Paige M. Best v. Fairbanks North Star Borough

493 P.3d 868
CourtAlaska Supreme Court
DecidedAugust 20, 2021
DocketS17734
StatusPublished
Cited by5 cases

This text of 493 P.3d 868 (Paige M. Best v. Fairbanks North Star Borough) is published on Counsel Stack Legal Research, covering Alaska Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Paige M. Best v. Fairbanks North Star Borough, 493 P.3d 868 (Ala. 2021).

Opinion

Notice: This opinion is subject to correction before publication in the PACIFIC REPORTER. Readers are requested to bring errors to the attention of the Clerk of the Appellate Courts, 303 K Street, Anchorage, Alaska 99501, phone (907) 264-0608, fax (907) 264-0878, email corrections@akcourts.gov.

THE SUPREME COURT OF THE STATE OF ALASKA

PAIGE M. BEST, ) ) Supreme Court No. S-17734 Appellant, ) ) Superior Court No. 4FA-18-02037 CI v. ) ) OPINION FAIRBANKS NORTH STAR ) BOROUGH, ) No. 7550 – August 20, 2021 ) Appellee. ) )

Appeal from the Superior Court of the State of Alaska, Fourth Judicial District, Fairbanks, Thomas I. Temple, Judge.

Appearances: Ward Merdes, Merdes Law Office, P.C., Fairbanks, for Appellant. Wendy M. Dau and Ehren D. Lohse, Assistant Borough Attorneys, and Jill S. Dolan, Borough Attorney, Fairbanks, for Appellee.

Before: Bolger, Chief Justice, Winfree, Maassen, Carney, and Borghesan, Justices.

MAASSEN, Justice.

I. INTRODUCTION A minor was severely injured in an all-terrain vehicle collision in which the other driver was at fault. The minor had medical benefits coverage through a health care plan provided by her father’s employer, the Fairbanks North Star Borough. As allowed by the terms of the plan, the Borough refused to pay the minor’s medical bills until she signed an agreement that included a waiver of certain defenses to the Borough’s subrogation rights, such as the common fund and made-whole doctrines. The minor refused to sign the agreement without reservation and filed suit, seeking a declaration that the Borough could not condition payment of her medical bills on her signature. The superior court decided on summary judgment that the Borough’s health care plan was not a true insurance plan and that, regardless of whether it was interpreted as an insurance policy or an ordinary contract, the parties could lawfully reject subrogation defenses. The minor appeals. We hold that the health care plan is a bargained-for employee benefit rather than a true insurance policy and that the superior court’s interpretation of it was correct. We therefore affirm the judgment of the superior court. II. FACTS AND PROCEEDINGS A. Facts In April 2017 Paige Best was severely injured in an accident involving two all-terrain vehicles at Arctic Man.1 She was sitting on the rear rack of one ATV when it was rear-ended by another ATV. Best was thrown off her vehicle, required surgery to repair a broken hip, and ultimately incurred over $191,000 in medical bills. At the time of the accident Best was “a covered health plan participant” in Fairbanks North Star Borough’s Health Benefit Plan #P62 (the plan) because of her

1 Arctic Man is a week-long festival held each spring in the Hoo Doo Mountains near Milepost 197.5 of the Richardson Highway. ARCTIC MAN 2017 Program, 1, 11, https://www.arcticman.com/images/pdf/AMAN_2017_PROGRAM.pdf. Centered around a snowmachine and ski race, the festival also features music and drinking. An estimated 12,000 people attend each year, making the event temporarily one of Alaska’s largest settlements. Laura Carpenter, Arctic Man: The Anti-Burning Man Draws ‘Slednecks’ To Remote Alaska, GUARDIAN (Apr. 24, 2016), https://www.theguardian.com/us-news/2016/apr/24/arctic-man-burning-man-festival­ alaska-ski-snowmobile-race.

-2- 7550 father’s employment by the Borough. The plan includes two provisions relevant to this appeal. The first is the third-party liability provision. It excludes coverage when a third party is liable for the loss. It also provides, however, that the plan may “as a convenience” advance a payment to cover expenses in such situations as long as the participant signs and returns a Subrogation and Reimbursement Agreement (subrogation agreement): A third party may be liable or legally responsible for expenses incurred by you or a Dependent for a health condition. The plan does not provide benefits for an injury, accident or illness to the extent for which there is or may be a recovery against a third party. However, if you or your Dependent has medical expenses as a result of an injury, accident or illness for which a third party is or may be held responsible, the plan, as a convenience to you or your Dependent, may advance payment of such expenses on the condition that you or your [D]ependent and/or legal counsel, if any, sign and return a Subrogation and Reimbursement Agreement and provide any other information as requested by the plan. The plan may suspend benefits until such Agreement is fully executed and returned to the Claims Office along with all other requested information. [Emphasis in orignal.] The second relevant provision to this appeal is the “100% First-Dollar Right of Recovery.” This section grants the plan priority in any recovery from a third party for “benefits paid or to be paid under this plan” regardless of whether the recovery fully compensates the participant for the loss and regardless of whether the participant’s recovery is for medical expenses: The plan has the right to recover or subrogate 100% of the benefits paid or to be paid under this plan that the claimant is entitled to receive from any third party and/or any other recovery source on a priority first-dollar basis, without

-3- 7550 apportionment of value, reduction, or offset of any kind, whether by suit, settlement or otherwise, regardless of whether the total recovery amount is less than the actual loss suffered, and regardless of whether the recovery is described as being related to medical costs. The subrogation agreement an injured participant is required to sign includes an express acceptance of these provisions, as well as an acknowledgment “that federal and/or state common law defenses [to subrogation] including, but not limited to, the made-whole doctrine and/or the common fund doctrine do not apply.”2 Best asked that the plan pay for her medical care. The plan administrator sent Best the subrogation agreement to sign and return. But Best did not sign the subrogation agreement and instead insisted that the Borough pay her medical expenses immediately; she asserted equitable defenses to subrogation and claimed that the plan could not legally condition coverage on her signature. She ultimately did sign the agreement — following months of correspondence between her attorney and the plan — but according to her attorney she did so only “[with] reservation”; she claimed she signed under duress and was reserving her equitable defenses to subrogation. The Borough responded that it could not advance payment for Best’s expenses unless she consented to the subrogation agreement without reservation but that the offer to pay on the stated conditions would remain on the table.

2 These doctrines subordinate an insurer’s subrogation claim to the insured’s interest in being fully compensated and the insured’s attorney’s interest in a reasonable attorney’s fee. O’Donnell v. Johnson, 209 P.3d 128, 135 (Alaska 2009) (explaining that the made-whole doctrine addresses circumstance in which subrogation lien would result in insured being less than fully compensated); Sidney v. Allstate Ins. Co., 187 P.3d 443, 454 (Alaska 2008) (explaining that common fund doctrine “provides that ‘a litigant or lawyer who recovers a common fund for the benefit of persons other than himself or his client is entitled to a reasonable attorney’s fee from the fund as a whole’ ” (quoting Edwards v. Alaska Pulp Corp., 920 P.2d 751, 754 (Alaska 1996))).

-4- 7550 Best never signed the agreement without reservation. She asserts in her brief that she ultimately recovered some amounts in auto liability and uninsured motorist insurance, though our record does not provide further information about that recovery. B.

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