Pumphrey v. City of New Orleans

925 So. 2d 1202, 2006 WL 860137
CourtSupreme Court of Louisiana
DecidedApril 4, 2006
Docket2005-C-979
StatusPublished
Cited by111 cases

This text of 925 So. 2d 1202 (Pumphrey v. City of New Orleans) is published on Counsel Stack Legal Research, covering Supreme Court of Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pumphrey v. City of New Orleans, 925 So. 2d 1202, 2006 WL 860137 (La. 2006).

Opinion

925 So.2d 1202 (2006)

Kathleen PUMPHREY
v.
The CITY OF NEW ORLEANS.
Darlene Rizzuto
v.
The City of New Orleans.
Fred Farve, Jr.
v.
The City of New Orleans.
Michael Ricks and Vivian Ricks
v.
The City of New Orleans.
Barbara Ellis
v.
The City of New Orleans.
Herbert Craig
v.
The City of New Orleans.
A. Ray Piattoly
v.
The City of New Orleans.
Patrick Murphy
v.
The City of New Orleans.
Ignatius James
v.
The City of New Orleans.

No. 2005-C-979.

Supreme Court of Louisiana.

April 4, 2006.

*1204 Penya Moses-Fields, City Attorney, Evelyn F. Pugh, Chief Deputy City Attorney, Thomas A. Robichaux, Heather M. Valliant, Franz L. Zibilich, Assistant City Attorneys, for applicant.

Silbert & Garson, Robert J. Garon, Tamica J. Cryer, New Orleans, William G. Merritt, for respondent.

KNOLL, Justice.

This civil case addresses the legal question of whether La.Rev.Stat. 33:3062(B) exempts the City of New Orleans with regard to its self-funded employee health care insurance plan from the penalty provisions of La.Rev.Stat. 22:657(A). Plaintiffs filed individual suits seeking penalties and attorneys fees for non-payment and/or untimely payment of insurance benefits, which were due and payable to plaintiffs, under the City of New Orleans's self-funded employee health care plan. After consolidation of these suits, the City of New Orleans ("City") filed a petition for declaratory judgment in all of the consolidated cases seeking a declaration that La.Rev.Stat. 33:3062(B) exempted the City with regard to its self-funded health plan from the penalty provisions of La.Rev.Stat. 22:657(A). The district court entered judgment against the City holding La.Rev.Stat. 33:3062 does not exempt the City or its health plan from the provisions of La.Rev.Stat. 22:657. The court of appeal affirmed. We granted writ primarily to resolve the alleged conflict between La. Rev. Stats. 22:657(C) and 33:3062(B) to determine whether La.Rev. Stat. 33:3062(B) exempts the City's health plan from the penalty provisions of La. Rev.Stat. 22:657(A). Pumphrey v. City of New Orleans, 05-0979 (La.12/16/05), 917 So.2d 1085. For the following reasons, we find the provisions of La.Rev.Stat. 33:3062(B) clearly and explicitly exempt the City's health plan from the penalty provisions of La.Rev.Stat. 22:657(A) and render declaratory judgment in favor of the City.

FACTS AND PROCEDURAL HISTORY

On January 1, 1978, the City became self-insured as to health care coverage for its employees and contracted with various *1205 vendors for administrative services in connection with its health care and hospitalization plan. The City offered as a benefit to its employees, retirees, and their dependants, the option of participating in the City's self-funded health care plan or participating in its preferred provider organization (PPO) health care plan. In March 1991, the City entered into a contract with Total Benefits Services ("Total") to administer its health care plan, and then in November 1991, the City entered into a contract with Group Insurance Administration of Louisiana ("Group") to secure medical service discounts through the use of Group's preferred provider network and to manage the PPO health care program. At all times relevant herein, the City has maintained a self-funded health care plan for the benefit of its employees, retired employees, and their families.

This consolidated matter arises out of multiple Petitions for Damages brought on behalf of eligible participants in the City's self-funded health care plan.[1] The plaintiffs, Kathleen Pumphrey, Darlene Rizzuto, Fred Farve, Jr., Michael and Vivian Ricks, Barbara Ellis, Herbert Craig, A. Ray Piattoly, Patrick Murphy, and Ignatius James, are seeking penalties and attorneys fees for non-payment and/or untimely payment of insurance benefits, which were due and payable to plaintiffs, under the plaintiffs' participation in the City's self-funded employee health care plan, in accordance with La.Rev.Stat. 22:657. Plaintiffs alleged more than thirty days had elapsed from the date upon which the plaintiffs submitted written notice and proof of claim on covered medical bills to the City's self-funded health care plan. Plaintiffs further contended the City had arbitrarily and capriciously delayed payment of benefits due or had arbitrarily and capriciously paid claims beyond thirty days after submission. Additionally, plaintiffs alleged the City breached its fiduciary duty of good faith and fair dealings and its contractual duties to the plaintiffs as a result of its arbitrary and capricious failure to pay claims. As a result of the City's actions, the plaintiffs alleged they suffered mental anguish and pain and suffering, all of which entitled them "to recover damages as are reasonable in the premises."

After filing her petition for damages, plaintiff, Darlene Rizzuto, filed a petition for declaratory judgment on March 26, 1993, to determine whether the penalty and attorney fees provision of La.Rev.Stat. 22:657 applies to the City and its self-funded health care plan. The Fourth Circuit *1206 in Rizzuto v. City of New Orleans, 94-1016 (La. App. 4 Cir. 1/19/95), 650 So.2d 341, affirmed the district court's declaratory judgment rendered in favor of plaintiff, which held that the provisions of La.Rev. Stat. 22:657 apply to the City, a political subdivision of the State of Louisiana, with regard to it self-funded health care plan.

The Rizzuto court found the broad based language of La.Rev.Stat. 22:657 mandates the imposition of penalties on any entity, including "corporation and other organization," which fails to timely pay health benefits with the only exclusion for "collectively bargained union welfare plans other than health and accident plans." 94-1016 at p. 4, 650 So.2d at 343. The court noted that although La.Rev.Stat. 22:657

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Bluebook (online)
925 So. 2d 1202, 2006 WL 860137, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pumphrey-v-city-of-new-orleans-la-2006.