State Department of Health & Welfare v. Hudelson

196 P.3d 905, 146 Idaho 439, 2008 Ida. LEXIS 195
CourtIdaho Supreme Court
DecidedOctober 16, 2008
Docket34495
StatusPublished
Cited by20 cases

This text of 196 P.3d 905 (State Department of Health & Welfare v. Hudelson) is published on Counsel Stack Legal Research, covering Idaho Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State Department of Health & Welfare v. Hudelson, 196 P.3d 905, 146 Idaho 439, 2008 Ida. LEXIS 195 (Idaho 2008).

Opinion

J. JONES, Justice.

This case involves a dispute over the entitlement of the Department of Health and Welfare to reimbursement from a Medicaid recipient’s personal injury settlement. The magistrate court held that the Department was entitled to reimbursement of about l/27th of the medical expenses it paid. The Department appealed to the district court, which affirmed the magistrate’s ruling. The Department appeals to this Court. We reverse and remand.

*441 i.

In 2000, Jonathon Hudelson, then twenty-two years old, was seriously injured in a car accident. He suffered a spinal cord injury, permanent paraplegia, brain damage, blindness in one eye and partial deafness. As a result of these injuries he became eligible for Medicaid and received at least $274,242.87 in benefits from the Department. 1

Jonathon sued the alleged tortfeasor, and the case settled for $1,000,000, subject to court approval. 2 The Department approved the amount of the settlement and asked to be sent a proposed plan for allocating the settlement funds. Jonathon did not send a proposed allocation plan to the Department, but instead determined a settlement allocation without its input or approval. He then filed two petitions regarding the settlement.

First, he petitioned the district court to approve the settlement, establish a Qualified Settlement Fund (QSF), and approve his proposed allocation of the $1,000,000 settlement. The Department was not notified of, or involved in, this petition. The district judge presiding in the personal injury action, Judge John Melanson, approved the petition, including the proposed settlement allocation, the day it was filed. He also authorized payment of $498,126.65 for Jonathon’s costs and attorney fees, and the purchase of a $300,000 annuity for Jonathon. After deducting these items, $201,873.35 remained and was held by the fund administrator to satisfy the Department’s claim for reimbursement.

Jonathon’s second petition, which was filed in magistrate court on the same day and which is the subject of this appeal, sought creation of a special needs trust. This petition asked the court to establish a special needs trust for Jonathon and to determine the amount necessary to satisfy the Department’s claim. 3 The Department did not oppose the establishment of a special needs trust for Jonathon, but contested Jonathon’s calculation of the amount necessary to satisfy its claim.

Jonathon argued that since the settlement was $1,000,000, his case was settled for approximately l/27th ($1,000,000 divided by $26,968,391.34) of its “total value.” Jonathon calculated the “total value” of his claim as follows:

A. Economic Loss
1. Property Loss $ 6,315.75
2. Past Medical Expenses $ 311,995.59
3. Lost Wages and Earning Capacity $ 580,963.00
4. Future Medical Expenses $ 8,069,117.00
B. Non-Economie Loss $18,000,000.00
TOTAL DAMAGES $26,968,391.34

Therefore, he argued that the Department should likewise receive only l/27th of the amount it paid in medical expenses.

In support of his petition, Jonathon submitted the settlement allocation that Judge Melanson had approved without the Department’s knowledge or participation. He apportioned the damages by multiplying each damage category by $1,000,000 and dividing by $26,968,391.34, producing the following allocation:

A. Economic Loss
1. Property Loss $ 238.76
2. Past Medical Expenses $ 11,568.94
3. Lost Wages and Earning Capacity $ 21,542.37
4. Future Medical Expenses $ 299,206.46
B. Non-Economie Loss $ 667,443.47
TOTAL DAMAGES $ 1,000,000.00

To calculate the Department’s interest, Jonathon multiplied $274,242.87 (the first expense figure advanced by the Department) by $1,000,000 and divided by $26,968,391.34, producing $10,169.05. He then reduced that figure by 35% for attorney fees and by the Department’s proportionate share of costs. This calculation resulted in a $5,103.57 inter *442 est for the Department. The Department contested this figure, arguing that it was entitled to full reimbursement of all medical benefits paid on Jonathon’s behalf, less its share of attorney fees and costs, a figure the Department calculated to be $133,376.03. 4

The magistrate court acknowledged that the proposed allocation approved by Judge Melanson was not binding on the Department. Thus, it held an evidentiary hearing where Jonathon presented evidence to show the total value of his claim and the Department presented evidence primarily directed at the future medical expense factor of the proposed valuation. After considering the evidence, the magistrate found Jonathon had shown that $26,968,391.34 was a fair and reasonable valuation of his claim and that the Department had not offered sufficient evidence to dispute the proposed valuation. The court further found that the allocation formula, which proportionately reduced the “total value,” was reasonable and therefore adopted the same. However, the court calculated the total reimbursement due to the Department in a different manner than Jonathon.

The magistrate held that the Department was entitled to the entire amount allocated to past medical expenses ($11,568.94), and not simply the proportionate share paid by Medicaid ($10,169.05). The court also determined that the correct way to deduct attorney fees and costs was to add the two amounts together, and divide by the total settlement. ($498,126.65 divided by $1,000,000). The court then converted that number to a percentage (49.81%) and reduced the Department’s interest by that percentage. The court applied the formula as follows: 5

[$311,995.59 (total past medicals) x $1,000,000] / $26,968,391.34 = $11,596.94
Less pro rata share of costs and fees (49.81% x $11,596.94) = ( $ 5,776.44)
Net reimbursement amount = $ 5,820.50

The magistrate determined that Jonathon was entitled to reimbursement for expert witness costs. Those costs totaled $2,355.00, which resulted in a $3,465.50 judgment in favor of the Department.

The Department appealed the magistrate’s decision to the district court, which affirmed the magistrate’s decision and awarded costs to Jonathon. The Department appeals to this Court.

II.

This appeal primarily hinges on whether the district court erred in holding that the reimbursement presumption in I.C. § 56-209b(6) did not apply.

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Cite This Page — Counsel Stack

Bluebook (online)
196 P.3d 905, 146 Idaho 439, 2008 Ida. LEXIS 195, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-department-of-health-welfare-v-hudelson-idaho-2008.