Miller v. Med. Mut. of Ohio

2013 Ohio 3179
Ohio Court of Appeals·Decided July 18, 2013·No. 2012CA0020·Published·Cited by 5 cases

Opinion

COURT OF APPEALS

COSHOCTON COUNTY, OHIO

FIFTH APPELLATE DISTRICT

ELISE MILLER, et al. JUDGES:

Hon. W. Scott Gwin, P. J.

Plaintiffs-Appellants Hon. John W. Wise, J.

Hon. Craig R. Baldwin, J.

-vs-

Case No. 2012CA0020

MEDICAL MUTUAL OF OHIO

Defendant-Appellee OPINION

CHARACTER OF PROCEEDING: Civil Appeal from the Court of Common Pleas, Case No. 2012CI0138

JUDGMENT: Affirmed in part; Reversed in Part and Remanded

DATE OF JUDGMENT ENTRY: July 18, 2013

APPEARANCES: For Plaintiffs-Appellants For Defendant-Appellee

RICHARD T. ROBOL CHRISTOPHER S. WILLIAMS RACHEL CHODERA MONAGHAN MAURA L. HUGHES ROBOL LAW OFFICE LAURA MCBRIDE 433 West Sixth Avenue MOLLY A DRAKE Columbus, Ohio 43201 1405 East Sixth Street Cleveland, Ohio 44114

DAVID J. WIGHAM

STEVE J. SHROCK

225 North Market Street

Wooster, Ohio 44691

Wise, J.

{¶1} Appellants Elise Miller and Pharmaceutical Alternatives, Inc. appeal from the October 4, 2012, decision entered in the Coshocton County Court of Common Pleas granting Appellee Medical Mutual of Ohio’s Civ.R. 12(B)(6) Motion to Dismiss.

STATEMENT OF THE FACTS AND CASE

{¶2} Pharmaceutical Alternatives, Inc. (PAI) is a "closed-door pharmacy" and provider of certain specialty pharmaceuticals which contracted with Medical Mutual of Ohio (MMO), an Ohio provider of health insurance. Elise Miller is the sole owner of PAI.

{¶3} In 2000, PAI and MMO entered into an agreement which provided for reimbursement to PAI for certain services and medications PAI would provide to MMO's insureds (the "Participation Agreement"), and two additional agreements, which provided for reimbursement to PAl on an in-network basis (the "Provider Agreements") (collectively, the "Agreements").

{¶4} During the course of the relationship between PAI and MMO, several disputes arose with regard to the Agreements. One such dispute resulted in a lawsuit filed on July 11, 2006, captioned Pharmaceutical Alternatives. Inc. v. Medical Mutual of Ohio, Case No. 06-CIV-525, currently pending in the Coshocton County Court of Common Pleas, Coshocton County, Ohio.

{¶5} On or about November 5, 2008, PAI filed a voluntary petition for relief under Chapter 11 of the Bankruptcy Code in the United States Bankruptcy Court for the Southern District of Ohio, Eastern Division.

{¶6} Subsequently, on or about March 18, 2009, PAI's case was converted to one under Chapter 7 of the Bankruptcy Code and William B. Logan was appointed the Chapter 7 Trustee ("Bankruptcy Trustee").

{¶7} On September 24, 2010, the Bankruptcy Court issued an agreed order authorizing the Bankruptcy Trustee to sell to Cardinal Health any and all rights, title and interest to claims and litigation held by PAI against MMO free and clear of any liens and encumbrances.

{¶8} On or about March 29, 2012, Plaintiffs-Appellants Pharmaceutical Alternatives Inc. and Elise Miller filed their Complaint against Defendant Medical Mutual of Ohio in the Court of Common Pleas for Coshocton County.

{¶9} Appellants' Complaint included claims for breach of written contract ("Count I"), breach of implied covenant of good faith and fair dealing ("Count II"), promissory estoppel ("Count III"), conversion ("Count IV"), tortious interference with contractual relations and with prospective business relations ("Count V"), negligent and intentional misrepresentation/fraud ("Count VI"), "destruction of business through bad faith in processing and paying insurance and guaranteed claims" ("Count VII"), and civil conspiracy ("Count VIII").

{¶10} On May 25, 2012, Defendant filed a motion to dismiss all claims for failure to state a claim under Civ.R. 12(B)(6).

{¶11} On July 16, 2012, Plaintiffs-Appellants filed their memorandum in opposition to the motion to dismiss.

{¶12} On October 4, 2012, the trial court granted the motion to dismiss.

{¶13} Appellants filed an appeal and assigned the following Assignments of Error:

ASSIGNMENTS OF ERROR

{¶14} "I. THE DECISION BELOW ERRS IN HOLDING THAT PLAINTIFF PAI IS BARRED FROM ANY AND ALL CLAIMS AGAINST DEFENDANT MMO BY A SEPTEMBER 24, 2010 ORDER OF THE U.S. BANKRUPTCY COURT FOR THE SOUTHERN DISTRICT OF OHIO.

{¶15} “II. THE DECISION BELOW ERRS IN HOLDING THAT COMPLAINT FAILS TO STATE A CLAIM FOR "[TORTIOUS] INTERFERENCE" BECAUSE MILLER'S CLAIM "INVOLVES A POTENTIAL BUSINESS AGREEMENT BETWEEN PAI AND THE WEINBERG & BELL GROUP.”

{¶16} “III. THE DECISION BELOW ERRS IN HOLDING THAT THE COMPLAINT FAILS TO STATE A CLAIM FOR PROMISSORY ESTOPPEL AS TO PLAINTIFF MILLER "BECAUSE MILLER FAILS TO IDENTIFY ANY STATEMENT, PROMISE OR REPRESENTATION MADE BY DEFENDANT.”

{¶17} “IV. THE DECISION BELOW ERRS IN HOLDING THAT THE COMPLAINT FAILS TO STATE A CLAIM BY PLAINTIFF MILLER FOR MISREPRESENTATION BECAUSE IT "INVOLVES CONTRACTS BETWEEN PAI AND THE DEFENDANT," AND "MILLER IS NOT A PARTY TO THESE CONTRACTS IN HER INDIVIDUAL CAPACITY."

{¶18} “V. THE DECISION BELOW ERRS IN HOLDING THAT THE COMPLAINT STATES NO CLAIM FOR RELIEF FOR CIVIL CONSPIRACY “BECAUSE IT SETS FORTH NO FACTUAL ALLEGATIONS IN SUPPORT OF THE CLAIM.”

{¶19} “VI. THE DECISION BELOW ERRS IN FAILING TO GRANT PLAINTIFFS LEAVE TO AMEND THEIR COMPLAINT.”

I.

{¶20} Appellant claims the trial court erred in granting Appellee’s motion to dismiss all of PAI’s claims against MMO based on the Sept. 24, 20120 Order of the U.S. Bankruptcy Court for the Southern District of Ohio. We agree.

{¶21} Our review of a trial court's decision to dismiss a complaint pursuant to Civ.R. 12(B)(6) is de novo. Ohio Bur. of Workers' Comp. v. McKinley, 130 Ohio St.3d 156, 2011–Ohio–4432, 956 N.E.2d 814, ¶ 12. In order for a court to dismiss a complaint under Civ.R. 12(B)(6) for failure to state a claim upon which relief can be granted, it must appear beyond doubt that the plaintiff can prove no set of facts warranting relief, after all factual allegations of the complaint are presumed true and all reasonable inferences are made in the nonmoving party's favor. State ex rel. Findlay Publishing Co. v. Schroeder, 76 Ohio St.3d 580, 581, 1996–Ohio–360, 669 N.E.2d 835. A complaint may not be dismissed under Civ.R. 12(B)(6) for failing to comply with the applicable statute of limitations unless the complaint on its face conclusively indicates that the action is time-barred. McKinley at ¶ 13.

{¶22} When ruling on a Civ.R. 12(B)(6) motion, a court may not rely upon evidence or allegations outside the complaint. State ex rel. Fuqua v. Alexander, 79 Ohio St.3d 206, 207, 1997-Ohio-169, 680 N.E.2d 985. Civ.R. 12(B)(6) instructs in pertinent part:

{¶23} “When a motion to dismiss for failure to state a claim upon which relief can be granted presents matters outside the pleading and such matters are not excluded by

the court, the motion shall be treated as a motion for summary judgment and disposed of as provided in Rule 56. Provided however, that the court shall consider only such matters outside the pleadings as are specifically enumerated in Rule 56. All parties shall be given reasonable opportunity to present all materials made pertinent to such a motion by Rule 56.”

{¶24} However, it has been recognized that courts may take judicial notice of “appropriate matters” in determining a Civ.R. 12(B)(6) motion without converting it to a motion for summary judgment. State ex rel. Scott v. Cleveland, 112 Ohio St.3d 324, 2006-Ohio-6573, 859 N.E.2d 923, ¶ 26, citing State ex rel. Neff v. Corrigan, 75 Ohio St.3d 12, 16, 1996-Ohio-231, 661 N.E.2d 170.

{¶25} In moving for a dismissal in this matter, Medical Mutual asserted that a bankruptcy decision bars PAI from bringing any litigation against Medical Mutual. No documents were attached to Medical Mutual’s Motion to Dismiss, but reference was made to such bankruptcy order throughout. We find that such decision was not an appropriate matter upon which judicial notice could be taken.

{¶26} Judicial notice allows a court to accept, “for purpose of convenience and without requiring a party['s] proof, * * * a well-known and indisputable fact.” State v. Blaine, Highland App. No. 03CA9, 2004-Ohio-1241, Evid.R. 201.

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