Kaiman v. Mercy Midlands Medical & Dental Plan

491 N.W.2d 356, 1 Neb. Ct. App. 148, 1992 Neb. App. LEXIS 76
CourtNebraska Court of Appeals
DecidedMay 19, 1992
DocketNo. A-90-435
StatusPublished
Cited by16 cases

This text of 491 N.W.2d 356 (Kaiman v. Mercy Midlands Medical & Dental Plan) is published on Counsel Stack Legal Research, covering Nebraska Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Kaiman v. Mercy Midlands Medical & Dental Plan, 491 N.W.2d 356, 1 Neb. Ct. App. 148, 1992 Neb. App. LEXIS 76 (Neb. Ct. App. 1992).

Opinion

Sievers, Chief Judge.

This appeal presents the first impression issue of whether a health care insurer who is reimbursed as the result of an injured employee’s successful workers’ compensation suit is obligated to pay attorney fees to the employee’s attorney.

This case comes to us after the district court for Douglas County sustained the demurrer of Mercy Midlands Medical and Dental Plan and its trustee (Mercy Midlands). In reviewing an order sustaining a demurrer, an appellate court accepts the truth of facts well pled and the factual and legal inferences which may reasonably be deduced from such facts, but does not accept the conclusions of the pleader. Balfany v. Balfany, 239 Neb. 391, 476 N.W.2d 681 (1991). However, regarding a question of law, an appellate court has an obligation to reach a conclusion independent of that of the trial court in a judgment under review. City of Newman Grove v. Primrose, 240 Neb. 70, 480 N.W.2d 408 (1992).

BACKGROUND

The factual background, as revealed by plaintiff’s petition, is that Patty Junge, an employee of Bergan Mercy Hospital, asserted that she had sustained an on-the-job injury. Her employer denied compensability. Junge, as an employee of [150]*150Bergan Mercy, was covered by Mercy Midlands Medical and Dental Plan, a health maintenance organization (HMO). Mercy Midlands paid $13,554.38 to those who had provided medical services to Junge for her injury.

Junge retained counsel, who is the appellant herein. Suit was filed against Junge’s employer in the Nebraska Workers’ Compensation Court, and after two full hearings, that court entered an award in Junge’s favor. As a result of the award in Junge’s favor, Mercy Midlands received full reimbursement of the $13,554.38 it had paid to Junge’s medical providers.

Junge’s attorney, Howard A. Kaiman, tendered a demand to Mercy Midlands for payment of a reasonable attorney fee, which he asserted was one-third of the amount reimbursed. The demand was denied, and as a result Kaiman filed suit against Mercy Midlands in the district court for Douglas County, seeking judgment against Mercy Midlands in the amount of $4,518.13.

Mercy Midlands filed a demurrer, which asserted that the district court had no jurisdiction over the subject matter and that the petition failed to state a cause of action because “Neb. Rev. Stat. §48-101 et seq. (Reissue 1988), is the governing statutory authority and does not provide for attorneys fees in this type of case.” On May 7, 1990, the district court sustained the demurrer without comment or opinion. Kaiman perfected his appeal and assigns the sustaining of the demurrer as error.

We must determine whether the petition states a cause of action, and if so, where jurisdiction lies.

IS A CAUSE OF ACTION STATED?

The issue of whether a cause of action is stated against an HMO by an attorney who has successfully presented an injured employee’s workers’ compensation claim against an employer with the result that an HMO is reimbursed is an issue of first impression in the State of Nebraska. We consider that an HMO is the equivalent of a health care insurer for purposes of our decision.

Nebraska’s Common Fund Doctrine.

Kaiman argues that through his efforts, Mercy Midlands received full reimbursement of its payments on behalf of the [151]*151injured employee Junge, and therefore under the common fund doctrine Mercy Midlands should bear a share of the cost of the recovery which was of direct and substantial benefit to Mercy Midlands. Mercy Midlands asserts that the common fund doctrine does not apply and that Neb. Rev. Stat. § 48-120 (Reissue 1988) provides for direct reimbursement to a health care insurer without provision for attorney fees and thus no cause of action can be stated for attorney fees.

Kaiman asserts that the reimbursement of $13,554.38 to Mercy Midlands is a “common fund” and that he is owed a reasonable attorney fee of one-third, or $4,518.13, fromMercy Midlands. Under Nebraska law the common fund doctrine had its origination in United Services Automobile Assn. v. Hills, 172 Neb. 128, 109 N.W.2d 174 (1961), where the court recognized that ordinarily the right of a lawyer to compensation for his services depends upon a contract of employment, express or implied, but that there are exceptions. The applicable exception in that case was that an attorney who renders services in recovering or preserving a fund, in which a number of persons are interested, may in equity be allowed compensation out of the whole fund where the services are rendered on behalf of and are of benefit to the common fund.

Thereafter, in Krause v. State Farm Mut. Auto. Ins. Co., 184 Neb. 588, 169 N.W.2d 601 (1969), the court once again followed and cited United Services Automobile Assn. v. Hills:

In awarding the insured’s attorney an attorney’s fee proportionate to the amount of services he had rendered in collecting the subrogation claim along with the personal injury claim against the tort-feasor, this court laid down the substantive principle of liability as follows: “The applicable rule is that where the holder of the subrogation right does not come into the action, whether he refuses to do so or acquiesces in the plaintiff’s action, but accepts the avails of the litigation, he should be subjected to his proportionate share of the expenses thereof, including attorney’s fees.”

Krause, 184 Neb. at 591, 169 N.W.2d at 603.

These cases are not precisely on point, as they involve the recovery of a subrogation interest in a tort action. Nonetheless, [152]*152the decisions show an unwillingness to allow the holder of the subrogated interest to have a “free ride” from the effort of the plaintiff and his or her attorney, who successfully bring the action which results in the creation of the fund which satisfies the subrogated interest. The concept that the employer or compensation insurer who benefits from third-party tort litigation must share in the expenses thereof is now codified in the Nebraska Workers’ Compensation Act, Neb. Rev. Stat. § 48-118 (Reissue 1988). The Nebraska Supreme Court observed that it may well be that the 1963 amendments to § 48-118 were influenced by the Hills decision. Gillotte v. Omaha Public Power Dist., 189 Neb. 444, 203 N.W.2d 163 (1973), overruled on other grounds, Nekuda v. Waspi Trucking, Inc., 222 Neb. 806, 388 N.W.2d 438 (1986).

Certainly, the principle of the Hills

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Kaiman v. MERCY MIDLANDS MED. & DENTAL PLAN
491 N.W.2d 356 (Nebraska Court of Appeals, 1992)

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Bluebook (online)
491 N.W.2d 356, 1 Neb. Ct. App. 148, 1992 Neb. App. LEXIS 76, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kaiman-v-mercy-midlands-medical-dental-plan-nebctapp-1992.