Kahrs v. Sanchez

1998 NMCA 037, 956 P.2d 132, 125 N.M. 1
CourtNew Mexico Court of Appeals
DecidedNovember 5, 1997
Docket17865
StatusPublished
Cited by20 cases

This text of 1998 NMCA 037 (Kahrs v. Sanchez) is published on Counsel Stack Legal Research, covering New Mexico Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Kahrs v. Sanchez, 1998 NMCA 037, 956 P.2d 132, 125 N.M. 1 (N.M. Ct. App. 1997).

Opinion

OPINION

FLORES, Judge.

1. On August 1, 1997, this Court filed its opinion in this case. On August 26, 1997, the New Mexico Human Services Department (HSD) filed a motion for rehearing. Thereafter, this Court ordered Plaintiff to file a response to the motion for rehearing, which response was filed on October 17, 1997. We hereby deny HSD’s motion, but we withdraw our opinion of August 1, 1997, and substitute this opinion in its place.

2. In this case we are called upon to interpret HSD’s statutory right to reimbursement of medicaid expenditures from a medicaid recipient’s claim against a third-party tortfeasor. See NMSA 1978, § 27-2-28(G)(1)(b) (1995) (providing for assignment to HSD of right to recovery against tortfeasor); NMSA 1978, § 27-2-23(B) (1969) (providing for subrogation of recipient’s right to recover medical expenses from third party). Plaintiff is the recipient, and co-defendant Karen Sanchez (Sanchez) is the third-party tortfeasor. HSD contends that its right to reimbursement is controlled by Section 27-2-28(G) and that assignment by operation of law entitles HSD to full reimbursement regardless of the facts. We disagree and affirm the trial court’s equitable reduction.

FACTUAL AND PROCEDURAL POSTURE

3. Medicaid is a federal and state-funded program administered by the states in accordance with federal law. See 42 U.S.C. §§ 1396,1396a (1994). HSD administers the Medical Assistance Program (medicaid) in New Mexico. See NMSA 1978, § 27-2-12 (1993).

4. Plaintiff applied for medicaid on or about December 26, 1989. As an eligibility requirement, Plaintiff assigned to HSD his right to medical support and other third-party payments.

5. On May 7, 1994 Plaintiff sustained serious and permanent injuries when Sanchez’s automobile collided with the motorcycle that Plaintiff was riding. As a result of the accident, HSD expended at least $35,871.85 for medical assistance on Plaintiffs behalf. Plaintiff alleged that he suffered over $500,-000 in damages resulting from physical pain and mental anguish, physical impairment, and loss of earnings and earning capacity. Although Sanchez had liability insurance of $50,000, she was otherwise judgment proof.

6. HSD discovered that Sanchez was a potentially liable third-party when Sanchez’s insurer contacted HSD to determine the amount of the medicaid claim. Thereafter, HSD notified Plaintiffs counsel of Plaintiffs assignment to HSD. On October 12, 1995 Plaintiff filed an action for personal injury against Sanchez, together with a claim for equitable reduction of HSD’s claim for reimbursement.

7. Plaintiff moved for partial summary judgment on the basis that the claim was comparable to on raised under Section 27-2-23(B), which White v. Sutherland, 92 N.M. 187, 585 P.2d 331 (Ct.App.1978), construed to be an equitable remedy. According to Section 27-2-23(B), “[w]hen the department makes medical assistance payments in behalf of a recipient, the department is subrogated to any right of the recipient against a third party for recovery of medical expenses to the extent that the department has made payment.”

8. HSD maintained that its claim was a legal remedy based on Section 27-2-28(G), which provides as follows:

By operation of law, an assignment to the human services department of any and all rights of an applicant for or recipient of medical assistance under the medicaid program in New Mexico or supplemental security income through the social security administration:
(1) is deemed to be made of:
(a) any payment for medical care from any person, firm or corporation, including an insurance carrier; and
(b) any recovery for personal injury, whether by judgment or contract for compromise or settlement[.]

9. Although the court granted Plaintiffs motion for partial summary judgment on the law, questions of fact regarding damages remained outstanding. The parties were able to resolve the outstanding issues by a stipulation that released Sanchez in exchange for her payment of the $50,000 policy limit. Plaintiff and Sanchez also stipulated that Plaintiff suffered $469,607.29 in damages proximately caused by the accident. HSD specifically did not stipulate to damages because HSD considered the amount of damages to be irrelevant to its statutory right of reimbursement.

10. The court entered judgment in accordance with the stipulation and reduced HSD’s reimbursement to $2,546.19 after concluding that HSD’s right to reimbursement under Sections 27-2-23(B) and -28(G) is a right of subrogation. The amount of reimbursement reflects a deduction for HSD’s share of Plaintiffs attorney’s fees, which HSD does not challenge on appeal. HSD, however, does challenge the trial court’s interpretation and application of Section 27-2-28(G).

DISCUSSION

1.Standard of review.

11. Interpretation of Section 27-2-28(G) is a question of law which we review de novo. See State v. Rowell, 1995 NMSC 086, ¶ 8, 121 N.M. 111, 908 P.2d 1379 (standard of review). The primary purpose of statutory interpretation is to ascertain and give effect to legislative intent. See Cummings v. X-Ray Assocs., 1996 NMSC 035, ¶ 44, 121 N.M. 821, 918 P.2d 1321. The initial inquiry is whether the language of Section 27-2-28(G) is ambiguous, also a question of law subject to de novo review. See Garcia v. Thong, 119 N.M. 704, 706, 895 P.2d 226, 228 (1995) (initial question); New Mexico State Bd. of Educ. v. Board of Educ., 95 N.M. 588, 590, 624 P.2d 530, 532 (1981) (standard of review). Absent ambiguity, or special circumstances, the plain meaning of the wording controls and no further interpretation is necessary. See Garcia, 119 N.M. at 706, 895 P.2d at 228; but see State ex rel. Helman v. Gallegos, 117 N.M. 346, 353, 871 P.2d 1352, 1359 (1994) (plain-meaning rule to be employed with caution because “[i]ts beguiling simplicity may mask a host of reasons why [the wording] ... give[s] rise to legitimate differences of opinion”).

2. Argument of the parties.

12. HSD does not deny that the remedy provided by Section 27-2-23(B) is an equitable remedy as determined in White. Rather, HSD asserts that Section 27-2-23(B) has no bearing on their right to the insurance proceeds because Plaintiff assigned the proceeds to HSD by operation of law pursuant to Section 27-2-28(G), which HSD maintains is a separate remedy that facilitates full reimbursement in every case.

13. Plaintiff, however, maintains that Section 27-2-28(G) “is merely an extension of the right of recovery contained at [Section] 27-2-23 and the nature of the State’s right of recovery is not modified by the assignment statute.” See § 27-2-23(13); White, 92 N.M.

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Bluebook (online)
1998 NMCA 037, 956 P.2d 132, 125 N.M. 1, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kahrs-v-sanchez-nmctapp-1997.