Spectera, Inc. v. Steven Wilson

Court of Appeals of Georgia·Decided July 16, 2012·No. A12A0773·Published

Opinion

FIRST DIVISION

ELLINGTON, C. J.,

PHIPPS, P. J., and ADAMS, J.

NOTICE: Motions for reconsideration must be physically received in our clerk’s office within ten days of the date of decision to be deemed timely filed.

(Court of Appeals Rule 4 (b) and Rule 37 (b), February 21, 2008)

http://www.gaappeals.us/rules/

July 16, 2012

In the Court of Appeals of Georgia A12A0773. SPECTERA, INC. v. WILSON et al.

ADAMS, Judge.

Spectera, Inc. appeals the trial court’s order holding that its independent eye care provider contract violates Georgia’s Patient Access to Eye Care Act, OCGA § 33-24-59.12 (the “Eye Care Act”), and granting injunctive relief to Steven M. Wilson, O. D.; Cynthia J. Murray, O. D.; Jodie E. Summers, O. D.; and David Price, O. D. (collectively the “Wilson Group”).

Spectera is a foreign vision care insurer providing eye care benefits to Georgia residents.1 Spectera contracts with vision care providers in Georgia to provide eye

1 In the Statement of Facts contained in its Appellant’s Brief, Spectera repeatedly cites to briefs it filed below as support for its factual assertions. We take this opportunity to remind counsel that briefs are not evidence and do not supply record support for facts asserted on appeal. See Tahamtan v. Sawnee Elec. Membership Corp., 228 Ga. App. 485, 485–486 (491 SE2d 918) (1997) (“[F]actual

care services to its plan members. Wilson is a licensed optometrist employed by Steven M. Wilson, O. D., P. C., doing business as Wilson Eye Center (“WEC”), which operates an eye care center in Lowndes County. McMurray, Summers, and Price are also licensed optometrists employed by WEC. Wilson, McMurray and Summers all qualified as members of Spectera’s panel of approved eye care providers (the “Panel”). Price applied to join the Panel, but he has not been accepted as an approved eye care provider.

Prior to this litigation, Wilson had maintained a participating provider contract with Spectera, and thus had been a member of its Panel, since 1986. Both Wilson and McMurray have a “legacy form” of participating provider contract called a “Patriot contract,” which allows them to prepare eyeglasses and eyeglass lenses for Spectera members in WEC’s own optical laboratory and to obtain “covered materials” (e. g., lenses, frames and contract lenses) from any source they choose, including from WEC’s own inventory. In late 2010, however, Spectera notified its legacy Patriot providers, including Wilson and McMurray, that it wished to “amend” those

assertions contained in the parties’ briefs to the lower court are not evidence.”) (Citations and punctuation omitted.). And it is not the job of this Court cull the record on a party’s behalf to find such evidentiary support. Walter v. Mitchell, 294 Ga. App. 689, 691 (2) n. 13 (669 SE2d 706) (2008).

agreements, or as Spectera’s Senior Vice President Lori Archer termed it, “to recontract” with those providers, shifting them from the Patriot contract to an independent participating provider agreement (“IPP agreement”). Under the new IPP agreement, independent providers such as the Wilson Group would be required to obtain all covered materials from Spectera’s optical laboratory.2 In contrast, Spectera’s provider agreement with its retail chain providers, such as Wal-Mart, still allows those providers to obtain covered materials from any source, including their own optical laboratories (the “RCP agreement”). Wilson and McMurray never signed the new IPP agreement. And although Summers signed an IPP agreement with Spectera, WEC’s chief executive officer, Kristian M. Keesling, stated that Spectera treated Summers’s IPP agreement from its inception as a Patriot contract.

Wilson initiated suit3 against Spectera, asserting that the IPP Agreement violated several provisions of the Eye Care Act, and afterwards, the insurer notified Wilson, McMurray, and Summers that it was terminating their provider agreements.

2 Spectera asserts that the new IPP agreement is intended as a cost savings measure to curb the growth of premiums for its plan members.

3 Wilson filed the initial action against Spectera on November 30, 2010. Price filed suit on March 8, 2011, and McMurray and Summers filed suit on March 18, 2011.

But after Price also sued Spectara and Summers and McMurray filed a separate suit, the trial court consolidated all three actions and entered an interlocutory injunction, with Spectera’s consent, maintaining the status quo and preventing the termination of its current provider contracts with Wilson, McMurray and Summers pending resolution of the lawsuit. Several months later, however, Spectera moved to lift the injunction and asked permission to terminate its agreements with Wilson, McMurray and Summers and to notify the Wilson Group that “unconditionally, it will not contract with [any of them] in the future” under its current provider contract. The parties also filed cross-motions for summary judgment.

The trial court ultimately found that the IPP agreement violated several provisions of the Eye Care Act and granted the Wilson Group’s motion for summary judgment, while denying Spectera’s motions for summary judgment and to lift the interlocutory injunction. Instead, the trial court issued a permanent injunction4 precluding Spectera from enforcing the restrictions contained in the IPP agreement,

4 The Eye Care Act provides that any person adversely affected by an insurer’s violation of the Act “may bring an action in a court of competent jurisdiction for injunctive relief against such insurer and, upon prevailing, in addition to any injunctive relief that may be granted, shall recover from such insurer damages of not more than $100.00 and attorney’s fees and costs.” OCGA § 33-24-59.12 (e). Here, the trial court also granted each member of the Wilson Group damages in the maximum amount of $100 and attorney fees in an amount to be determined.

not only with regard to the Wilson Group, but also with regard to “any other licensed eye care provider on [Spectera’s] provider panel” or those who had applied for admittance to the panel. The trial court later modified its injunction by suspending it “as to eye care providers other than [the Wilson Group] pending a final determination on appeal.” Spectera appeals the trial court’s order on the merits and also its extension of the injunction to include third party eye care providers not participating in this lawsuit.

On appeal from the grant or denial of a motion for summary judgment, we review the evidence de novo, and all reasonable conclusions and inferences drawn from the evidence are construed in the light most favorable to the nonmovant. Congress Street Properties v. Garibaldi’s, 314 Ga. App. 143, 145 (723 SE2d 463) (2012). “Summary judgment is proper if the record evidence, including affidavits, ‘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.’” (Footnote omitted.) Id. An appellate court’s review of the lower court’s statutory construction is also de novo. Kennedy Dev. Co. v. Camp, 290 Ga. 257, 258 (719 SE2d 442) (2011).

1. The Wilson Group asserts that the requirement in the IPP agreement that they obtain all covered materials from Spectera (the “Materials Requirement”),

violated subsections (c) (2), (3), (5) and (6) of the Eye Care Act, especially when considered in conjunction with the RCP agreement, which does not contain the same requirement for retail chain providers. The trial court agreed. But Spectara argues that the trial court misinterpreted the Eye Care Act and erred in holding that the IPP agreement was in violation of its provisions.

Subsection (c) of the Eye Care Act sets out certain requirements for vision care insurers in this State and provides in pertinent part:

(c) A health care insurer providing a health benefit plan which includes eye care benefits shall:

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