Mississippi Division of Medicaid v. Pittman ex rel. Pittman

171 So. 3d 583, 2015 Miss. App. LEXIS 363
CourtCourt of Appeals of Mississippi
DecidedJune 30, 2015
DocketNo. 2014-SA-00765-COA
StatusPublished

This text of 171 So. 3d 583 (Mississippi Division of Medicaid v. Pittman ex rel. Pittman) is published on Counsel Stack Legal Research, covering Court of Appeals of Mississippi primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mississippi Division of Medicaid v. Pittman ex rel. Pittman, 171 So. 3d 583, 2015 Miss. App. LEXIS 363 (Mich. Ct. App. 2015).

Opinion

MAXWELL, J.,

for the Court:

¶ 1. When approving a minor’s settlement, the chancellor here denied the sub-rogation rights of the Mississippi Division of Medicaid (Medicaid), citing the “made whole” rule. But the made-whole rule only applies to an insurer’s contractual right to subrogation.1 Medicaid’s right to subrogation is not contractual. It is statutory.2 And the made-whole rule does not apply to statutory subrogation rights.3

¶ 2. The chancellor, despite his equitable powers, could not disregard the clear statutory directive that Medicaid recover its $10,308.40 interest from the $25,000 third-party payment to the minor.4 Thus, we reverse the chancellor’s order denying Medicaid’s statutory subrogation right as a condition of the settlement approval. We remand this case back to the chancery court for further proceedings consistent with this opinion.

Facts and Procedural History

¶ 3. Javas Pittman, a minor, was riding on the hood of a car when it crashed. Javas was seriously injured. He was airlifted to University of Mississippi Medical Center, where he underwent surgery. Months later, he had another surgery. By the time he reached maximum medical recovery, Javas’s medical bills totaled more than $170,000. Javas’s providers billed Medicaid for $66,699.19 of those expenses. And Medicaid reimbursed the providers $10,308.04.

¶ 4. The driver of car was not insured. So Javas’s mother, Melissa Pittman, made a claim under her automotive policy, which included $25,000 in uninsured-motorist coverage. Melissa’s carrier, Progressive Gulf Insurance Company (Progressive), agreed to settle for full policy limits. So Melissa initiated a guardianship proceeding, requesting the Jasper County Chancery Court authorize her to accept Javas’s settlement. See Miss.Code Ann. § 93-13-59 (Rev.2013).

¶ 5. Medicaid appeared in the guardianship and asserted a $10,308.04 lien against the settlement proceeds. The chancellor required Melissa to also notify two other potential lien holders: American Medical Response (AMR), which had billed Java's $1,225 for air transport, and Mississippi Children’s Health Insurance Program (CHIPS), which had covered $42,228.18 of Javas’s medical expenses. Neither AMR nor CHIPS ever appeared in the matter and were deemed to have waived any lien or right to subrogation they may otherwise have held. But Medicaid was vigilant to put forth its statutory right to recover $10,308.04 from the $25,000 settlement with Progressive. See Miss.Code Ann. § 43-13-125 (Rev.2009).

¶ 6. Progressive also appeared in the matter, informing the chancellor that Medicaid’s statutory subrogation rights authorized Medicaid to go after Progressive directly. See Miss.Code Ann. § 43-13-125(4). Progressive voiced its concern that, were the court to deny Medicaid its $10,308.40 portion of the settlement, Progressive may be still be liable to Medicaid for that amount.

¶ 7. When a Medicaid recipient, like Javas, recovers any amount from a third-party for his injuries, section 43-13-125(2) directs the amount recovered to be ap[585]*585plied, first, to attorney’s fees, second, to the amount of Medicaid’s interest on behalf of the recipient, and, finally, if there is “[a]ny excess,” to the recipient.5 While the chancellor here approved paying Javas’s attorney $8,640.89 in legal fees and expenses, he refused to apply any portion of the settlement toward Medicaid’s $10,308.04 claim. The chancellor deemed the approximately $6,000 excess as too negligible and not in Javas’s best interest.

¶ 8. Citing cases where the Mississippi Supreme Court has applied the made-whole rule to deny an insurer’s contractual right to subrogation, the chancellor found that, because Javas would not have been made whole by the settlement given the extent of his injuries, Medicaid would not be allowed to assert its subrogation right over the settlement proceeds. See Mem’l Hosp. at Gulfport v. Proulx ex rel. Proulx, 121 So.3d 222, 224’ (¶ 6) (Miss.2013); Hare v. State, 733 So.2d 277, 284 (¶26) (Miss.1999). In his final order, the chancellor authorized Melissa to accept the $25,000 settlement on Javas’s behalf “conditioned upon cancellation of the subrogation claims of CHIPS, AMR[,] and the Mississippi Division of Medicaid.”

¶ 9. Medicaid timely appealed. On appeal, the critical inquiry is a question of law—Does the equitable made-whole doctrine apply to Medicaid’s statutory right to subrogation? We review questions of law de novo. In re Guardianship of Duckett, 991 So.2d 1165, 1173 (¶ 15) (Miss.2008).

Discussion

¶ 10. Despite his good intentions, the chancellor erred when he disallowed Medicaid’s claim based on the equitable made-whole doctrine. Medicaid’s subrogation right exists by virtue of statute. So whether Medicaid could assert its right was strictly a matter of statute, which could not be disregarded simply because its effect seemed unfair. Because the chancellor’s order contained the express condition that Melissa not reimburse Medicaid from Javas’s settlement—a clear violation of section 43-13-125—that order must be reversed. -

I. Made-Whole Rule

¶ 11. The chancellor relied on Hare and its application of the made-whole rule to disallow Medicaid’s subrogation claim. See Hare, 733 So.2d at 284 (¶27). But Hare dealt specifically with a contractual right to subrogation placed in the insurance policy by the insurance company. Id.

¶ 12. The made-whole rule “is the general principle that an insurer is not entitled to equitable subrogation until the insured has been fully compensated.” Id. at 281 (¶ 14). In Hare, the supreme court “adopt[ed] the ‘made whole’ rule and [held] that it is not to be overridden by contract language [.] ” Id. at 284 (¶ 27) (emphasis added). The supreme court found this to be particularly true of the insurance policy in Hare, because the insurer had expressly stated the intent of its subrogation clause was “to eliminate double payments of [the insured’s] medical expenses.” Id. at 280 (¶ ID-

¶ 13. The supreme court concluded its analysis in Hare by observing that to otherwise “allow the literal language of an insurance contract to destroy an insured’s equitable right to subrogation ignores the fact that this type of contract is realistical[586]*586ly a unilateral contract of insurance and overlooks the insured’s total lack of bargaining power in negotiating the terms of these types of agreements.” Id. at 284 (¶ 27).

II. Medicaid’s Statutory Right to Subrogation

¶ 14. Unlike Hare, here there are no “issues of unilateral contracts and bargaining power in negotiations.” Miss. Ins. Guar. Ass’n v. Brewer, 922 So.2d 807, 812 (¶ 23) (Miss.Ct.App.2005). Instead, we are faced with a statute creating a clear right to reimbursement. Miss.Code Ann. §

Related

Federated Mut. Ins. Co. v. McNeal
943 So. 2d 658 (Mississippi Supreme Court, 2006)
Hare v. State
733 So. 2d 277 (Mississippi Supreme Court, 1999)
Reikes v. Martin
471 So. 2d 385 (Mississippi Supreme Court, 1985)
In Re Guardianship of Duckett
991 So. 2d 1165 (Mississippi Supreme Court, 2008)
Louisville & NR Co. v. Hasty
360 So. 2d 925 (Mississippi Supreme Court, 1978)
In Re Estate of Miller
840 So. 2d 703 (Mississippi Supreme Court, 2003)
Memorial Hospital at Gulfport v. Guardianship of Proulx ex rel. Proulx
121 So. 3d 222 (Mississippi Supreme Court, 2013)
Mississippi Food & Fuel Workers' Compensation Trust v. Tackett
778 So. 2d 136 (Court of Appeals of Mississippi, 2000)
Davis v. Smith
891 So. 2d 811 (Mississippi Supreme Court, 2005)

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Bluebook (online)
171 So. 3d 583, 2015 Miss. App. LEXIS 363, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mississippi-division-of-medicaid-v-pittman-ex-rel-pittman-missctapp-2015.