House v. Stephens

21 Misc. 3d 527
New York Supreme Court·Decided September 17, 2008·Published

Opinion

OPINION OF THE COURT

David R. Demarest, J.

In this medical malpractice action — wherein plaintiff Sally House does not appear to seek recovery for medical expenses paid on her behalf — Excellus Health Plan, Inc. moves for permission to intervene, pursuant to CPLR 1012 and 1013. Ex-cellus argues the relief sought is proper because it has an interest in the matter, it will be bound by the judgment rendered, its interests will not be adequately represented by the parties, and its claims are founded upon questions of law and fact which are common to this action. Plaintiff and defendants oppose the relief, citing conflict of interest between plaintiff and Excellus, litigation delay and complication, and that intervention would violate CPLR 4545. Defendants cite to Berry v St. Peter’s Hosp. of City of Albany (250 AD2d 63 [3d Dept 1998]) in support of their opposition.

In Berry the Third Department reversed the Supreme Court order permitting intervention by permission upon the basis of both prejudice to the substantial rights of plaintiff and potential delay. As to prejudice, the Third Department noted that the intervenor’s presence at any potential settlement discussions would undoubtedly visit prejudice upon plaintiff since the insurance proceeds available to the remaining defendants in that lawsuit were significantly less than those which could be recovered at trial. Characterizing prejudice as being “the overriding reason for our decision to reverse,” the Court went on to explain that if plaintiff were to accept a settlement and “have a good-faith basis for allocating it to an element of damages that does not include medical expenses,” any insurer which was permitted to intervene would now wield “veto power over such a settlement” (at 66-67). This, the Court said, “strikes at the heart of the relationship between insureds and insurers and impermissibly allows the latter to dictate the course of litigation.” (Id. at 68-69.)

The facts in Berry also included a history of bitter dispute between the insurers (two) and the insured’s wife over the reasonableness of medical costs incurred for her insured husband, a 15-year coma patient with irreparable brain damage, at St. [529]*529Peter’s Hospital with around-the-clock nursing care, sustained by a respirator and feeding tube. The Court noted that since the wife had commenced a federal action seeking to compel the two insurers to pay for her comatose husband’s private-duty nursing services, these costs would, no doubt, prove to be a hotly contested issue. Litigation delay and complexity weighed against permitting the insurers’ intervention motions.

The Court, in Berry, analyzed the insured-insurer relationship, noting the insurer is paid to assume the risk of loss and, thus must bear the loss if the insured’s recovery does not exceed its loss. Citing to Humbach v Goldstein (229 AD2d 64, 68 [2d Dept 1997]), the Third Department agreed that to permit intervention “could create an adversarial posture between carriers and plaintiffs,” stating that “public interest in assuring the integrity of relations between insurers and their insureds requires that even the potential for conflict of interest in these situations be avoided and militates against allowing an insurer to, directly or indirectly, place its own interests above those of its insured.” (Berry at 67.) The Court went on to note that, for this reason, although the Court of Appeals has permitted an insurer to enforce its subrogation rights against a third-party tortfeasor, considerations of equity will not permit such relief if to do so would diminish the insured’s rights.

Acknowledging its earlier decision in Winkelmann v Excelsior Ins. Co. (85 NY2d 577, 581 [1995]), holding an insurer has an equitable right of subrogation to the extent of benefits paid by it to its insured, the Court of Appeals in Teichman v Community Hosp. of W. Suffolk (87 NY2d 514 [1996]) permitted intervention by an insurer after a settlement was achieved on behalf of an infant. It is important to note that Teichman was a case brought by an insured against its insurer seeking to vacate any reimbursement claims and to declare the insurer had no right to settlement proceeds. Granting relief to the insured would have otherwise foreclosed the insurer from asserting its rights. Basing its decision on the insurer’s right of reimbursement under the insurance contract, it noted the policy’s language which authorized the insurer’s recovery of a refund from its insured for all expenses the insured received from another source. It is important to note that intervention in Teichman was permitted to determine whether the settlement included compensation for medical expenses. To be sure, the Court of Appeals (at 523) stated, “[t]he trial court itself noted that ‘the settlement amount herein is inextricably intertwined with [530]*530components of pain and suffering and medical expenses’ ” and found that “there exists the possibility that the settlement did actually include some payment for medical expenses.”

In Humbach v Goldstein (229 AD2d 64 [1997]), the Second Department upheld the trial court’s decision denying intervention to an insurer at a preverdict stage. The contract causes of action were held to be premature insofar as the policy’s language permitted the insurer to recover the reasonable value of the insured’s care or sickness upon the insured’s receipt of payment by virtue of third-party settlements or satisfied judgments which were identified “as amounts paid for health care services or benefits and only to the extent of the care provided for such injury or sickness” (at 66). Clearly, without either benefit of a settlement or a satisfied judgment paid to the insured, the insurer’s contractual rights could not yet be exercised, relegating the insurer to principles of equitable subrogation.

That Court noted that since an equitable subrogee’s rights are derivative to that of its insured’s rights, the insurer (as subrogee) is subject to any defenses the third-party tortfeasor may assert against its insured. On this subject, the Court stated that although the Court of Appeals in Teichman (supra) noted CPLR 4545 did not apply to pretrial settlements, the Court of Appeals had not yet spoken to the effect of CPLR 4545 on such subrogation issues at the preverdict stage. Relying on legislative history which included arguments it would prevent plaintiffs double recovery and keep policyholder’s costs down for liability insurance, the Second Department held that “[t]he question of whether the defendants’ liability insurance carriers should be held ultimately responsible for all of the plaintiff’s damages, even for damages specified in CPLR 4545 which have been compensated from collateral sources, is a question best left to the Legislature.” (Humbach at 68.)

In Humbach, the Second Department determined both prejudice and delay militated against permitting intervention. It found that to permit intervention of every insurance carrier (health, disability and no-fault) and unpaid, but insured medical service providers would complicate “[s]imple personal injury actions . . . transforming] [them] into complicated, unmanageable, multiparty litigation” (id.). Prejudice would be further visited upon a plaintiff by submitting issues of collateral source compensation to the jury, “permitting the jury to speculate that the plaintiff already has been compensated, so the ‘case should not be seriously regarded.’ ” (Humbach at 68, quoting Posnick v

Free access — add to your briefcase to read the full text and ask questions with AI

House v. Stephens, 21 Misc. 3d 527 (N.Y. Super. Ct. 2008).

21 Misc. 3d 527 (House v. Stephens) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

Teichman v. Community Hospital of Western Suffolk
663 N.E.2d 628 (New York Court of Appeals, 1996)
Winkelmann v. Excelsior Insurance
650 N.E.2d 841 (New York Court of Appeals, 1995)
Posnick v. H. S. & S. O. Crystal
181 A.D. 660 (Appellate Division of the Supreme Court of New York, 1918)
Humbach v. Goldstein
229 A.D.2d 64 (Appellate Division of the Supreme Court of New York, 1997)
Berry v. St. Peter's Hospital
250 A.D.2d 63 (Appellate Division of the Supreme Court of New York, 1998)
Graves v. County of Albany
278 A.D.2d 578 (Appellate Division of the Supreme Court of New York, 2000)
Kaiser v. Metropolitan Transit Authority
171 Misc. 2d 273 (New York Supreme Court, 1996)