Gravier v. Missouri Department of Social Services, Division of Medical Services

968 S.W.2d 149, 1998 Mo. App. LEXIS 476, 1998 WL 113386
Missouri Court of Appeals·Decided March 17, 1998·No. No. 72506·Published

Opinion

GARY M. GAERTNER, Judge.

Appellant, Missouri Department of Social Services, Division of Medical Services (“Department”), appeals the judgment entered by the Circuit Court of St. Louis County in favor of respondent, Timothy Gravier (“recipient”), on his petition for reduction of the Department’s hen. We reverse and remand.

Recipient was rendered a quadriplegic as the result of a diving accident at his sister’s home in June of 1992. Recipient was in the hospital for approximately two-and-a-half to three months after the accident. Department expended $81,598.80, in the form of Medicaid payments, to health care providers who treated recipient for his injuries. The Department had a hen against any recovery obtained by recipient pursuant to RSMo section 208.215.1

Recipient engaged the services of Dearing & Hertzog, L.C., to represent him in his claim against his sister’s homeowner’s insurance for damages arising from the accident. The firm was to receive 33.3% of any amount recovered from the insurance company, as well as any monies it expended in pursuit of the claim. Recipient and the insurance company ultimately settled recipient’s claim for $50,000.

Thereafter, Department served notice on recipient that it had a hen in the amount of $31,598.80 for medical payments made on behalf of recipient and that it intended to execute the hen against the $50,000 settlement. Recipient filed a petition for reduction of the state’s hen pursuant to RSMo section 208.215, requesting he be awarded the remaining portion of the settlement after the payment of his attorney’s fees and costs.

On March 31,1997, the trial court held the requisite hearing on recipient’s petition, at which time the following evidence was adduced: before the accident, recipient had no physical limitations. He earned $30,000-$35,000 a year as a self-employed automobile upholsterer. Recipient had already earned approximately $30,000 for the first six months of June 1992, when the accident occurred. The accident left him paralyzed from the chest down; he has the use of his arms but not his hands or fingers. He is able to push himself in a wheelchair and can drive his car, which has been fitted with adaptors. He did not expect further significant improvement.

Recipient was single and had two children from previous marriages. At the time of the hearing, the eldest child was emancipated, and the youngest child received support payments from the Social Security Administration on recipient’s behalf. For a six month period after the accident, recipient had no income nor did he receive public aid. He borrowed $2,000 to $4,000 from his family and friends for support. During this time, he fell in arrears on his mortgage, his child support payments, and his state and federal taxes. Recipient then began receiving social security disability benefits; at the time of trial he received $970 a month. He testified he had incurred approximately $1,200 in additional medical expenses which were not covered by Medicaid.

At trial, recipient offered Exhibit A, which was prepared by a life planner and which contained estimated costs of recipient’s anticipated annual needs.2 These costs ranged from approximately $18,000 to $19,000. Recipient further testified he wanted to make certain architectural renovations to his home in order to increase his mobility.3 At the time of the hearing, recipient was in school working toward a bachelor’s degree in psychology, which was paid for by vocational rehabilitation.

Lastly, recipient testified he settled his claim against his sister’s homeowner’s insurance company for $50,000 because of the “liability questions and the difficulty of proving this kind of case.” He acknowledged his attorney’s fees were 33.3% of the settlement [151]*151amount along with approximately $4,000 in costs. He also stated he had a lawsuit pending against the swimming pool manufacturer in the City of St. Louis.

On cross-examination, recipient acknowledged he had been given an abatement with respect to the missed mortgage payments, stated neither the Internal Revenue Service nor the Director of Revenue had taken any action against him with respect to his tax arrearage, and admitted neither ex-wife had proceeded against him for the missed child support payments. He further testified he had not worked out any repayment plan with those from whom he had borrowed money nor were any of them threatening action against him for repayment.

Recipient testified he did not have medical insurance at the time of the accident. He did not know if he would have had to pay the bills which were paid by Medicaid. With respect to the medical costs which he had subsequently incurred, recipient could not place a dollar amount on this debt,4 and testified he was paying it off in monthly installments of $30 to $40. He stated he no longer received Medicaid, but received Medicare, Part A, According to recipient, this covered “any type of hospitalization ... in a limited form” but excluded doctors’ visits. Recipient further testified he is in need of medical treatment for kidney and bladder problems, which are care issues peculiar to quadriplegics.

At the close of the case, Department offered into evidence Exhibit 1, which included calculations on the Department’s pro rata share of recipient’s attorney’s fees and costs. Department indicated its willingness to reduce its lien by its pro rata share of these expenses, for a total lien amount of $17,-905.99. Department also submitted Exhibit 2, a billing statement regarding recipient’s medical treatment and examples of claim documents.

The trial court subsequently entered its judgment in favor of recipient and recipient’s attorney. The trial court found recipient suffered permanent injuries which left him paralyzed from the chest down. It further found recipient could no longer work as an auto upholsterer, was in arrears on his child support, taxes, and mortgage, and was not malingering, but was attending school to obtain a bachelor’s degree. The court entered its findings regarding the amount of the settlement, the amount of the attorney’s fees and costs, and the amount of Department’s lien. It thereafter awarded recipient’s attorney $21,666.66, the full amount of his fees and costs. It awarded recipient $28,333.34, the remaining balance of the settlement, stating,

that fifty-thousand dollars ($50,000.) does not compensate [recipient] for his injuries, and that [recipient] is not being unjustly enriched by a failure to pay, as against this fund, the [Department’s] charge; nor, is the failure to pay the [Department’s] charge from this fund likely to lead to a double recovery.

The trial court further held Department’s lien was not to be reduced, but rather was to be a charge against any subsequent recovery from recipient’s litigation against the swimming pool manufacturer. Department appeals.

Department raises three issues on appeal, arguing different theories as to why the trial court erred in awarding Department no portion of the settlement recovery. Because we find Department’s second issue dispositive, we address it first. In its second point on appeal, Department argues the trial court erred in denying it any part of the recovery as the recipient produced insufficient evidence on which to base the judgment. We agree.

RSMo section 208.215 governs the disposition of this ease and sets forth the law pertaining to monies contributed by the state in the form of Medicaid.

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Gravier v. Missouri Department of Social Services, Division of Medical Services, 968 S.W.2d 149, 1998 Mo. App. LEXIS 476, 1998 WL 113386 (Mo. Ct. App. 1998).

968 S.W.2d 149 (Gravier v. Missouri Department of Social Services, Division of Medical Services) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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