Smith v. Arizona Long Term Care System

84 P.3d 482, 207 Ariz. 217, 417 Ariz. Adv. Rep. 10, 2004 Ariz. App. LEXIS 8
CourtCourt of Appeals of Arizona
DecidedJanuary 22, 2004
DocketNo. 1 CA-CV 03-0262
StatusPublished
Cited by15 cases

This text of 84 P.3d 482 (Smith v. Arizona Long Term Care System) is published on Counsel Stack Legal Research, covering Court of Appeals of Arizona primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Smith v. Arizona Long Term Care System, 84 P.3d 482, 207 Ariz. 217, 417 Ariz. Adv. Rep. 10, 2004 Ariz. App. LEXIS 8 (Ark. Ct. App. 2004).

Opinion

OPINION

LANKFORD, Judge.

¶ 1 Defendant, Arizona Long Term Care System (“ALTCS”), appeals from the superi- or court’s order affirming the Administrative Law Judge’s (“ALJ’s”) recommended decision and vacating the Arizona Health Care Cost Containment System (“AHCCCS”) Director’s decision. ALTCS argues that the superior court erred when (1) it applied an incorrect standard of review by failing to give deference to the expertise of the Director, (2) it misconstrued federal law as to Plaintiffs eligibility for ALTCS, and (3) it erroneously decided that the Director’s decision was arbitrary and capricious.

¶ 2 The dispositive issue is whether liability insurance proceeds as yet unpaid should be considered resources available to Plaintiff as of the date of his accident. The Director correctly decided that insurance proceeds could not be counted. Accordingly, we reverse the superior court’s order vacating the Director’s decision.

¶ 3 The basic facts are these. On April 6, 2000, Plaintiff suffered severe injuries as a [219]*219result of a motorcycle accident. The driver of the other vehicle admitted fault. The at-fault driver lacked liability insurance. However, Plaintiff and his Wife had two insurance policies, one issued by Dairyland Insurance and the other by Atlantic Casualty. The Dairyland policy provided a maximum of $100,000 coverage in the event of a collision with an uninsured motorist. The Atlantic policy provided an additional $25,000 in un-derinsured coverage.

V4 The insurance companies eventually agreed to pay the maximum coverage amounts to the marital community of Plaintiff and his Wife. Dairyland Insurance paid $50,000 in July 2000 and paid $50,000 in August 2000. Atlantic Casualty paid the marital community its coverage limit of $25,000 in December 2000.

¶ 5 Due to his injuries, Plaintiff has been institutionalized since the accident. On Plaintiffs behalf, Wife applied for ALTCS benefits in February 2001. Wife then requested a resource assessment, which is the process by which ALTCS determines how much the applicant’s spouse is entitled to exempt from being counted at the time eligibility is determined. This eligibility figure is called the Community Spouse Resource Deduction (“CSRD”). The resource valuation date for the exemption was April 6, 2000, the date of the accident.

¶ 6 According to ALTCS eligibility rules, the exempt property is equal to one-half of the otherwise included resources of both spouses as of the applicant’s spouse first continuous period of institutionalization. The exemption cannot exceed $87,000. In February 2001, ALTCS issued an assessment which set the couple’s resources as of April 6, 2000 at $108,421.98 and the exemption at $54,210.99. ALTCS did not consider any portion of the $125,000 received from the insurance companies as resources.

¶ 7 To qualify for the program, Plaintiff had to “spend down” all other assets to $2,000. In May, 2001, the Plaintiffs initial application was denied, because as of February, 2001, the Plaintiff had not yet spent down to the $2,000 limit. The subsequently received insurance proceeds were only counted as income when received and also had to be spent down to reach the eligibility limit.

¶ 8 Several months after the initial application, another application was submitted and approved, making Plaintiff eligible for ALTCS benefits as of May 2001. However, Wife timely appealed the earlier denial of her application for benefits and the calculation of the exemption. Wife contended that the insurance proceeds should have been included in the couple’s resources as of April 6, 2000 for purposes of her initial application. This would have permitted her to retain the maximum allowable exemption of $87,000.

¶ 9 Wife argued that if the exemption had been correctly calculated as $87,000, Plaintiff would have been eligible for the benefits as of February instead of May.1 Wife contended that as of the accident date (April 6, 2000, the date ALTCS used to assess the community’s resources), she and Plaintiff had a legal right to receive $125,000 in insurance payments based on the accident and severity of the injuries, even if the insurance companies would not pay until a later date. She further argued that ALTCS routinely considers similar types of illiquid resources to be countable.

¶ 10 Following a hearing, the ALJ issued a decision and a recommended order in Plaintiffs favor. The ALJ found that Wife had proved the severity of Plaintiffs injuries, the fact that the at-fault driver was uninsured and found that the insurance proceeds were measurable and certain as of April 6, 2000, even if not received until a later date.

¶ 11 The Director of AHCCCS accepted the ALJ’s findings of fact as to the circumstances of the accident, the fault of the other driver, the severity of Plaintiffs injuries and the existence of insurance coverage. However, the Director disagreed with the ALJ’s finding that the insurance proceeds were certain and measurable as of April 6, 2000.

¶ 12 Plaintiff timely appealed the Director’s decision to the superior court. The court vacated the Director’s ruling and af[220]*220firmed the ALJ’s recommended decision. Defendant timely appealed. We have jurisdiction pursuant to Arizona Revised Statutes (“A.R.S.”) section 12-901 (2003).

¶ 13 We first address the argument that the superior court applied an inappropriate standard of review and thereby failed to give proper deference to the Director’s decision. Defendant argues that the correct standard of review is whether the Director’s decision was supported by substantial evidence, not whether substantial evidence supported the ALJ’s decision.

¶ 14 In an appeal of an administrative board’s decision pursuant to the Administrative Review Act, the superior court determines whether the administrative action was either illegal, arbitrary, capricious, or was an abuse of discretion. Ethridge v. Ariz. St. Bd. of Nursing, 165 Ariz. 97, 100, 796 P.2d 899, 902 (App.1989); Berenter v. Gallinger, 173 Ariz. 75, 77, 839 P.2d 1120, 1122 (App.1992). The trial court cannot re-weigh the evidence and substitute the court’s find ings for that of the agency. Plowman v. Ariz. St. Liquor Bd., 152 Ariz. 331, 335, 732 P.2d 222, 226 (App.1986). In reviewing factual determinations, the court determines only whether there is substantial evidence to support the administrative decision. Woerth v. City of Flagstaff, 167 Ariz. 412, 417, 808 P.2d 297, 302 (App.1990). A decision supported by substantial evidence may not be set aside as being arbitrary and capricious. Id. The court has authority to make its own rulings on questions of law. Bucciarelli v. Ariz. Dep’t of Transp., 166 Ariz. 67, 68, 800 P.2d 54, 55 (App.1990).

¶ 15 The Director’s decision is the final administrative decision entitled to deference. Under A.R.S. § 41-1092.08

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Bluebook (online)
84 P.3d 482, 207 Ariz. 217, 417 Ariz. Adv. Rep. 10, 2004 Ariz. App. LEXIS 8, Counsel Stack Legal Research, https://law.counselstack.com/opinion/smith-v-arizona-long-term-care-system-arizctapp-2004.