Weyant v. The Phia Group LLC

CourtDistrict Court, S.D. New York
DecidedAugust 17, 2021
Docket1:17-cv-08230-LGS
StatusUnknown

This text of Weyant v. The Phia Group LLC (Weyant v. The Phia Group LLC) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Weyant v. The Phia Group LLC, (S.D.N.Y. 2021).

Opinion

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK -------------------------------------------------------------X : JESSICA WEYANT, : : Plaintiff, : 17 Civ. 8230 (LGS) : -against- : OPINION AND ORDER : THE PHIA GROUP LLC, et al., : : Defendants. : -------------------------------------------------------------X

LORNA G. SCHOFIELD, District Judge: Plaintiff Jessica Weyant brings this putative class action against Defendants The Phia Group, LLC (“Phia”) and INDECS Corporation (“INDECS”) (collectively, “Defendants”), on behalf of herself and those similarly situated. The only remaining claim is Plaintiff’s claim for conversion. The parties cross-moved for summary judgment on this claim. The Court granted summary judgment in favor of Defendants on the ground that Plaintiff did not exhaust her administrative remedies. On appeal, the Second Circuit vacated the Court’s decision, held that there was no clear administrative remedy available for Plaintiff to pursue and remanded for consideration of the remaining arguments presented in the parties’ motions for summary judgment. Weyant v. Phia Grp. LLC, 823 F. App’x 51, 53 (2d Cir. 2020) (summary order). Upon further consideration of the parties’ remaining arguments, the parties’ motions are denied. I. BACKGROUND A. Overview Unless otherwise stated, the following facts are undisputed and drawn from the parties’ submissions on the motions. During the relevant period, Plaintiff was a participant in the Orange-Ulster School Districts Health Plan (the “Plan”). Defendant INDECS is the claims administrator for the Plan. Defendant Phia is the authorized agent of INDECs for the purposes of subrogation and reimbursement efforts on behalf of the Plan. On April 10, 2012, Plaintiff was injured in a motor vehicle accident in Maryland (the

“Accident”). As a result of Plaintiff’s injuries from the Accident, the Plan provided $16,057.19 in medical benefits to Plaintiff (the “Plan Benefits”). Plaintiff returned the Plan Benefits under protest, after Defendants asserted a lien on certain settlement funds she had recouped in a separate action related to the Accident (the “Maryland Action”). Plaintiff brought this action seeking entitlement to the Plan Benefits against INDECS and Phia, but not against the Plan -- the party that ultimately received Plaintiff’s repayment of Plan Benefits minus a service fee. B. Repayment of Plan Benefits Plaintiff contested the validity of the lien and objected to repayment of the Plan Benefits.

On October 4, 2016, Raymond Marshall, Plaintiff’s counsel, emailed Mary Burkhalter, Phia’s claims handler, stating: As I just mentioned to you over the phone, my client desires to contest the validity of the entire lien. Because a lien has been asserted, I believe there are two potential options. The first option is that the amount of the lien could remain in escrow pending the dispute. The second option, and what I propose, is that my firm mail a check to the Phia Group for the entire amount of the lien . . . but that the payment will be sent to Phia Group under protest.

In support of their motion for summary judgment Defendants submitted a sworn declaration from Ms. Burkhalter. Ms. Burkhalter asserts that she spoke with Mr. Marshall on October 4, 2016, and “[i]nstead of holding the funds in escrow until any dispute could be resolved, it was his proposal that his firm send Phia a check for the full amount ‘right away.’” The parties dispute the reasons for, and extent of, Plaintiff’s objections to repayment. Defendants contend that Plaintiff objected to repayment on the ground that some of the Plan Benefits may have been for treatment that was not related to the Accident and, as a result, should not be subject to repayment on account of Plaintiff’s receipt of the Maryland Action settlement funds. In support of this contention Defendants assert that on October 13, 2016, Charles

Kannebecker,1 another lawyer for Plaintiff, informed Ms. Burkhalter that “he want[ed] [Phia] to sign an agreement that Phia would accept the funds but that if Ms. Weyant felt that the Plan had paid claims for treatment that was not related to this accident, she could appeal those payments.” Plaintiff denies that she or her counsel stated that her dispute “was only regarding claims purportedly not related to the accident,” and contends that she communicated that she contested the entire lien. In an email dated October 11, 2016, Ms. Burkhalter asked Mr. Marshall to provide a “reason patient feels [the] plan [is] not entitled to reimbursement,” and stated that the Plan will “accept $10,000.00 in satisfaction [of] its subrogation claim in the amount of $16,057.19.” The record does not include a response from Mr. Marshall to Ms. Burkhalter’s

question regarding the reasons for Plaintiff’s objection to the repayment or to the Plan’s proposed reduction of the repayment. On November 16, 2016, Ms. Burkhalter emailed Mr. Marshall, stating: Our office agrees to accept payment in full in the amount of $16,057.19 with the understanding that if said amount reimbursed represents payment for the claims not related to the above incident, the patient has the right to dispute said reimbursement.

1 As addressed in Section II(A)(4) infra, Plaintiff objects to the admissibility of Mr. Marshall’s and Mr. Kannebecker’s statements on hearsay grounds. On November 18, 2016, Ms. Burkhalter again emailed Mr. Marshall, stating that “the Plan will accept the payment in full and if the patient wishes to contest the payment, the patient may do so.” On November 22, 2016, Plaintiff sent Phia a check for $16,057.19 with a letter stating: Enclosed please find a check in the amount of $16,057.19, representing the lien for the above employee. [Plaintiff] has reserved her right to contest the validity of the lien. You agreed in your November 18, 2016, email to me that [Plaintiff] could proceed in this manner.

This check is remitted with the condition that this payment is made under protest, does not waive any dispute or constitute a voluntary payment by [Plaintiff]. If you do not agree to these conditions, then you must immediately return this check and you may not keep, cash or deposit this check.

If you do keep, cash or deposit this check, it constitutes an agreement that this payment is made under protest, does not waive any dispute or constitute voluntary payment by [Plaintiff].

Plaintiff testified that she submitted a payment because she was afraid of the consequences of not doing so -- specifically, losing her health insurance while she was pregnant and still recovering from the Accident. Phia retained $3,532.58 of Plaintiff’s payment as a “service fee” and sent the balance to INDECS. Per the sworn declaration of Bruce Buchanan, Sr., President of INDECS, “INDECS forwarded 100% of the recovery to the Plan and has not retained any of the funds paid by [Plaintiff] nor was it paid a fee for its service.”2

2 Plaintiff disputes, but does not point to any evidence in the record to rebut, this fact. Plaintiff’s denial without more does not raise a genuine issue of fact. See Fed. Trade Comm’n v. Moses, 913 F.3d 297, 305 (2d Cir. 2019) (“Conclusory allegations or denials therefore are not evidence and cannot by themselves create a genuine issue of material fact where none would otherwise exist.”) (internal quotation marks omitted). II. STANDARD Summary judgment is appropriate where the record establishes “that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(a). There is a genuine dispute of material fact “if the evidence is such that a reasonable jury could return a verdict for the nonmoving party.” Anderson v. Liberty Lobby,

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Weyant v. The Phia Group LLC, Counsel Stack Legal Research, https://law.counselstack.com/opinion/weyant-v-the-phia-group-llc-nysd-2021.