of-state, non-network medical providers in 2006. After Appellant's payment of her non-network, out-of-pocket maximum, Insurer paid a portion of Appellant's claim but declined payment of the balance owed in excess of the "allowed charge."2 In July 2007, Appellant filed a request for review of Insurer's denial by the Board's three-member grievance panel (the Panel), complaining "coverage amounts paid calculated on basis of 'allowable' rather than actual cost contrary to employee agreement."

T4 In January 2008, Appellant petitioned the Board for a declaratory ruling under § 307 of the APA,3 concerning its alleged failure "to follow the rule making procedure under the [APA]" when "compiling a comprehensive schedule of medical benefits pursuant to 74 0.8. § 1821." The administrative record establishes the Panel's chairman held a pre-hearing conference the same month at which the parties (1) stipulated to a single hearing on the grievance and declaratory ruling and (2) agreed to a briefing schedule on those issues. A hearing was held before the Panel on April 2, 2008. Following the Panel's announcement that the parties' pre-hearing briefs had been read and identification of the issues before it, Appellant and two other witnesses testified. Prior to recessing for a later deliberation, the Panel accepted the parties' stipulations concerning the numerous exhibits submitted by the Board.

T5 By order signed and mailed to the parties April 4, 2008, the Panel denied her claim and concluded the Board was only required to follow the notice and publication requirements of the Oklahoma Meeting Act whenever it determines rates and benefits as expressly stated in § 1821. Appellant filed a timely petition for review in the Tulsa County District Court in accordance with § 318(B)(2) of the APA.4 The Board responded and filed the administrative record. Upon review of the parties' briefs, court file and administrative record, the district court affirmed the Board's declaratory ruling and denial of Appellant's payment request and entered its order May 6, 2009. Nine days later, Appellant filed a motion for reconsideration. The District Court denied the motion by order filed November 15, 2009, from which Appellant filed a timely Petition in Error.5

[559]*55916 As briefed, Appellant's argument the Board is required to comply with Article I rule making and publication requirements of the APA when compiling the Schedule of Benefits relies on three statutes within Oklahoma's "State and Education Employee Group Insurance Act" (Group Insurance Act), 74 0.98.2001 § 1801 et seq. Under the first, 74 0.8.Supp.2005 § 1804(12), the Board "shall adopt rules requiring payment for medical and dental services and treatment rendered by duly licensed hospitals, physicians, and dentists." The second statute, 74 O.S.Supp.2005 § 1806(12), reads, "[the Board, pursuant to [the APA, §§ 250 et seq.] shall adopt such rules consistent with the provisions of the [Group Insurance Act] as it deems necessary to carry out its statutory duties and responsibilities." (Emphasis added.)

T7 The third statute, 74 O.S. Supp. 2005 § 1821(A), requires the Board "to determine all rates and life, dental and health benefits" and "all rates shall be compiled in a comprehensive Schedule of Benefits." Appellant contends these three "enabling statutes" establish the Board (1) must adopt rules pursuant to Article I of the APA when determining rates for the Schedule of Benefits and (2) has incorrectly interpreted the first two sentences of 74 0.8.2001 $ 1821(C), which provides:

The Board may approve a mid-year adjustment provided the need for an adjustment is substantiated by an actuarial determination or more current experience rating. The only publication or notice requirements that shall apply to the Schedule of Benefits shall be those requirements provided in the Oklahoma Open Meeting Act. It is the intent of the Legislature that the benefits provided not include cosmetic dental procedures except for certain orthodontic procedures as adopted by the Board. (Emphasis added.)

Appellant contends the second sentence's notice and publication requirement under the Open Meeting Act (OMA) only applies to the "mid-year adjustment" addressed in the first sentence. She admits her interpretation results from application of the last antecedent rule. By this aid to statutory construction, limiting or restrictive phrases or clauses within a statute generally refer to and limits or restricts the immediately preceding clause or last antecedent. Matter of Estate Tax Protest of Leake Estate, 1994 OK CIV APP 157, ¶ 13, 891 P.2d 1299, 1303.

18 In determining whether a statute applies to a given set of facts, we focus on legislative intent which controls statutory interpretation. Keating v. Edmondson, 2001 OK 110, ¶ 8, 37 P.3d 882, 886. Intent is ascertained from the whole act in light of its general purpose and objective considering relevant provisions together to give full force and effect to each. Id. The Court presumes that the Legislature expressed its intent and that it intended what it expressed. Id. Statutes are interpreted to attain that purpose and end championing the broad public policy purposes underlying them. Id. Only where the legislative intent cannot be ascertained from the statutory language, i.e., in cases of ambiguity or conflict, are rules of statutory construction employed. Id.

T9 Appellant's second "more rational" interpretation of § 1821(C) appears to suggest it is ambiguous. Considering she fails to consider the express language and all of § 1821's provisions when interpreting the Legislature's notice and publication requirement in § 1821(C) to apply only to a "midyear adjustment," we disagree.

10 There is no definition of "Schedule of Benefits" in the Group Insurance Act, in which the term is found only in § 1821. As used in § 1821(A),6

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Related

City of Sand Springs v. Department of Public Welfare
608 P.2d 1139 (Supreme Court of Oklahoma, 1980)
Southwestern Bell Telephone Co. v. Oklahoma Corporation Commission
1994 OK 38 (Supreme Court of Oklahoma, 1994)
City of Tulsa v. State Ex Rel. Public Employees Relations Board
1998 OK 92 (Supreme Court of Oklahoma, 1998)
Marty v. Board of Education
1997 OK 111 (Supreme Court of Oklahoma, 1997)
Stipe v. State Ex Rel. Board of Trustees
2008 OK 52 (Supreme Court of Oklahoma, 2008)
Keating v. Edmondson
2001 OK 110 (Supreme Court of Oklahoma, 2001)
Leake Estate v. Oklahoma Tax Commission
891 P.2d 1299 (Court of Civil Appeals of Oklahoma, 1994)

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Bluebook (online)
2011 OK CIV APP 123, 268 P.3d 556, 2011 Okla. Civ. App. LEXIS 109, Counsel Stack Legal Research, https://law.counselstack.com/opinion/funderburk-v-oklahoma-state-education-employees-group-insurance-board-oklacivapp-2011.