Roush v. Gelnett

31 Pa. D. & C.4th 420, 1996 Pa. Dist. & Cnty. Dec. LEXIS 287
CourtPennsylvania Court of Common Pleas, Snyder County
DecidedJune 4, 1996
Docketno. 290-1994
StatusPublished
Cited by3 cases

This text of 31 Pa. D. & C.4th 420 (Roush v. Gelnett) is published on Counsel Stack Legal Research, covering Pennsylvania Court of Common Pleas, Snyder County primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Roush v. Gelnett, 31 Pa. D. & C.4th 420, 1996 Pa. Dist. & Cnty. Dec. LEXIS 287 (Pa. Super. Ct. 1996).

Opinion

WOELFEL, J.,

Before the court is the plaintiffs’ petition for approval of minor’s settlement, which seeks the approval of this court of a settlement in the amount of $96,000 dollars for all claims made by the plaintiffs against the defendants arising out of the accidental shooting of Shane Roush by his minor friend, Jeffrey Gelnett. The shooting occurred in the home of defendants Lois Gelnett and Frederick Golder. The settlement was arrived at shortly before trial. The insurance policy limits available for the defendants are $100,000. The petition reflects that Capital Blue Cross/Pennsylvania Blue Shield is seeking reimbursement for claims it paid to various entities “for Shane’s shooting-related medical expenses.” Petition, paragraph 26.

The petition seeks the approval of the $96,000 settlement, a determination as to what, if any, sums are [422]*422due out of the settlement to Capital Blue Cross/Pennsylvania Blue Shield, an award of 35 percent of the gross recovery to counsel for defendant, the payment of out-of-pocket expenses to counsel for the plaintiff, and the court’s permission for the parents of Shane Roush to spend $6,000 for items that Shane “wants but his parents cannot afford” (Petition, paragraph 36), with the balance of the settlement proceeds to be deposited in an insured bank account.

The proposed settlement of $96,000 causes us no concern. Nor does the payment of $2,653.38 in out-of-pocket costs and expenses related to the litigation.

SUBROGATION CLAIM

Plaintiff Scott Roush is employed at Wood-Mode Inc. As a benefit of his employment, he and his dependents are provided with medical insurance through Capital Blue Cross/Pennsylvania Blue Shield. The bills for the grievous abdominal injuries suffered by Shane have been paid for by Capital Blue Cross/Pennsylvania Blue Shield. At the hearing held on the instant petition the testimony reflected that a total of $56,530.97 of medical bills related to this shooting incident have been paid by Capital Blue Cross/Pennsylvania Blue Shield.1

At the said hearing a copy of a “Handbook for Employees of Wood-Mode Inc.” was introduced by Capital Blue Cross/Pennsylvania Blue Shield as claimants exhibit no. 5. Scott Roush acknowledged receiving a copy of the said handbook. The following appears at page 45 of the handbook:

[423]*423 Subrogation

To the extent that benefits for covered services are provided or paid under this program, the plan should be subrogated and succeed to any rights of recovery of the subscriber for expenses incurred against any person or organization except insurers on policies of health insurance issued to and in the name of the subscriber.

You shall pay the plan the amount recovered by suit, settlement, or otherwise, from any third party or his insurer to the extent of the benefits provided or paid under this program.

You shall take such action, furnish such information and assistance, and execute such papers as the plan may require to facilitate enforcement of its rights, and shall take no action prejudicing the rights and interests of the plan under this program.

These provisions shall not apply where subrogation is specifically prohibited by law.

At page 6 of the handbook a subscriber was defined as follows:

“Subscriber — an eligible person who has satisfied the specifications for eligibility as defined in this booklet and who has enrolled for coverage under this program.”

At page 44 of the handbook the following appears:

“Eligibility

“Those eligible to enroll for the comprehensive major medical coverage are the employee, the employee’s spouse, and unmarried children under 19 years of age who are the employee’s children. . . .”

Thus, Shane Roush was eligible to receive benefits from Capital Blue Cross/Pennsylvania Blue Shield by virtue of his father’s employment at Wood-Mode, and by virtue of the definitions contained in the handbook, [424]*424was defined as a subscriber who was obligated to cooperate with Capital Blue Cross/Pennsylvania Blue Shield concerning subrogation claims which it may make as a consequence of claims and recoveries made by the Roushes against third parties.

Plaintiffs contend that a minor has no obligation to pay his own medical bills, that the payment of those bills is the minor’s parents’ responsibility, that the parents are receiving no benefit from this settlement, and that the parents’ only claim was the medical bills incurred. The plaintiffs further contend that it would be “inequitable to allow Capital Blue Cross to recover from Shane’s settlement sums that this minor could not recover through a lawsuit and has no obligation to pay.” Page 2, plaintiffs’ supplemental brief in support of petition for approval of minor’s settlement.

Distilled to its essence, plaintiffs’ assertion is that there is no right of subrogation either by contract or in equity against the minor. Curiously, neither counsel for the plaintiffs nor for Capital Blue Cross/Pennsylvania Blue Shield, nor this court, have been able to find a case directly addressing the issue of a subrogation claim of a medical insurance provider for medical bills incurred on behalf of a minor. The instant matter is not the first case in which medical insurance which is provided as a benefit to a parent has paid medical bills incurred by a child of that parent who is covered through the medical insurance plan, with the plan then pursuing subrogation. We can only conclude that the paucity of cases in this area is because it is assumed without question that the right of subrogation extends to sums recovered by or on behalf of minors.

The right of subrogation can either be created by contract or arise in equity. Holloran v. Larrieu, 431 Pa. Super. 558, 637 A.2d 317 (1994). As noted above, [425]*425the handbook, which defines the relationship between Capital Blue Cross/Pennsylvania Blue Shield on the one hand, and the employees of Wood-Mode on the other, provides for subrogation for benefits paid on behalf of its subscribers, with all of the plaintiffs being encompassed within the definition of subscribers.

Concerning the doctrine of equitable subrogation: “ [t]he doctrine of subrogation is based on considerations of equity and good conscience ... to promote justice . . . [and] is granted as a means of placing the ultimate burden of the debt on the person who should bear it. It is not a matter of contract or privity. It may be invoked in favor of persons who are legally obligated to make good a loss caused by the negligent or tortious acts of another. It is a device adopted by equity to compel the ultimate discharge of an obligation by him who in good conscience ought to pay it. . . . Where the property of one person is used in discharging an obligation owed by another ..., under such circumstances that the other would be unjustly enriched by the retention of the benefit thus conferred, the former is entitled to be subrogated to the position of the obligee.” Holloran v. Larrieu, supra at 560-61, 637 A.2d 318, quoting Potoczny v. Vallejo, 170 Pa. Super. 377, 380-81, 85 A.2d 675, 677 (1952). (citations omitted)

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Cite This Page — Counsel Stack

Bluebook (online)
31 Pa. D. & C.4th 420, 1996 Pa. Dist. & Cnty. Dec. LEXIS 287, Counsel Stack Legal Research, https://law.counselstack.com/opinion/roush-v-gelnett-pactcomplsnyder-1996.