Mellor v. Wasatch Crest Insurance Co. in Liquidation

2015 UT App 239, 360 P.3d 784, 795 Utah Adv. Rep. 30, 2015 Utah App. LEXIS 255, 2015 WL 5474242
CourtCourt of Appeals of Utah
DecidedSeptember 17, 2015
Docket20131174-CA
StatusPublished

This text of 2015 UT App 239 (Mellor v. Wasatch Crest Insurance Co. in Liquidation) is published on Counsel Stack Legal Research, covering Court of Appeals of Utah primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mellor v. Wasatch Crest Insurance Co. in Liquidation, 2015 UT App 239, 360 P.3d 784, 795 Utah Adv. Rep. 30, 2015 Utah App. LEXIS 255, 2015 WL 5474242 (Utah Ct. App. 2015).

Opinion

Opinion

VOROS, Judge:

1 1 This appeal involves a claim against an insolvent health insurance company in a liquidation proceeding. The district court ruled the claim untimely and, in any event, that it did not qualify for priority treatment, because Medicaid had refmbursed the claimant for the losses she claimed. We reverse on the first point and affirm on the second.

BACKGROUND

12 In early August 2001, Appellant Chris Ann Mellor's son suffered a near-drowning incident that left him with permanent injuries. At the time of the incident, Mellor's son had health coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) through his father's insurance policy with Wasatch Crest Insurance Company (Wasatch Crest). After the accident, Mel-lor also obtained Medicaid coverage for her son. Medicaid back-dated its coverage to August 1, 2001. Wasatch Crest paid claims arising from the near-drowning incident until November 2001. Then Wasatch Crest determined that Mellor's son's Medicaid coverage made him ineligible for coverage under the terms of its policy. Wasatch Crest informed Mellor that her son had no coverage under its policy due to his Medicaid coverage, and consequently, as of November 1, 2001, she stopped paying COBRA premiums. Wasatch Crest then began requesting and receiving 'reimbursements for payments it made to providers on claims during the period of the overlapping coverage. Since August 1, 2001, Medicaid has paid Mellor's son's medical expenses in full.

1 8 In September 2002, Mellor entered into a collection agreement with the Utah State Office of Recovery Services (ORS). The collection agreement made ORS an assignee of any recovery Mellor obtained from Wasatch Crest for wrongly denying her son's coverage. In March 2003, Mellor filed suit against Wasatch Crest alleging, among other things, breach of contract for its failure to pay Mel-lor's son's medical expenses. In July 2008, 'the district court declared Wasatch Crest insolvent under Utah's Insurers Rebabilitation and Liquidation statutes (the Liquidation Act), Utah Code Ann. §§ 81A-27-101 to -411 (LexisNexis 2002). 1 The district *787 court also appointed a liquidator (the Liquidator) to manage the Wasatch Crest estate, and the court set a July 81, 2004 deadline to file a proof of claim against Wasatch Crest's estate.

T4 Wasatch Crest's insolvency automatically stayed all pending litigation against it. Id. § S31A-27-817(1). Mellor then submitted a timely proof of elaim to the Liquidator. The Liquidator denied Mellor's claim in its first amended notice of determination on the ground that Mellor's son's Medicaid coverage excluded him from coverage under the terms of Wasatch Crest's policy. Mellor filed a timely objection to the first amended notice of determination. A referee found that Wasatch Crest had no liability for the claims Mellor asserted on behalf of her son after the date that he acquired Medicaid coverage. The referee recommended that the district court affirm the Liquidator's denial of Mel-lor's proof of claim.

¶ 5 -At a hearing before the district court on Mellor's objection to the referee's findings and recommendation, the Liquidator raised the issue of Mellor's standing and moved to have her claim dismissed. The district court ultimately determined that Mellor had standing to assert claims on behalf of her son. Nevertheless, the district court approved the recommendation of the referee and denied Mellor's claim on the merits.

T 6 Mellor appealed the district court's ruling on the issue of her son's COBRA coverage. The Liquidator cross-appealed on the issue of standing. The Utah Supreme Court ruled for Mellor on both issues-affirming on the issue of standing but reversing on the issue of coverage. Mellor v. Wasatch Crest Mut. Ins. Co. (Mellor I ), 2009 UT 5, ¶¶ 9, 20, 201 P.3d 1004. The court held that Mellor's son's Medicaid coverage did not terminate his COBRA coverage as a matter of contract law. Id. 120. Accordingly, the supreme court concluded that because Mellor's son "is a beneficiary of the Wasatch Crest plan, he, and through him his mother .. .., have standing to pursue an action for recovery of benefits owing ... under the plan." Id. 121.

T7 For approximately one year after re-mittitur from the supreme court, little happened with Mellor's claim. In an apparent effort to move things along, Mellor filed a motion for summary judgment in the district court, She asserted that, under Mellor I, her son was a covered beneficiary of the Wasatch Crest insurance plan. Therefore, she argued, principles of estoppel entitled her son to the reinstatement of his COBRA coverage under the Wasatch Crest insurance | plan, and accordingly, her son had a reimbursable claim.

T8 The Liquidator moved to strike or stay Mellor's motion for summary judgment. The Liquidator argued that Mellor's claim was not properly before the district court, because the qumdator had not yet made a second determination on Mellor's claim. In the alternative, the Liquidator opposed Mel-lor's motion for summary judgment on the merits,. The Liquidator explained, "As a result of ... [the Liquidation Act's] priority scheme, it is evident that Mellor does not have a Class Three Claim." The Liquidator continued that any valid claim arising from the collection agreement Mellor entered into with ORS "the Liquidator will classfiy Class Six."

19 Mellor filed a response to the Liquidator's opposition to the motion for summary judgment. In her response, Mellor. argued that the parties need not wait for the Liquidator to make a second determination on her claim, because the Liquidator's opposition to summary judgment made the Liquidator's official denial a mere formality. Mellor went on to challenge the Liquidators opposition on the merits and its determination that Mel-lor's claim constituted a class<six and not a class-three claim. Mellor then requested that the district court "proceed with a ruling on the proper classification of ' Mellor's claim."

A 10 The L1qu1dator filed a reply memorandum. The reply memorandum's caption page indicated, in a single sentence, that the Liquidator had attached his official denial of *788 Mellor's claim-the second amended notice of determination (the Second Notice)-as an exhibit to the reply memorandum:

In conjunction with this Reply Memorandum, the Liquidator ... attaches its See-ond Amended Notice of Determination with respect to the Proof of Claim filed by [Mellor] on behalf of her son ..., a copy of which is attached hereto as Exhibit A.

The Second Notice, dated June 29, 2010, denied Mellor's claim:

Based upon review of the documents that were submitted and the records of [Wasatch Crest], the Liquidator has DENIED the claim in the amount of $200,000+. The basis for the Denial is included in the attached Reply Memorandum, the essence of which is that [Mellor] has been indemnified by a third party [Medicaid] and thus has suffered no unreimbursed logs. . ..

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Salt Lake Child & Family Therapy Clinic, Inc. v. Frederick
890 P.2d 1017 (Utah Supreme Court, 1995)
Mellor v. Wasatch Crest Mutual Insurance Co.
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Bissland v. Bankhead
2007 UT 86 (Utah Supreme Court, 2007)
Mellor v. Wasatch Crest Mutual Insurance
2012 UT 24 (Utah Supreme Court, 2012)
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972 P.2d 439 (Utah Supreme Court, 1998)

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Bluebook (online)
2015 UT App 239, 360 P.3d 784, 795 Utah Adv. Rep. 30, 2015 Utah App. LEXIS 255, 2015 WL 5474242, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mellor-v-wasatch-crest-insurance-co-in-liquidation-utahctapp-2015.