Penelope Stillwell v. State Farm Fire & Casualty Co.

Court of Appeals for the Eleventh Circuit·Decided May 27, 2026·No. 21-13740·Unpublished

Opinion

USCA11 Case: 21-13740 Document: 86-1 Date Filed: 05/27/2026 Page: 1 of 25

NOT FOR PUBLICATION

In the

United States Court of Appeals For the Eleventh Circuit

No. 21-13740

WILLIAM STILLWELL, Plaintiff,

PENELOPE STILLWELL, Individually, and as personal representative of the estate of William Stillwell, Plaintiff-Appellant,

versus

STATE FARM FIRE & CASUALTY CO., MOTORISTS MUTUAL INSURANCE CO., Defendants-Appellees.

Appeal from the United States District Court for the Middle District of Florida D.C. Docket No. 8:17-cv-01894-SDM-AAS

Before BRANCH, LUCK, and TJOFLAT, Circuit Judges. LUCK, Circuit Judge:

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William and Penelope Stillwell settled their tort claims after a slip-and-fall accident. As part of the settlement, the Stillwells received a lump-sum payment in exchange for their releasing State Farm Fire and Casualty Company and Motorists Mutual Insurance Company from all future liability for the tort claims. Despite the settlement, the Stillwells believed that the insurers had an ongoing responsibility to reimburse Medicare for William’s post-settlement accident-related medical expenses. So, Penelope, for herself and on behalf of William’s estate, sued the insurers under the Medicare Secondary Payer Act and the False Claims Act, seeking to recoup damages for the government based on the insurers’ failure to reimburse Medicare for William’s post-settlement medical expenses. The district court dismissed the complaint after concluding that the insurers were not legally responsible for paying for the medical expenses and, therefore, did not have a responsibility to reimburse Medicare for them. After careful review and with the benefit of oral argument, we affirm.

FACTUAL BACKGROUND

In December 2010, William suffered serious injuries after a slip-and-fall accident at the Sycamore Springs living community in Indianapolis, Indiana. In March 2011, William became eligible for Medicare. As his injuries worsened, he had to amputate his lower left leg.

In 2011, the Stillwells sued the property management company of the living community, the homeowners’ association, and the landscaping company for negligence in Indiana state court.

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They sought damages for William’s past and future medical expenses and Penelope’s loss of consortium. State Farm insured the homeowners’ association and property management company, and Motorists insured the landscaping company. In 2013, the Center for Medicare and Medicaid Services sent William a letter, informing him that Medicare was notified about his tort suit.

In 2016, the Stillwells agreed to settle their tort claims and signed a “settlement recap,” itemizing the amounts to be paid under the settlement. Specifically, the parties agreed that the insurers would pay $200,000 for full settlement of all claims. Notably, $5,000 of that amount came from the insureds’ “unused medpay funds,” which stemmed from the no-fault insurance coverage under the liability insurance policies. The agreement itemized payments for attorney’s fees and costs, private health insurance reimbursement , Medicare reimbursement for conditional payments already paid for pre-settlement accident-related medical expenses, and a lump sum to the Stillwells. The Stillwells signed a memorandum of understanding stating that the case was settled and that the Stillwells would sign releases and dismiss the case after formalizing the settlement agreement. The memorandum was filed in the Indiana trial court.

In December 2016, Medicare sent William another letter.

This letter said that Medicare was aware that William settled his tort claim. And the letter explained that the Medicare Secondary Payer Act obligated William to reimburse Medicare for $19,672.99

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in pre-settlement accident-related medical expenses once William received the settlement payment.

The insurers sent the Stillwells a check for the full amount and a proposed formal settlement agreement. The proposed formal agreement released the insurers from any further liability, including from William’s future medical costs, in return for the lump-sum payment. The proposed agreement also provided that the Stillwells: (1) “ha[d] considered the interests of Medicare”; (2) “ha[d] an obligation to Medicare . . . that an incident was the subject of a settlement”; (3) “ha[d] an obligation to reimburse Medicare . . . for medical services rendered to date in this matter”; and (4) “ha[d] complied with all known obligations pursuant to” federal law. The agreement continued that the Stillwells’ “future medical care [would] not be affected by the terms and conditions” of the agreement and that the Stillwells would be responsible for “any existing or future medical lien or liens of any type relating to William Stillwell.” But the Stillwells refused to sign the proposed formal agreement because they believed that the insurers had an ongoing obligation to reimburse Medicare for post-settlement accident-related medical expenses.

The insurers moved to enforce the terms of the proposed formal settlement agreement in the Indiana trial court. The Indiana trial court granted the motion and entered judgment enforcing the terms of the proposed settlement agreement. The trial court’s judgment found that the “Stillwells [were] jointly and severally liable for payment of any existing or future medical lien . . . relating

21-13740 Opinion of the Court 5

to William Stillwell.” The judgment showed the insurers had paid what they owed under the settlement agreement, including the $19,672.99 payment to Medicare to reimburse the cost of William’s pre-settlement accident-related medical expenses. The Court of Appeals of Indiana affirmed the judgment on appeal.

PROCEDURAL HISTORY

Soon after the Indiana trial court entered judgment, Penelope sued State Farm and Motorists in federal district court. The complaint asserted two claims under the Medicare Secondary Payer Act and eight claims under the False Claims Act. As to her Medicare Secondary Payer Act claims, Penelope alleged that the insurers failed to reimburse Medicare for thousands of dollars in post-settlement accident-related medical expenses, entitling Penelope to double damages under the Act.

Her eight False Claims Act claims (four claims against each insurer) were based on the assumption that the insurers held primary responsibility to pay for William’s post-settlement accident- related medical expenses, meaning William’s medical providers should have submitted claims to the insurers and not to Medicare. Specifically, two counts alleged that the insurers caused William’s medical providers to submit false claims to Medicare; two counts alleged that the insurers submitted false statements material to his medical providers’ false claims to Medicare; two counts alleged that the insurers unlawfully concealed their primary payment responsibility to reduce the amount that had to be reimbursed to Medicare under the Medicare Secondary Payer Act; and the other two counts

USCA11 Case: 21-13740 Document: 86-1 Date Filed: 05/27/2026 Page: 6 of 25

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alleged that the insurers conspired to commit the other acts of fraud.

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Penelope Stillwell v. State Farm Fire & Casualty Co., (11th Cir. 2026).

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