Kennie Willett, Jessica Willett, a Minor Who Sues by and Through Her Father and Next Friend, Cross-Appellants v. Blue Cross and Blue Shield of Alabama, Cross-Appellee. Ernest L. Roden, Sheila Roden, Cross-Appellants v. Blue Cross and Blue Shield of Alabama, Cross-Appellee. Marvin A. Baugh Betty F. Baugh, Cross-Appellants v. Blue Cross and Blue Shield of Alabama, Cross-Appellee. Rickey D. Silas v. Blue Cross and Blue Shield of Alabama

953 F.2d 1335, 14 Employee Benefits Cas. (BNA) 2636, 1992 U.S. App. LEXIS 2319
CourtCourt of Appeals for the Eleventh Circuit
DecidedFebruary 19, 1992
Docket91-7222
StatusPublished
Cited by59 cases

This text of 953 F.2d 1335 (Kennie Willett, Jessica Willett, a Minor Who Sues by and Through Her Father and Next Friend, Cross-Appellants v. Blue Cross and Blue Shield of Alabama, Cross-Appellee. Ernest L. Roden, Sheila Roden, Cross-Appellants v. Blue Cross and Blue Shield of Alabama, Cross-Appellee. Marvin A. Baugh Betty F. Baugh, Cross-Appellants v. Blue Cross and Blue Shield of Alabama, Cross-Appellee. Rickey D. Silas v. Blue Cross and Blue Shield of Alabama) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Kennie Willett, Jessica Willett, a Minor Who Sues by and Through Her Father and Next Friend, Cross-Appellants v. Blue Cross and Blue Shield of Alabama, Cross-Appellee. Ernest L. Roden, Sheila Roden, Cross-Appellants v. Blue Cross and Blue Shield of Alabama, Cross-Appellee. Marvin A. Baugh Betty F. Baugh, Cross-Appellants v. Blue Cross and Blue Shield of Alabama, Cross-Appellee. Rickey D. Silas v. Blue Cross and Blue Shield of Alabama, 953 F.2d 1335, 14 Employee Benefits Cas. (BNA) 2636, 1992 U.S. App. LEXIS 2319 (11th Cir. 1992).

Opinion

953 F.2d 1335

60 USLW 2603, 14 Employee Benefits Cas. 2636

Kennie WILLETT, Jessica Willett, a minor who sues by and
through her father and next friend,
Plaintiffs-Appellees, Cross-Appellants,
v.
BLUE CROSS AND BLUE SHIELD OF ALABAMA, Defendant-Appellant,
Cross-Appellee.
Ernest L. RODEN, Sheila Roden, Plaintiffs-Appellees, Cross-Appellants,
v.
BLUE CROSS AND BLUE SHIELD OF ALABAMA, Defendant-Appellant,
Cross-Appellee.
Marvin A. BAUGH; Betty F. Baugh, Plaintiffs-Appellees,
Cross-Appellants,
v.
BLUE CROSS AND BLUE SHIELD OF ALABAMA, Defendant-Appellant,
Cross-Appellee.
Rickey D. SILAS, Plaintiff-Appellee,
v.
BLUE CROSS AND BLUE SHIELD OF ALABAMA, Defendant-Appellant.

Nos. 90-7846, 90-7884 and 91-7222.

United States Court of Appeals,
Eleventh Circuit.

Feb. 19, 1992.

Cathy S. Wright, Maynard, Cooper, Frierson & Gale, P.C., Birmingham, Ala., for defendant-appellant, cross-appellee.

Myron K. Allenstein, Gadsden, Ala., for plaintiffs-appellees, cross-appellants.

Appeals from the United States District Court for the Northern District of Alabama.

Before COX, Circuit Judge, JOHNSON* and REAVLEY**, Senior Circuit Judges.

JOHNSON, Senior Circuit Judge:

This consolidated appeal involves two cases presenting identical questions of law that arise from the same occurrence. The first case, Willett, et al. v. Blue Cross, arises on appeal following the lower court's grant of summary judgment to plaintiffs in a consolidated case involving six of the appellees in this consolidated appeal. The second case, Silas v. Blue Cross, comes before this Court after the lower court entered a judgment on the merits after receiving factual stipulations from the parties. Because genuine issues of material fact exist in Willett, we reverse the lower court's grant of summary judgment and remand the case for further proceedings. Because the lower court failed to make a critical factual finding necessary to support its decision in favor of Silas, we also reverse the decision of the lower court in Silas, and remand the case to the lower court for additional proceedings.

I. STATEMENT OF THE CASE

A. Background Facts

Appellees Kennie and Jessica Willett, Ernest and Sheila Roden, Marvin and Betty Baugh, and Rickey Silas (beneficiaries) were employees of Mays Enterprises, Inc. (Mays). Incident to their employment, they were entitled to group health insurance from Blue Cross and Blue Shield of Alabama (Blue Cross).

Under the policy between Mays and Blue Cross, Mays was required to pay a monthly plan premium by the first of every month. The contract provided, however, for a thirty-day grace period for late payments. During the grace period, insurance coverage continued, subject to the eventual payment of the premium. Mays failed to remit to Blue Cross the premium that was due November 1, 1987.

Following Mays' nonpayment of the November 1987 premium, Mays and Blue Cross entered into negotiations regarding the payment of the plan premiums. These negotiations continued into February 1988. In February, Mays tendered to Blue Cross a check for $8,000, an amount representing about one-half of Mays' arrearage with Blue Cross. Then, on March 19, 1988, Mays laid off its entire work force, and on March 21, 1988, Blue Cross returned Mays' $8,000 check and informed Mays that it was cancelling Mays' health insurance policy, retroactively from November 1, 1987.

The master contract between Blue Cross and Mays required Mays to provide all required documents and notices to employees. However, Mays failed to notify the employees/beneficiaries in a timely fashion that their coverage was suspended effective November 1, 1987, and that their coverage was subject to cancellation because Mays had failed to pay the required premiums. Moreover, Mays continued to deduct weekly employee copayments for health insurance,1 thus giving the employees the impression that their health insurance coverage remained in effect. The former Mays' employees were not informed that they did not have health insurance coverage as of November 1, 1987, until Mays notified them by a letter of March 28, 1988 that Blue Cross had cancelled the Mays plan because Mays had failed to pay Blue Cross the required plan premiums. All of the plaintiffs/appellees incurred medical expenses in the period between November 1, 1987 and March 28, 1988, that would have been covered under the cancelled plan.

Willett's daughter required a kidney operation in November 1987, and hip surgery in January 1988, incurring covered medical expenses of over $20,000 during the period from November 1, 1987, to March 28, 1988. Mays laid off Willett in mid-February 1988. Incident to the layoff, Willett received a COBRA2 application from Mays. Willett claims that he inquired of Blue Cross whether he could elect COBRA benefits in light of his layoff in order to continue his health insurance coverage under the Mays plan. Willett also claims that Blue Cross assured him that he could elect COBRA coverage and informed him that he was automatically covered under the Mays policy for thirty days beyond his termination. The record does not clearly establish whether or not Willett obtained COBRA coverage, and the district court made no factual finding on this matter. In addition, the record contains a letter from Scottish Rite Children's Hospital to Blue Cross dated April 11, 1988, stating that Blue Cross verified Willett's coverage with Blue Cross to Scottish Rite Children's Hospital in a telephone conversation on January 29, 1988.

Roden's wife became pregnant during the time period at issue. The Rodens incurred $159 of expenses during the period from November 1, 1987 to March 31, 1988. However, they incurred $4,013 in expenses related to Mrs. Roden's pregnancy subsequent to March 28, 1988. By a letter of February 3, 1988, Blue Cross informed the Rodens that Mrs. Roden's admission to her hospital had been approved for an August delivery, and that Blue Cross would cover the costs under the terms of the Mays' policy.

Mr. Baugh suffered heart problems on March 20, 1988. Baugh incurred total medical expenses of $21,242 between November 1, 1987 and March 28, 1988. As a new employee,3 Baugh was required to wait 90 days before receiving health care coverage under the Mays plan. On November 1, 1987, the day that Mays' coverage ostensibly lapsed, Baugh received his Blue Cross card and a letter informing him that he was now covered under the plan. It is unclear, however, whether Blue Cross issued the card before Mays failed to pay its required premiums.

Mr. Silas was involved in an automobile accident on March 19, 1988, and incurred medical bills of $4,267. Silas, like Baugh, was a new Mays' employee. Silas was not eligible for health care coverage under the Mays plan until December 1, 1987.

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Bluebook (online)
953 F.2d 1335, 14 Employee Benefits Cas. (BNA) 2636, 1992 U.S. App. LEXIS 2319, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kennie-willett-jessica-willett-a-minor-who-sues-by-and-through-her-father-ca11-1992.