Valora v. Pennsylvania Employees Benefit Trust Fund

847 A.2d 681, 2004 Pa. Super. 73, 2004 Pa. Super. LEXIS 267
CourtSuperior Court of Pennsylvania
DecidedMarch 22, 2004
StatusPublished
Cited by4 cases

This text of 847 A.2d 681 (Valora v. Pennsylvania Employees Benefit Trust Fund) is published on Counsel Stack Legal Research, covering Superior Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Valora v. Pennsylvania Employees Benefit Trust Fund, 847 A.2d 681, 2004 Pa. Super. 73, 2004 Pa. Super. LEXIS 267 (Pa. Ct. App. 2004).

Opinion

OPINION BY TAMILIA, J.:

¶ 1 Pennsylvania Employees Benefit Trust Fund (PEBTF) appeals from the January 3, 2003 Order denying its exceptions to and making final the Order docketed January 17, 2002 enjoining it from terminating and/or continuing the termination of benefits provided to appellee, William Valora, Jr., under the Retired Employees Healthcare Plan (REHP).

¶ 2 Succinctly, appellee’s infant son, born with severe congenital hydrocephalus, received a sealed financial settlement to which appellant, that insured infant at that time, argues it is entitled to subrogation of $210,633. Appellant PEBTF is not an insurance company but administers the health plan provided to active and retired Pennsylvania State Troopers and their beneficiaries through Capitol Blue Cross and Pennsylvania Blue Shield. Upon review of a stipulated record, the trial court found that while appellant may have been entitled to subrogation, it waived that right by failing to raise that claim until after the case had settled.

[Appellant’s] first notice of its subro-gation rights came approximately 31/ years after the suit; a little more than one year after the trial; ten months after settlement had occurred; and approximately six months after the Court approved and sealed the settlement. Although the length of time does not shock us, we believe that the totality of the circumstances surrounding the duration of time does not equate to the [appellant] exercising reasonable diligence in presenting its subrogation claim.

Trial Court Opinion, Cherry, J., 1/18/02, at 7. The underlying facts of this case, as thoroughly set forth by the trial court, follow.

The Plaintiff in this case, William Valo-ra, Jr., the parent and natural guardian of Benjamin Valora, is a retired Pennsylvania State Police Trooper, having retired from service to the Commonwealth on April 12, 1991. Mr. Valora was covered by, and subject to, the Collective Bargaining Agreement between the Commonwealth of Pennsylvania and the Fraternal Order of Police upon his retirement. Mr. Valora was and is also subject to the Pennsylvania State Police Handbook and the provisions therein.
The Defendant is responsible for administering the health plan for retired Pennsylvania State Police Troopers, including Mr. Valora. Capital Blue Cross and Pennsylvania Blue Shield provide the health benefits to State Police retirees and their dependents.
On April 2, 1993, Benjamin Valora was born and became a dependent under Mr. Valora’s health benefit plan. Benjamin was born with severe congenital hydrocephalus, which is “an abnormal accumulation of fluid in the cerebral ventricles resulting] in enlargement of the skull and compression of the brain.” WEBSTER’S II NEW COLLEGE DICTIONARY 541 (1st ed.1996). As a result, Benjamin is severely and profoundly mentally retarded and physically handicapped. Benjamin has no hope of any semblance of recovery and will never be able to tend to his own needs or care for himself in any way for the rest of his life.
As a result of Benjamin’s prenatal care, a medical malpractice lawsuit and complaint were filed in March of 1995. See Benjamin Valora, et al. v. Hershey Medical Center, et al., No. 1057-S-1995. The case proceeded through litigation *683 and finally went to trial before Judge Joseph H. Kleinfelter of this Court on August 18,1997. Thereafter, each party filed motions for post trial relief in September 1997. Judge Kleinfelter granted a new trial in October, 1997. Ultimately, the parties reached a settlement agreement in December, 1997.
Because Plaintiff in the case was a minor, the settlement required approval of the Court. Thus, Plaintiffs filed a Petition for Approval and later, an Amended Petition for Approval. Judge Kleinfelter eventually approved the settlement by Order on April 17, 1998 and said Order was sealed. The settlement required, inter alia, a release to be signed by Benjamin’s parents. The release outlined the structured settlement agreement, which included the purchase of an annuity for the benefit of Benjamin. In furtherance of the settlement agreement, a Special Needs Trust was established for Benjamin’s benefit, with Sentry Trust Company appointed as Trustee. The settlement provided for monthly as well as lump-sum payments over the course of Benjamin’s life. The settlement did not specify an amount for past or future medical expenses.
Upon learning of the settlement between Valora and Hershey Medical, a representative of the Defendant contacted Plaintiffs counsel via letter on October 2, 1998 concerning a subrogation claim to the settlement amount. The parties exchanged correspondence between November 27, 1998 and September 21, 2000, regarding Defendant’s sub-rogation rights. Initially, Plaintiff was not cooperative or responsive toward the Defendant as to the inquiries regarding the supposed subrogation claim, which was for two hundred ten thousand, six hundred and thirty three dollars ($210,-633). In response to its perceived lack of cooperation on the part of the Plaintiff, Defendant threatened to and did in fact terminate Plaintiffs healthcare coverage through the REHP.1
In response, Plaintiff filed a Complaint In Action (Equity) to Enjoin Termination Of Healthcare Benefits. Defendant filed an Answer, New Matter, and Counterclaims against William Valo-ra in both Equity and in Assumpsit. This Court entertained argument on the matter. Plaintiff submitted a legal memorandum on the subrogation interest of the Defendant. Both parties stipulated to various facts of this case.
1. We would like to note that Defendant’s counsel, Richard Kirschner, Esquire, informed this Court via a letter dated January 23, 2001, that “Mr. Valo-ra’s benefits were immediately and prospectively reinstated and remain so at this time.” We have no reason to believe that Defendant has, at any time since the date of the representative letter, done anything to change the status of Mr. Valora’s benefits; that being the reinstatement of said benefits.

Id., at 1-3. The court ultimately found in favor of appellee.

¶3 Appellant argues the trial court erred when it concluded its failure to act with reasonable diligence caused waiver of any subrogation claim that may have existed. Appellant also contends that by commencing and settling a lawsuit without notice, appellee breached his contractual agreement to take no action that would prejudice appellant’s right to subrogation. Appellant argues, contrary to the trial court’s suggestion, that its failure to “remind” appellee of its subrogation interest should not result in waiver of that contractual right and, given the fact that the release signed by appellee required him to “satisfy any and all hens that have been asserted and/or may be asserted for reim *684 bursement of medical benefits,” it is apparent appellee was aware of his obligation to reimburse medical providers. Appellant’s brief at 14. Appellant also argues the trial court’s reliance on workers’ compensation cases for the principle appellant waived its right to subrogation is misplaced, as in those cases and unlike here, employers and their insurers are automatically notified of pending suits.

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Cite This Page — Counsel Stack

Bluebook (online)
847 A.2d 681, 2004 Pa. Super. 73, 2004 Pa. Super. LEXIS 267, Counsel Stack Legal Research, https://law.counselstack.com/opinion/valora-v-pennsylvania-employees-benefit-trust-fund-pasuperct-2004.