Tucker v. Ochsner Health Plan

674 So. 2d 1052, 1996 WL 229821
CourtLouisiana Court of Appeal
DecidedMay 8, 1996
Docket28318-CA
StatusPublished
Cited by4 cases

This text of 674 So. 2d 1052 (Tucker v. Ochsner Health Plan) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Tucker v. Ochsner Health Plan, 674 So. 2d 1052, 1996 WL 229821 (La. Ct. App. 1996).

Opinion

674 So.2d 1052 (1996)

Austin TUCKER & Beverly Tucker, Plaintiffs-Appellees,
v.
OCHSNER HEALTH PLAN, d/b/a Ochsner Preferred Choice, Defendant-Appellant.

No. 28318-CA.

Court of Appeal of Louisiana, Second Circuit.

May 8, 1996.

*1053 Monroe & Lemann by Perry R. Staub, Jr., New Orleans, for Defendant-Appellant.

Jack M. Bailey, Jr., Shreveport, for Plaintiffs-Appellees.

Before MARVIN, GASKINS and CARAWAY, JJ.

MARVIN, Chief Judge.

This appeal concerns whether Caddo Parish is the proper venue for an action against a Jefferson Parish health maintenance organization (HMO) under a group health care plan for reimbursement of medical expenses incurred outside of the HMO's geographical (New Orleans-Baton Rouge) "service area" by the plaintiff-plan member.

Overruling the HMO's venue exception, the trial court found that the action could be brought in Caddo Parish, where the plaintiff incurred the "damages" he seeks to recover from the HMO, both in tort and in contract, notwithstanding that the HMO's business office is located in Jefferson Parish. CCP Arts. 42, 74, 76.1.

We affirm the judgment for these reasons:

FACTS

The plaintiff, Austin Tucker, received extensive medical treatment in Caddo Parish for injuries he sustained there when he fell from a tree on June 6, 1994. Tucker's injury occurred shortly after he returned to Caddo Parish, where he and his wife are domiciled, from New Orleans, where Tucker temporarily resided to fill a one-year teaching position at a theological seminary. Tucker apparently began teaching at the seminary in August 1993 and completed his teaching duties in May 1994.

At the start of his seminary employment, Tucker enrolled in a health care plan offered by his employer under a group health services agreement with Ochsner Preferred Choice HMO, the trade name of a partnership, Ochsner Health Plan. The business was later incorporated as Ochsner/Sisters of Charity Health Plan, Inc. We refer to the HMO hereafter as OHP, the designation used in the group agreement.

OHP's principal business office is located in Jefferson Parish. Its geographical "service area" includes New Orleans and Baton Rouge. OHP does not have an office in Caddo Parish. The group health care plan, however, expressly "covers" certain medical expenses incurred outside of OHP's service area, as discussed infra.

*1054 Tucker brought his action against OHP in Caddo Parish, alleging that he has incurred over $200,000 in medical bills as a result of his injury, which left him partially paralyzed. Anticipating OHP's contention that Tucker's coverage under the group plan ended before his June 1994 injury, Tucker also alleged that he was covered under the plan until his one-year employment contract with the seminary ended in August of that year.

The merits of the coverage issue are yet pending in the trial court and are not before us in this appeal. At this juncture, we simply accept the allegation of coverage as true for purposes of discussing and resolving the venue issue. While references are made in the record to Tucker having separate actions against other defendants for either or both tort damages and workers' compensation benefits, OHP is the sole defendant in this action.

TRIAL COURT RULING

Excepting to venue in Caddo Parish, OHP asserted that the proper venue for the action was Jefferson Parish, the location of OHP's principal place of business as a partnership and of its registered corporate office. CCP Art. 42(2), (3). Tucker opposed the exception by advancing three alternative CCP provisions:

Art. 76, which generally allows an action on an insurance policy to be brought in the parish where the insured is domiciled or in the parish where the loss occurred. The article specifically states that an action "on a health and accident insurance policy" may be brought in the parish of the insured's domicile or in the parish where the accident or illness occurred.
Art. 76.1, which allows an action "on a contract" to be brought in the parish where the contract was executed or in the parish where any work or service was performed or was to be performed under the terms of the contract.
Art. 74, establishing venue for an action to recover "damages for an offense or quasi offense" in the parish where the wrongful conduct occurred, or in the parish where the damages were sustained.

The trial court overruled the exception, citing Arts. 76.1 and 74. This court denied supervisory review of the ruling without reaching the merits of the application. OHP then appealed the judgment, as authorized by Herlitz Const. Co. v. Hotel Investors of New Iberia, Inc., 396 So.2d 878 (La.1981) and McInnis Bros. v. Peoples Water Service, 28,216 (La.App.2d Cir. 1/24/96), 666 So.2d 1323.

DISCUSSION

At the outset, we note that the longstanding jurisprudential deference to the "home base" venue provisions of CCP Art. 42, generally establishing the parish of the defendant's domicile as the proper venue in which to bring an action, and the corresponding strict or narrow construction of the codal "exceptions" to the Art. 42 "general rule," contained in Arts. 71-85, has been tempered somewhat in recent years. See Jordan v. Central Louisiana Electric Co., 95-1270 (La. 6/23/95), 656 So.2d 988, citing with approval the court's earlier construction of Arts. 71-85 as "alternative" or "supplemental" venue provisions to be applied as "part and parcel of the general venue rules set forth in Article 42." Jordan, supra, at p. 2, 656 So.2d at 989, citing Kellis v. Farber, 523 So.2d 843 (La. 1988). See also McInnis Bros. v. Peoples Water Service, supra.

As mentioned, the alternative venue provisions asserted by Tucker include Art. 76 (action on insurance policy), Art. 76.1 (action on a contract) and Art. 74 (action for tort damages).

Art. 76: Action on insurance policy

The trial court implicitly, and in our view correctly, determined that Tucker's action is not an action on an insurance policy, which, under Art. 76, may be brought where the loss occurred or where the insured is domiciled.

Notwithstanding that the entirety of LRS Title 22, which bears the heading "Insurance," is sometimes referred to as the "Insurance Code," we note that the legislature has used that name only for Chapter 1 of Title 22, the chapter dealing with traditional forms of insurance, such as life insurance and health and accident insurance. The provisions concerning HMOs appear in Chapter 2 *1055 of Title 22, the chapter entitled "Miscellaneous Provisions." The Health Maintenance Organization Act, LRS 22:2001-2027, was enacted in 1986 as Part XII of Chapter 2.

The legislature has defined a "health maintenance organization" as a domestic corporation

which undertakes to provide or arrange for the provision of basic health care services to enrollees in return for a prepaid charge. The health maintenance organization may also provide or arrange for the provision of other health care services to enrollees on a prepayment or other financial basis. Notwithstanding any laws, regulations, or definitions contained in any other section of Title 22 to the contrary, a health maintenance organization is deemed to be an insurer for the purposes of liquidation, conservation, rehabilitation, and/or receivership all as defined and set out within Title 22. A health maintenance organization shall not be considered an insurer for any other purpose.

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Cite This Page — Counsel Stack

Bluebook (online)
674 So. 2d 1052, 1996 WL 229821, Counsel Stack Legal Research, https://law.counselstack.com/opinion/tucker-v-ochsner-health-plan-lactapp-1996.