Hamrick's, Inc. v. Roy

115 S.W.3d 468, 2002 Tenn. App. LEXIS 290
CourtCourt of Appeals of Tennessee
DecidedApril 29, 2002
StatusPublished
Cited by3 cases

This text of 115 S.W.3d 468 (Hamrick's, Inc. v. Roy) is published on Counsel Stack Legal Research, covering Court of Appeals of Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hamrick's, Inc. v. Roy, 115 S.W.3d 468, 2002 Tenn. App. LEXIS 290 (Tenn. Ct. App. 2002).

Opinion

OPINION

D. MICHAEL SWINEY, J.,

delivered the opinion of the court,

in which HERSCHEL P. FRANKS, J., and CHARLES D. SUSANO, JR., J., joined.

Deborah Roy (“Roy”) was employed at Hamrick’s, Inc. (“Hamrick’s” or “Plaintiff”) and was provided health insurance through a self-funded company sponsored health insurance plan (“Plan”) covered by ERISA. Roy was involved in an automobile accident. The driver of the other automobile, Mr. Nguyen, was responsible for the accident. Roy retained Kevin Shepherd (“Shepherd”) to represent her in the lawsuit against Nguyen. Both Roy and Shepherd (collectively referred to as “Defendants”) signed a Reimbursement Agreement (“Agreement”) wherein they agreed to reimburse Hamrick’s out of any proceeds collected in the underlying tort lawsuit for medical expenses related to the accident. Unbeknownst to Hamrick’s, Roy settled her lawsuit against Nguyen for $25,000.00. Roy retained two-thirds of the proceeds and Shepherd retained one-third. Hamrick’s filed this lawsuit seeking to enforce the Agreement and recover the sums it paid on Roy’s behalf. The Trial Court entered judgment against both Defendants for their pro-rata share of the settlement proceeds due Hamrick’s under the terms of the Agreement. Defendants appeal. We affirm.

Background

This lawsuit involves Plaintiff’s successful attempt in the Trial Court to recover sums it paid on Roy’s behalf pursuant to a company sponsored health insurance plan. Plaintiff employed Roy and provided her with health insurance through the Plan. Roy was involved in an automobile accident in August of 1997 with Mr. Nguyen. According to Plaintiff, pursuant to the terms of the Plan, it retained the right to *470 seek subrogation and/or reimbursement from any sums received by Roy from third parties responsible for the automobile accident. Plaintiff claimed since the Plan was controlled by ERISA, the common law “made whole” doctrine did not apply and Plaintiff was entitled to collect the full amount of its subrogation interest. Both Roy and Shepherd had executed the Agreement whereby they agreed to honor Plaintiffs subrogation interest, which Plaintiff claimed totaled $30,985.12. Plaintiff asserted Defendants had settled the underlying third-party tort action and failed to honor its subrogation and/or reimbursement claim.

The Agreement, entered into on October 2, 1997, and signed by Defendants, provides as follows:

In accordance with the provisions of the Employee Benefit Plan provided in the Hamrick’s, Inc. Plan Documents, the undersigned hereby agrees to reimburse and pay promptly to the Hamrick’s, Inc. Health Benefit Plan an amount not exceeding the aggregate amount of benefits paid under said Plan for charges incurred as a result of injury or disease sustained on or about 8-12-97 in the State of Tenn[.], such payment to come from any recovery by the undersigned of (sic) for their benefit from any person, corporation, or organization as a result of the incident therein referenced.
The undersigned further agrees to execute instruments and papers, furnish information and assistance, and take other necessary and related action as The Plan Supervisor may require to facilitate its rights of reimbursement under the Reinsurance Plan.
The undersigned represents and warrants that no release or discharge has been given with respect to his or her rights of recovery described herein and that the undersigned has done nothing to prejudice said rights.

After filing an answer denying the pertinent allegations of the complaint, Defendants filed a motion to transfer the lawsuit to federal court, apparently claiming the federal courts had exclusive jurisdiction over the claim. Plaintiff responded by pointing out Defendants’ motion was filed almost four months after they were served with process, and, therefore, the time period in which to remove the case to federal court had expired. 1 Defendants then filed a motion to dismiss for lack of subject matter jurisdiction. Defendants claimed, pursuant to 29 U.S.C. § 1132(e)(1), participants and beneficiaries to a plan governed by ERISA could maintain a lawsuit in state court, but a fiduciary could not. Plaintiff responded by arguing its subrogation claim was not a cause of action brought pursuant to ERISA. The Trial Court denied Defendants’ motion to dismiss.

The case was tried in August of 2001. The first witness was Karen Paris (“Paris”), who for eight years was the “company nurse” and Plaintiffs administrator of employee benefits. Paris first learned Roy was involved in an automobile accident when she received a claim form indicating there had been an automobile accident. Paris stated when she receives this type claim, she will “automatically send out sub-rogation [paperwork] to see if they want us to pay the claims.” In addition to the language contained in the Agreement signed by Defendants, Paris identified the language contained in the actual Plan regarding subrogation. The Plan provides:

SUBROGATION AND OTHER RIGHTS: This Plan may withhold payment of benefits *471 when a party other than the employee, dependent, of the Plan, may be liable for expenses until liability is legally determined. However, in the event any payment is made under this Plan for which any party other than the employee, dependent, or this Plan may be hable, this Plan shall be subrogated to all the rights of recovery to the extent of such payments by this Plan. Any employee, dependent, or other person or organization receiving payment from this Plan shall execute and deliver instruments and papers and do whatever else necessary to secure such rights to the Plan, and shall do nothing either before or after payment by the Plan to prejudice such rights.

Paris explained no payments would have been made for injuries resulting from the automobile accident if Roy had not signed the Agreement. Once the signed Agreement was received, Plaintiff made payments for the medical expenses related to the automobile accident. Paris considered anything related to Roy’s neck injury as caused by the automobile accident. Paris relied on the ICD-9 diagnosis codes when determining what bills were for treatment for the neck injury. In the lawsuit filed by Plaintiff, Paris claimed Plaintiff was seeking only reimbursement for claims paid on the neck injury. The ICD-9 Codes are used industry wide and are also used by Medicare and Medicaid.

Paris had no communications with Roy from the time she received the signed Agreement in 1997 until a letter was sent to Shepherd in May of 2000 requesting an update on the status of the lawsuit against Mr. Nguyen. In this letter, Paris claimed $31,001.92 had been paid for medical bills related to the accident. Shepherd replied to the letter, stating Nguyen had minimum insurance limits of $25,000.00, which Shepherd claimed “did not even come close to compensating Ms. Roy for the permanent injury which she received in the accident.” According to Shepherd, there were “not available funds for the money which Ham-rick’s has sought against Ms. Roy in this matter.

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Cite This Page — Counsel Stack

Bluebook (online)
115 S.W.3d 468, 2002 Tenn. App. LEXIS 290, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hamricks-inc-v-roy-tennctapp-2002.