Hawkins v. True North Energy, Unpublished Decision (6-25-2004)

2004 Ohio 3341
CourtOhio Court of Appeals
DecidedJune 25, 2004
DocketCase Nos. 2002-P-0098, 2002-P-0101, 2002-P-0102.
StatusUnpublished
Cited by13 cases

This text of 2004 Ohio 3341 (Hawkins v. True North Energy, Unpublished Decision (6-25-2004)) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hawkins v. True North Energy, Unpublished Decision (6-25-2004), 2004 Ohio 3341 (Ohio Ct. App. 2004).

Opinions

OPINION
{¶ 1} Appellant, Sharon Hawkins, appeals the August 19, 2002 judgment entry of the Portage County Court of Common Pleas, in which the trial court overruled her motion for a new trial and for judgment notwithstanding the verdict. Also, appellee, NGS American, Inc. Medical Insurance Company ("NGS"), filed a cross-appeal from the foregoing judgment entry, in which the trial court overruled its motion for prejudgment interest.

{¶ 2} On April 14, 1998, appellant, a store manager for the Lyden Company ("Lyden") and its successor, True North Energy, LLC, ("True North") was involved in a three car "chain" rear-end collision caused by defendant Clint D. Anchors ("Anchors"). The driver of the other vehicle involved in the accident, Christina L. Willis ("Christina") and the passenger, Josephine Willis ("Josephine"), filed a complaint on August 30, 1999, against Anchors and appellant, alleging negligent operation of their motor vehicles in Case No. 99 CV 0732. Anchors filed an answer on September 29, 1999. On October 18, 1999, appellant filed an answer with a cross-claim against Anchors in Case No. 2000 CV 0058.

{¶ 3} On January 20, 2000, appellant and her husband, Roger E. Hawkins ("Roger"), filed a complaint against Anchors and appellant's underinsured motorist carrier, Travelers Property Casualty Insurance Company ("Travelers"), alleging negligent operation of Anchors's motor vehicle. On February 18, 2000, Anchors filed an answer as well as a motion to consolidate, which was granted by the trial court on February 23, 2000.1 Travelers filed an answer to appellant's cross-claim on February 25, 2000.

{¶ 4} On June 15, 2000, appellant filed a motion pursuant to Civ.R. 19(A) to include an additional party plaintiff, NGS, the administrator of Lyden's and True North's health plan, which was granted on June 20, 2000.

{¶ 5} On February 22, 2001, appellant and Roger settled their claim with Anchors and his insurance carrier, Progressive, for the policy limits of $12,500, after obtaining consent from Travelers and agreeing to place $2,000 in escrow for any possible claims to be asserted by NGS, who had not filed any pleadings at that time. On April 27, 2001, NGS entered an appearance in the case. On May 29, 2001, NGS filed a cross-claim against appellant, attaching to their complaint the right of recovery agreement which was signed by appellant on February 25, 2000. On June 7, 2001, appellant filed her answer in which she admitted that there may be a subrogation to NGS or Lyden as well as alleged the defense of the "make-whole" doctrine.

{¶ 6} On December 7, 2001, NGS served appellant with Ohio Health Choice Plan, which was restated on May 1, 2001, naming True North as the plan administrator and NGS as the plan supervisor. That plan was self-insured by Lyden and True North.

{¶ 7} According to appellant's brief, on December 17, 2001, a mediation conference was held between appellant, Travelers, and NGS. Appellant settled her claim with Travelers for $115,000, however, no settlement was reached with NGS. On January 26, 2002, a settlement agreement and release was signed between appellant and Travelers, in which $23,433.92 was to be placed in escrow pending the dispute between appellant and NGS.

{¶ 8} According to the March 1, 2002 judgment entry, the trial court concluded that appellant and Roger had settled all matters in dispute with Travelers and dismissed with prejudice all claims against Travelers.

{¶ 9} A bench trial commenced on April 16, 2002. According to appellant's testimony, the force of the collision caused the back of her seat to break off, throwing her in the back seat of her vehicle. Because she was unable to get out of her car by herself after the accident, appellant was removed by emergency personnel and transported by ambulance to Robinson Memorial Hospital ("Robinson Memorial") in Ravenna, Ohio. Appellant was treated, x-rayed, medicated, and then released that same day.

{¶ 10} On April 16, 1998, appellant was treated by her family physician, Dr. Edward Jastrzemski ("Dr. Jastrzemski"), as well as several times after this date. Dr. Jastrzemski eventually referred appellant to Dr. Tharp at Western Reserve Spine Pain, Inc., and her first visit commenced on November 11, 1999. Appellant underwent physical therapy, three epidural blocks, a nerve conduction study and several MRIs. On June 8, 2001, appellant ultimately underwent surgery with Dr. Tharp at Robinson Memorial in which she had a disk removed between C-5 and C-6 as well as a plate inserted in her neck.

{¶ 11} As an employee of Lyden and True North, appellant received health insurance benefits from the administrator of its health plan, NGS. At trial, appellant testified that the bills paid by NGS arose from the April 14, 1998 accident.2 Based on the plan, each and every time that appellant made a claim for insurance benefits, that claim was subject to the defined terms of the plan. Pursuant to the provisions of the plan signed subsequent to the date of the accident as well as the plan of True North, in effect on May 1, 2001, the plan had an absolute right of recovery for any expenses that it pays "as a result of an illness or accident (such as a fall in a store) for which payment may be available through another source[.]" The right of recovery provision in the plan indicated that the plan may "ADVANCE benefit payment in order to assist [the insured] during [his or her] time of need." The plan further stated that "[a]cceptance of benefits from this plan automatically assigns to this plan any rights to recovery." However, there was no specific mention of uninsured/underinsured proceeds being subject to this subrogation provision.

{¶ 12} The reimbursement provision in the Right of Recovery provision further provides:

{¶ 13} "If a covered individual or their beneficiary or estate receives any payment or reimbursement from or on behalf of any other person or organization, any sum received (either by judgment or compromise) and whether or not designated as payment for medical expenses shall be applied first to reimburse the plan until the plan has been repaid in full.

{¶ 14} "The plan shall have a lien upon any payments or reimbursements received by a covered individual due to settlement, judgment or otherwise (and whether or not designated as payment for medical expenses) until repayment to the plan has been made in full.

{¶ 15} "This plan will, in all events, have the right to recover payment directly from a covered individual as well as have the right to make a claim to any responsible party or organization or bring a lawsuit against them in the coveredindividual's name in order to recover any paid benefits. This provision is intended to supersede the covered individual's right to be `made whole' and intends to have a claim to any reimbursement whether received by a judgment, settlement or through some other source." (Emphasis sic.)

{¶ 16} In addition, appellant also entered into a Right of Recovery Agreement with the plan on February 25, 2000, which provides that:

{¶ 17} "If another person or organization is responsible to pay for my medical expenses under the [p]lan and the [p]lan has paid a part or all of my claim, then:

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Bluebook (online)
2004 Ohio 3341, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hawkins-v-true-north-energy-unpublished-decision-6-25-2004-ohioctapp-2004.