Terry v. Retirement Board, Public Employees' Health Program

2007 UT App 87, 157 P.3d 362, 573 Utah Adv. Rep. 30, 2007 Utah App. LEXIS 83
CourtCourt of Appeals of Utah
DecidedMarch 15, 2007
Docket20060019-CA
StatusPublished
Cited by7 cases

This text of 2007 UT App 87 (Terry v. Retirement Board, Public Employees' Health Program) is published on Counsel Stack Legal Research, covering Court of Appeals of Utah primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Terry v. Retirement Board, Public Employees' Health Program, 2007 UT App 87, 157 P.3d 362, 573 Utah Adv. Rep. 30, 2007 Utah App. LEXIS 83 (Utah Ct. App. 2007).

Opinion

OPINION

BENCH, Presiding Judge:

T1 David C. Terry (Petitioner) challenges the Utah State Retirement Board's (the Board) decision upholding the denial of benefits claimed under a Public Employees' Health Program (PEHP) life insurance policy. The alleged policy is in the name of Petitioner's deceased mother (the Decedent) and Petitioner is the primary beneficiary. The record as a whole supports the Board's determination that no insurance contract existed between PEHP and the Decedent. Though Petitioner has presented an insurance policy certificate (the Certificate), PEHP has shown that the Decedent was not eligible to receive the type of insurance coverage from PEHP that the Certificate purports to evidence and that no premiums were ever paid on the alleged policy. Also, because Petitioner has not proved the facts of his case with sufficient certainty, nor shown any reliance on the Certificate or any resulting harm, Petitioner cannot assert the principle of equitable estoppel against PEHP, a governmental entity. Finally, the Board followed statutory procedures in deciding Petitioner's claim, and did not deny Petitioner due process. We therefore affirm.

BACKGROUND

12 PEHP offers life insurance to certain qualified public employees. PEHP cannot sell life insurance policies to individuals and can only provide life insurance for Utah State employees whose employers have selected PEHP life insurance coverage. The Decedent worked as a Nutrition Technician in the Salt Lake City School District from 1970 until 1979, when she retired. The Certificate states that the policy amount is $18,000, that it is provided as a benefit to early retirees of the state of Utah, and that it was issued in 1998.

T3 The Decedent allegedly showed the Certificate to Petitioner and told him that he would be the primary beneficiary of the policy. Prior to the alleged receipt of the Certificate, the Decedent had made some inter vivos gifts to Petitioner's sister and wanted to ensure that Petitioner would receive an equal share in the Decedent's estate. Following the Decedent's death in 2008, Petitioner presented the Certificate to PEHP in an effort to collect on the policy. PEHP denied payment on multiple grounds, and Petitioner requested a hearing before an Administrative Hearing Officer (the Hearing Officer).

I 4 At the hearing, PEHP officials testified that the Decedent's employment with the Salt Lake City School District did not qualify her for the type of term life insurance cover *364 age specified on the Certificate. The record also reflects that no premiums were paid on the policy by the Decedent or by anyone else on her behalf and that PEHP did not uncover any evidence of the alleged policy in their internal records. Petitioner testified that he received a larger part of the Decedent's estate than his sister and that everything between them was equal. He also could not attribute any action, forbearance of action, or resulting harm to his belief in the validity of the Certificate. The Hearing Officer ruled that no life insurance contract was formed and that estoppel did not apply because Petitioner failed to show reliance or harm.

T5 The Board conducted a statutorily mandated review of the Hearing Officer's order denying Petitioner's claim and adopted the Hearing Officer's decision. Language in the Board's written order outlines the procedure for petitioners to request reconsideration by the Board, and explains that petitioners are not required to request reconsideration before seeking judi-clal review. Petitioner filed for judicial review of the Board's decision without requesting the Board to reconsider.

ISSUES AND STANDARDS OF REVIEW

T6 Our decision as to the level of deference we should afford the administrative agency's decision has been made difficult by Petitioner's failure to properly characterize his claims in terms of Utah Code section 63-46b-16(4), which outlines the various considerations for granting judicial relief from state agency decisions. See Utah Code Ann. § 63-46b-16(4) (2004). The subsections therein require reviewing courts to apply different standards of review, depending on what petitioners claim. We therefore "strongly encourage [future] counsel to clearly identify under what section review is being sought and to make certain they identify the appropriate standard of review under that section." King v. Industrial Comm'n, 850 P.2d 1281, 1286 n. 6 (Utah Ct.App.19983); see also Utah Code Ann. § 63-46b-16(4).

17 Petitioner challenges the Board's conclusion that an insurance contract did not exist between the Decedent and PEHP. "Whether a contract has been formed is ultimately a conclusion of law." In re Estate of Flake, 2003 UT 17, 127, 71 P.3d 589 (quotations and citation omitted). Challenges to an agency's legal conclusions of general law best fall under Utah Code seetion 68-46b-16(4)(d), which allows an appellate court to grant relief when an agency has "erroneously interpreted or applied the law." Utah Code Ann. § 63-46b-16(4)(d). We review an agency's legal conclusions for correctness, giving no deference to the agency's decision. See Drake v. Industrial Comm'n, 939 P.2d 177, 181 (Utah 1997).

18 Petitioner's equitable estoppel claim presents a mixed question, which "involves the application of law to fact." State v. Hamilton, 2008 UT 22, ¶ 33 n. 12, 70 P.3d 111 (quotations and citations omitted). The estoppel claim also falls under Utah Code section 63-46b-16(4)(d) because it challenges the agency's application of the law. See Utah Code Ann. § 63-46b-16(4)(d). There are factors, including policy concerns, an agency's expertise in a specific area of law, and the complexity of the given legal question, which may alter the amount of deference an appellate court gives an agency's decision when reviewing mixed questions of law and fact. See Drake, 989 P.2d at 181 (applying the general "mixed question" standard of review to judicial review of agency decisions). Depending on the cireumstances, an appellate court may review the agency decision with a level of deference "falling anywhere between a review for 'correctness' and a broad 'abuse of discretion' standard." Id. Here, Petitioner has not directly challenged the Board's underlying factual determinations on which the Board's estoppel conclusions are based and estoppel does not present a legal question within the special purview of the Board. Therefore, "we review the underlying empirical facts under a deferential clear error standard," but "no deference need be given [the Board's] resolution of such questions of law." Id.

19 Finally, Petitioner contends that the Board denied him due process of law by not granting him a sufficient review prior to taking initial action on the Hearing Officer's decision. This claim is properly made under *365

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Cite This Page — Counsel Stack

Bluebook (online)
2007 UT App 87, 157 P.3d 362, 573 Utah Adv. Rep. 30, 2007 Utah App. LEXIS 83, Counsel Stack Legal Research, https://law.counselstack.com/opinion/terry-v-retirement-board-public-employees-health-program-utahctapp-2007.