Scroggins v. Red Lobster

325 S.W.3d 389, 2010 Mo. App. LEXIS 1019, 2010 WL 3064357
CourtMissouri Court of Appeals
DecidedAugust 6, 2010
DocketSD 30214
StatusPublished
Cited by2 cases

This text of 325 S.W.3d 389 (Scroggins v. Red Lobster) is published on Counsel Stack Legal Research, covering Missouri Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Scroggins v. Red Lobster, 325 S.W.3d 389, 2010 Mo. App. LEXIS 1019, 2010 WL 3064357 (Mo. Ct. App. 2010).

Opinions

NANCY STEFFEN RAHMEYER, Judge.

Pamela Scroggins (“the Participant”) was seriously injured in a non-work-related trip and fall accident at a Red Lobster on February 17, 2007, while employed at St. John’s Hospital in Springfield, Missouri. The Participant’s medical expenses were covered by an employee contributory self-funded health plan (“the Plan”) that provided benefit coverage for employees of St. John’s Hospital, a subsidiary of Sisters of Mercy (“the Insurer”) which is a nonprofit corporation.1 As a result of the trip and fall, the Participant sued Red Lobster, Inc., which is a subsidiary of GMRI, Inc. (“GMRI”), and the manager of the Red Lobster, Gary Rush. The lawsuit resulted in a settlement. One of the Plan’s provisions purports to grant the Insurer a lien upon the proceeds of the Participant’s tort recovery, and a right to payment from any recovery, to the extent of the sum that the Insurer paid for injuries the Participant [391]*391suffered. The trial court found the lien to be a veiled partial assignment of the Participant’s personal injury claim and, as such, invalid as contrary to longstanding Missouri public policy. We agree.

Section 5.02(h) of the Plan provides that Notwithstanding the foregoing subsections of this Section 5.02 ... with respect to a Covered Individual whose coverage relates to a Participating Employer located in the State of Missouri, if a Covered Individual sustains an injury or sickness and a third party is or may be liable for compensating the Covered Individual for such injury or sickness ... the Plan shall have a lien on the proceeds recovered by or on behalf of the Covered Individual from the Third Party, to the extent of the amount of Covered Expenses that are paid or payable with respect to the sickness or injury.

(emphasis added). The Plan also contains the following provisions: (1) Section 5.02(g)(4) requires the Participant to “[ajgree not to settle a claim against the Third Party without the consent of the Plan.”; (2) Section 5.02(a)(i) gives the Plan a “right to be reimbursed for Covered Expenses paid with respect to the injury or sickness for which the Third Party is liable, from any judgment, award, formal or informal settlement, contract or any other payment of any kind, paid to ... the Covered Individual by such Third Party.”; (3) Section 5.02(a)(iii) gives the Plan “the right of subrogation to assert the Covered Individual’s right to recover against such Third Party.”; and (4) Section 10.09 contains this severability clause: “If any provision of this Plan shall be held illegal or invalid, the remaining provisions of this Plan shall be construed as if such provision had never been included.”

Before the final settlement payment was made, the Insurer advised GMRI’s insurer, Liberty Mutual, of its alleged lien upon the settlement proceeds to the extent of the Plan’s $151,323.83 in payments of medical expenses incurred as a result of the accident. GMRI, concerned about the potential for double liability that could result if it paid the Participant and was later found liable to the Insurer, filed a motion for leave to add the Insurer to the underlying action the Participant brought against GMRI, and sought a declaration of ownership of the $151,323.83 in dispute. The trial court, acting on cross-motions for summary judgment, found the lien was, in substance, a partial assignment of the Participant’s personal injury claim and sustained summary judgment in favor of the Participant.

We review a summary judgment de novo. ITT Commercial Fin. Corp. v. Mid-Am. Marine Supply Corp., 854 S.W.2d 371, 376 (Mo. banc 1993). Summary judgment is proper where the motion, response, reply, and sur-reply “show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law[.]” Rule 74.04(c)(6).2 Under de novo review of a summary judgment, this Court will review the record from the trial court and independently decide whether there were no genuine issues of material fact and that the successful party was entitled to judgment as a matter of law. In re Gene Wild Revocable Trust, 299 S.W.3d 767, 773-74 (Mo.App. S.D.2009). We review the record in the light most favorable to the party whom judgment was entered against, and draw all reasonable inferences in that party’s favor. ITT, 854 S.W.2d at 376. In this case, the facts are not contested. It is [392]*392an issue of law whether the trial court reached a proper conclusion based upon the facts. Schroeder v. Horack, 592 S.W.2d 742, 744 (Mo. banc 1979).

Missouri public policy prohibits the transfer of a personal injury claim, in whole or part. Travelers Indem. Co. v. Chumbley, 394 S.W.2d 418, 428-25 (Mo.App.Spfld.D.1965). This rule holds except in the limited circumstance when the transfer is of the proceeds of a potential claim and is granted to an existing creditor. Ford Motor Credit Co. v. Allstate Ins. Co., 2 S.W.3d 810, 812-13 (Mo.App. W.D.1999). This has been Missouri’s policy since at least 1913 and, in all likelihood much longer, as the prohibition against the assignment of personal tort claims dates back to English common law and the Middle Ages.3 In 1913, this Court explained that “[t]here is every reason for holding that a cause of action for personal injuries, where the gist of the damages recovered is physical pain and mental anguish, should not be the subject of barter or trade, or a matter of profit to the creditors of the injured party.” Beechwood v. Joplin-Pittsburg Ry. Co., 173 Mo.App. 371, 158 S.W. 868, 870 (Mo.App.Spfd.D.1913). The Western District of this Court, contributed this brief history concerning insurers in Hays v. Missouri Highways and Transp. Comm’n, 62 S.W.3d 538 (Mo.App. W.D.2001):

Insurers paying benefits to insureds as a result of injuries caused by third persons claim an interest in recovering those costs if the insured obtains a settlement or collects upon a judgment against the third party. To that end, insurers have repeatedly attempted to draft policy provisions or establish other requirements for the purposes of seeking reimbursement from the insured in such situations.
Such provisions or other requirements have been regularly invalidated by the appellate courts.

Id. at 540.

In Schweiss v. Sisters of Mercy, St. Louis, Inc., 950 S.W.2d 537 (Mo.App. E.D.1997), for example, the court held that a reimbursement provision in a health plan was unenforceable and that the insurer could not refuse to pay medical expenses based on the insured’s refusal to sign a reimbursement agreement. Id. at 538-39.

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Scroggins v. Red Lobster
325 S.W.3d 389 (Missouri Court of Appeals, 2010)

Cite This Page — Counsel Stack

Bluebook (online)
325 S.W.3d 389, 2010 Mo. App. LEXIS 1019, 2010 WL 3064357, Counsel Stack Legal Research, https://law.counselstack.com/opinion/scroggins-v-red-lobster-moctapp-2010.