Petty v. Hospital Service Ass'n of Northeastern Pennsylvania

967 A.2d 439, 2009 Pa. Commw. LEXIS 60
CourtCommonwealth Court of Pennsylvania
DecidedFebruary 19, 2009
StatusPublished
Cited by34 cases

This text of 967 A.2d 439 (Petty v. Hospital Service Ass'n of Northeastern Pennsylvania) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Petty v. Hospital Service Ass'n of Northeastern Pennsylvania, 967 A.2d 439, 2009 Pa. Commw. LEXIS 60 (Pa. Ct. App. 2009).

Opinions

OPINION BY

Judge PELLEGRINI.

Robert Petty and R.G. Petty Masonry, on behalf of themselves and all others similarly situated (collectively, Petty), appeal the order of the Court of Common Pleas of Lackawanna County (trial court) sustaining the Preliminary Objections of the Hospital Service Association of Northeastern Pennsylvania, d/b/a Blue Cross of Northeastern Pennsylvania (Northeastern Blue Cross) and dismissing Petty’s Complaint with prejudice. For the reasons that follow, we affirm.

R.G. Petty Masonry, a sole proprietorship in Clarks Summit, Pennsylvania, with Robert Petty as its sole proprietor, contracted with Northeastern Blue Cross to provide health insurance for its employees under a group policy. Northeastern Blue Cross is a Pennsylvania non-profit corporation that provides hospitalization insurance as an independent licensee of the Blue Cross Blue Shield Association. Petty filed this class action on behalf of all policyholders, subscribers, and members of Northeastern Blue Cross alleging that as of December 31, 2001, Northeastern Blue Cross had accumulated an excessive surplus (listed as reserves and unassigned funds) of over $403 million and established a corporate structure with a primary profit motive in violation of its charter, social mission, and the Pennsylvania Nonprofit Corporation Law of 1988 (Nonprofit Law), 15 Pa.C.S. §§ 5101-6162.

Count I of the Petty Complaint alleged that Northeastern Blue Cross violated Section 5545 of the Nonprofit Law,2 15 Pa.C.S. § 5545, because of its accumulation of excessive profits and reserves and conduct operating with a “for profit” motive. Count II included a Breach of Contract claim based on the relationship between subscribers and policyholders with Northeastern Blue Cross in a health insurance coverage contract. The third count in the Complaint alleged that Northeastern Blue Cross breached its fiduciary duty to the subscribers and policyholders while Count IV included a demand for inspection of Northeastern Blue Cross’s books and records. The relief sought by Petty, among other things, requested the following: 1) the excess surplus be disgorged in a manner that the court deemed appropriate; 2) an order for an accounting and imposition of a constructive trust over the excess [442]*442surplus; and 3) an award of reasonable attorneys’ fees from the excess surplus.

Northeastern Blue Cross filed Preliminary Objections to the Complaint;3 however, by order of the trial court and stipulation of the parties, the matter was stayed pending this Court’s decision in Ciamaichelo v. Independence Blue Cross, 814 A.2d 800 (Pa.Cmwlth.2002) (Ciamaichelo I). The parties filed a joint stipulation on January 23, 2002, in which they agreed to further stay the action pending the Pennsylvania Supreme Court’s decision in Ciamaichelo v. Independence Blue Cross, 589 Pa. 415, 909 A.2d 1211 (2006) (Ciamaichelo II). A brief summation of the Ciamaiche-lo line of cases follows.4

Ciamaichelo dealt with a declaratory judgment action filed by subscribers and a policyholder of Independence Blue Cross (Independence) in which alleged that Independence breached contractual and fiduciary duties based on its alleged accumulation of excessive surplus and reserves. In Ciamaichelo I, we held that the approval of insurer’s rates and reserves were matters within the exclusive jurisdiction of the Department. We further found that the filed-rate doctrine barred the cause of action because the claims set forth in it were essentially a collateral attack upon the Department’s determination of an insurer’s rates, from which the amount of an insurer’s reserves were a consideration, and a finding that Independence’s reserves were excessive would then require the Department to recalculate its approved rates.

In Ciamaichelo II, our Supreme Court reversed our determination that the Department had exclusive jurisdiction and instead held that the trial court should refer to the Department any issue or matter lying within its regulatory jurisdiction, including any remedial action necessary that would require its special competence. The Supreme Court remanded the matter to this Court to consider whether the trial court erred in overruling Independence’s preliminary objections that the matter should be dismissed because the parties [443]*443lacked standing and did not state claims for relief under the Nonprofit Law.

On remand in Ciamaichelo III, we held that Independence’s subscribers had standing and a right to relief under Section 5793(a) of the Nonprofit Law, 15 Pa. C.S. § 5793(a),5 because based on an examination of Independence’s Articles of Incorporation, they placed subscribers in the same class as members, directors, other body members and officers and accorded the subscribers standing to state a claim under Section 5793(a) of the Nonprofit Law. By contrast, we found that the policyholders lacked standing because as consumers, they did not have special status, rights or duties under Independence’s Articles of Incorporation. We then remanded the matter to the trial court for further proceedings.

After we issued our decision in Ciamaichelo III, the trial court sustained Northeastern Blue Cross’s Preliminary Objections6 and dismissed Petty’s complaint with prejudice. Based on its review of the Nonprofit Law, applicable caselaw, and Northeastern Blue Cross’s by-laws, the trial court found that Petty, as a subscriber, was not a member of Northeastern Blue Cross with governance rights and, as a result, lacked standing under 15 Pa. C.S. § 5793(a). The trial court also found that Petty lacked standing for its Breach of Contract and Breach of Fiduciary Duty claims and concluded that the allegations in the Complaint were more suitable for the Department than the trial court. It then dismissed the complaint, and this appeal followed.7

I.

Petty contends that it was improper for the trial court to sustain Northeastern Blue Cross’s challenge to its standing because a preliminary objection based on the lack of a capacity to sue cannot be determined simply by the facts of record. Petty points to American Housing Trust III v. Jones, 548 Pa. 311, 696 A.2d 1181 (1997), as persuasive authority that a court may not grant preliminary objections that raise a factual issue as to “lack of a capacity to sue,” but must instead resolve the dispute by receiving evidence via interrogatories, depositions, or an evidentiary hearing. We disagree.

In American Housing Trust III, the issue before the trial court was whether [444]*444the corporation’s activities in the Commonwealth constituted “doing business” under Section 4121(a) of the Foreign Business Corporations Law, 15 Pa.C.S. § 4121(a), which would require the corporation to then obtain a certifícate of authority without which it could not bring suit in the Commonwealth.

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Bluebook (online)
967 A.2d 439, 2009 Pa. Commw. LEXIS 60, Counsel Stack Legal Research, https://law.counselstack.com/opinion/petty-v-hospital-service-assn-of-northeastern-pennsylvania-pacommwct-2009.