Holden Business Forms Co. v. Louisiana State University Health Sciences Center-Shreveport

811 So. 2d 1102, 2002 La. App. LEXIS 474, 2002 WL 272439
CourtLouisiana Court of Appeal
DecidedFebruary 27, 2002
DocketNo. 35,694-CA
StatusPublished
Cited by1 cases

This text of 811 So. 2d 1102 (Holden Business Forms Co. v. Louisiana State University Health Sciences Center-Shreveport) 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
Holden Business Forms Co. v. Louisiana State University Health Sciences Center-Shreveport, 811 So. 2d 1102, 2002 La. App. LEXIS 474, 2002 WL 272439 (La. Ct. App. 2002).

Opinion

LKOSTELKA, J.

Defendants, Louisiana State University Health Sciences Center Shreveport (“LSUHSC”) and Dr. Anthony Tran (“Dr. Tran”) (collectively “appellants”), appeal from a judgment ordering them to repay $96,137.58 to plaintiff, Holden Business Forms Company, Inc. (“Holden”). For the following reasons, we reverse and remand.

FACTS

Because this case comes before this court on the grant of Holden’s Motion for Summary Judgment, facts are taken primarily from the affidavits submitted in support of that motion. On May 8, 1998, Jimmy Hughes (“Hughes”) was injured in a motorcycle accident in Louisiana. There is very little information about the accident itself in this record. Specifically, there is no affidavit from an individual with personal knowledge of the facts of the accident stating that Hughes was operating the motorcycle when it crashed or estimating the time when the accident occurred.

Hughes was the spouse of an employee of Holden, and, as such, he was covered under Holden’s health insurance plan. Holden is self-insured for health insurance, and its insurance plan is administered by [1104]*1104Assure Care, Inc.1

Hughes was transported to LSUHSC after the accident. Some of Hughes’s medical records from LSUHSC, properly certified under La. R.S. 13:3715, are included in this record. One of these records shows the following information:

_]2.. • • •
[D] AY: 1
[DJATE: 05/08/98
[T] IME: 2045
[A] LCOHOL: 212 [MG/DL]
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FOOTNOTES—
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ALCOHOL RESULTS FOR DIAGNOSTIC PURPOSES ONLY.
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A “urine immunassay drug panel” taken at 2052 hours on May 8, 1998 returned a positive result for amphetamines, but this result is not further explained by the records.

Hughes ultimately incurred $72,918.43 in charges at LSUHSC and $23,215.15 in charges with Dr. Tran. Holden, through Assure Care, Inc., paid these charges. According to the affidavit of Rich Agar, CEO of Assure Care, Inc.:

Assurecare, Inc. diligently attempted to secure a copy of the accident report for the Jimmy Hughes accident, but was unable to secure an accident report within sixty days of the claims presented by the various health providers for medical services and treatment provided to Jimmy Hughes. As a result, Assure-care, Inc. paid out on behalf of Holden under the Plan various amounts to various health providers....
[A]fter these claims were made, the Louisiana State Police finally released the accident report for this accident, which clearly showed that Jimmy Hughes was intoxicated at the time of the motorcycle accident which gave rise to his injuries ... The accident report of the motorcycle accident in this case was caused by the action of Jimmy Hughes in driving his motorcycle on a Louisiana highway while intoxicated (in violation of the criminal statutes of the State of Louisiana)....

Holden’s medical benefit plan contains the following exclusion:

This Plan does not cover:
_k- • • •
16. Charges resulting from Illness or Injury caused, or contributed to, by engagement in an illegal occupation or commissions or attempt to commit a misdemeanor and/or felony.
[[Image here]]

Relying on this exclusion, on April 17, 2000, Holden filed suit against LSUHSC and Dr. Tran to recover the sums it paid for Hughes’s care. The appellants answered the lawsuit admitting that they had treated Hughes and received payment therefor but denying Holden’s allegations that Hughes was not covered under the plan and that payment was made through Holden’s mistake and error. On October 5, 2000, Holden added Hughes as a defendant.

Thereafter, Holden filed two motions for summary judgment along with the above-referenced support. LSUHSC and Dr. Tran opposed the motions. In opposition, appellants presented an affidavit from the director of medical records at LSUHSC [1105]*1105stating that the first request for a copy of Hughes’s laboratory test results was made on February 4, 1999 and that Hughes’s insurer made a second request on February 11, 1999. The manager of patient accounts at LSUHSC stated in an affidavit that Hughes was hospitalized at LSU from May 8, 1998 until May 25, 1998, that it billed Assure Care, Inc. on June 9, 1998 and that Assure Care, Inc. paid the bill on July 28, 1998. LSUHSC and Dr. Tran also asserted in their opposition that Hughes had not been convicted of driving under the influence of alcohol.

|4In response, Holden filed a supplemental brief in support of its summary judgment motions. With this supplement, Holden attached another affidavit from the CEO of Assure Care, Inc. stating in part:

[I]n submitting their claims for payment, none of the defendants in this case ever disclosed that Defendant LSU Health Sciences Center had conducted a blood test approjdmately one hour after Jimmy Hughes’ accident which shows a blood alcohol level of 0.212, nor was this information disclosed to Plaintiff until a subpoena was issued to LSU-HSC for the Jimmy Hughes medical records.

The affidavit goes on to say that Assure Care, Inc. first learned of “pending criminal charges” against Hughes in December, 1998.

On May 7, 2001, the court signed a judgment granting summary judgment for Holden. On May 29, 2001, the court signed an amended judgment granting summary judgment and specifically ordering LSUHSC to pay Holden $72,918.43 and ordering Dr. Tran to pay Holden $23,219.15. On that same date, the court granted LSUHSC and Dr. Tran a suspen-sive appeal. On June 8, 2001, LSUHSC and Dr. Tran filed a motion for new trial, and Holden opposed this motion on procedural grounds. On July 9, 2001, the court held a hearing on the motion for new trial. The court maintained its earlier judgment granting summary judgment for Holden, signed a judgment to that effect on July 30, 2001 and granted LSUHSC and Dr. Tran an appeal from that judgment. The matter is now presented to this court for review.

DISCUSSION

Summary judgment shall be rendered if the pleadings, depositions, answers to interrogatories, admissions on file, and any affidavits show that there is no genuine issue of material fact and that the mover is entitled to | ¿judgment as a matter of law. La. C.C.P. art. 966. The mover has the burden of establishing the absence of a genuine issue of material fact.

The party opposing summary judgment cannot rest on the mere allegations of his pleadings but must show that he has evidence which could satisfy his evidentiary burden at trial. If he does not produce such evidence, then there is no genuine issue of material fact and the mover is entitled to summary judgment. La. C.C.P. art. 966(C)(2). Appellate courts review summary judgments de novo under the same criteria that govern a district court’s consideration of whether summary judgment is appropriate. NAB Natural Resources v. Willamette Industries, Inc., 28,555 (La.App.2d Cir.08/21/96), 679 So.2d 477.

La. C.C.P. art.

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811 So. 2d 1102, 2002 La. App. LEXIS 474, 2002 WL 272439, Counsel Stack Legal Research, https://law.counselstack.com/opinion/holden-business-forms-co-v-louisiana-state-university-health-sciences-lactapp-2002.