Janice E. Spurgeon v. Missouri Consolidated Health Care Plan, Board of Trustees, and Judith Muck, Executive Director, Missouri Consolidated Health Care Plan

481 S.W.3d 604, 2016 Mo. App. LEXIS 129
CourtMissouri Court of Appeals
DecidedFebruary 16, 2016
DocketWD78785
StatusPublished
Cited by6 cases

This text of 481 S.W.3d 604 (Janice E. Spurgeon v. Missouri Consolidated Health Care Plan, Board of Trustees, and Judith Muck, Executive Director, Missouri Consolidated Health Care Plan) is published on Counsel Stack Legal Research, covering Missouri Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Janice E. Spurgeon v. Missouri Consolidated Health Care Plan, Board of Trustees, and Judith Muck, Executive Director, Missouri Consolidated Health Care Plan, 481 S.W.3d 604, 2016 Mo. App. LEXIS 129 (Mo. Ct. App. 2016).

Opinion

Lisa White Hardwick, Judge

Janice Spurgeon (“Spurgeon”) appeals the dismissal of her request for judicial review of the Missouri Consolidated Health Care Plan’s (“MCHCP”) decision to deny her application for survivor enrollment. The circuit court dismissed her petition for failure to state a claim upon which relief could be granted. Spurgeon contends the court erred in dismissing her petition because she met all of the statutory requirements for enrollment- in MCHCP’s medical plan. Because we find that Spurgeon’s petition stated a claim for judicial review of MCHCP’s decision, we reverse and remand the case for further proceedings consistent with this opinion.

Factual and PROCEDURAL History;

In an appeal from a dismissal for failure to state a claim, we assume the facts alleged in the petition to be true. Whispering Oaks Residential Facility, LLC v. Mo. Dep’t of Nat. Res., 456 S,W.3d 46, 49 (Mo.App. 2015). Spurgeon’s late husband, Gary Spurgeon (“Gary”), 1 was an employee of the Missouri Department of Public Safety, Division of Alcohol and Tobacco Control, from January 12,1976, until his retirement on December 1, 2009. Gary received retirement benefits from the State and kept his health insurance through MCHCP throughout his retirement. Spurgeon was, and still is, an employee of Crawford Electric Cooperative and' has always maintained coverage under her employer’s health insurance plan.

Spurgeon and Gary intended that Spur-geon would be covered under Gary’s health insurance plan during her own retirement. In October 2013, Spurgeon contacted MCHCP to inquire about’ her eligibility to enroll as a dependent of Gary’s, who had been diagnosed with terminal cancer. During this phone call, an MCHCP representative told Spurgeon that “all she would need to do” to enroll in the plan would be to complete a survivor enrollment application upon Gary’s death.

Gary -died on March 4, 2014. Six days after Gary’s death, Spurgeon submitted a survivor enrollment application form to MCHCP. MCHCP denied the application; stating that Spurgeon was ineligible for survivor coverage because she did not have MCHCP coverage as a dependent at the time of Gary’s death. Spurgeon appealed this decision to the MCHCP Board of Trustees, which denied her, appeal.

*606 Spurgeon subsequently filed a petition for judicial review of MCHCP’s determination, alleging that MCHCP acted unlawfully, unreasonably, arbitrarily, and capriciously in denying her application for survivor enrollment because she met the statutory requirements to enroll. 2 MCHCP moved to dismiss the petition. Following a hearing, the court found that the petition failed to state a claim upon which relief could be granted and dismissed the petition. Spurgeon appeals,

STANDARD OF REVIEW

On appeal from the circuit court’s review of a non-contested administrative decision, we review the circuit court’s judgment, not the administrative agency’s decision. Mo. Nat’l Educ. Ass’n v. Mo. State Bd. of Educ., 34 S.W.3d 266, 274 (Mo.App. 2000). Our review is de novo. Whispering Oaks, 456 S.W.3d at 49.

“ ‘A motion to dismiss for failure to state a cause of action is solely a test of the adequacy of the plaintiffs petition.’ ” Id. (quoting Bosch v. St. Louis Healthcare Network, 41 S.W.3d 462,'464 (Mo. banc 2001)). We do. not determine whether the facts alleged in the petition are credible or persuasive. Id. Instead, “we accept all properly pleaded facts as true, giving the pleadings their broadest intendment, and we construe all allegations favorably to the pleader ... to determine if the facts alleged meet the elements of a recognized cause of action, or of a cause that might be adopted in that case.” Harris v. Presson, 445 S.W.3d 127, 129 (Mo.App. 2014) (internal quotation marks and citations omitted).

Analysis

In her sole point on appeal, Spur-geon' contends the court' erre'd' in finding that her petition for judicial review failed to state a claim upon which relief could be granted. Spurgeon’s petition sought judicial review of MCHCP’s decision to deny her survivor enrollment application in MCHCP’s health insurance plan. Section 536.150, 3 provides for judicial review of non-contested eases- of an agency action that determines the “ ‘legal rights, duties or privileges of hriy person.'’ ” McIntosh v. LaBundy, 161 S.W.3d 413, 415-16 (Mo. App. 2005) (quoting § 536.150.1). To adequately plead- a claim for judicial review under Section 536.150, “an individual must plead facts that, if true, would show that he has been denied some legal right or entitlement to a privilege by an agency decision that was ‘unconstitutional, unlawful, unreasonable, arbitrary, or capricious or involve[d] an abuse of discretion.’ ” Id. at 416 (quoting § 536.150.1).

, Spurgeon argues that she demonstrated a legal right to enroll in MCHCP’s health insurance plan, in that she met all of the statutory requirements for enrollment by a surviving dependent. Specifically, she asserted in her petition that she met the requirements outlined in Section 103.085. Section 103.085 provides:

Except as otherwise provided by sections 103.003 to 103.080, medical benefits *607 coverage as provided by sections 103.003 to 103.080 shall terminate when the member ceases to be an active employee; except persons receiving or entitled to receive an annuity or retirement benefit or disability benefit or the spouse of or unemancipated children of deceased persons receiving or entitled to receive an annuity or retirement beneñt or disability benefit from the state, participating member agency, institution, political subdivision or governmental entity may elect to continue coverage, provided the individuals to be covered have been continuously covered for health care beneñts:
(1) Under a separate group or individual policy for the six-month period immediately preceding the member’s date of death or disability or eligibility for normal or early retirement; or
(2) Pursuant to sections 103.003 to 103.080, since the effective date of the most recent open enrollment period pri- or to the member’s, date of death or disability or eligibility for normal or early retirement; or
(3) From the initial date of eligibility for the benefits provided by sections 103.003 to 103.080; or

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481 S.W.3d 604, 2016 Mo. App. LEXIS 129, Counsel Stack Legal Research, https://law.counselstack.com/opinion/janice-e-spurgeon-v-missouri-consolidated-health-care-plan-board-of-moctapp-2016.