White v. Sutherland

585 P.2d 331, 92 N.M. 187
CourtNew Mexico Court of Appeals
DecidedAugust 1, 1978
Docket3378
StatusPublished
Cited by45 cases

This text of 585 P.2d 331 (White v. Sutherland) is published on Counsel Stack Legal Research, covering New Mexico Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
White v. Sutherland, 585 P.2d 331, 92 N.M. 187 (N.M. Ct. App. 1978).

Opinion

OPINION

WOOD, Chief Judge.

Plaintiff sought damages from defendant chiropractor, alleging malpractice. H.S. S.D. (Health and Social Services Department of the State of New Mexico) paid various medical bills of plaintiff and intervened in the damage suit. H.S.S.D. sought to recover the amount of medical assistance payments made. The damage suit was settled. This appeal is concerned with the division of the settlement money between plaintiff and H.S.S.D. We discuss: (1) § 13-1-20.1, N.M.S.A. 1953 (Repl. Vol. 3, pt. 1); (2) N.M.Const. art. IV, § 32; and (3) equitable division of the settlement money.

Section 13-1-20.1, supra

One hundred thousand dollars was paid in settlement. The settlement involved both plaintiff’s damage claims and H.S.S.D.’s medical payments.

Plaintiff’s injuries were serious and permanent. Her damage claim was for $2,000,000. The testimony of defendant’s attorney, introduced by stipulation, was that this damage claim was “ ‘not out of line’ ”. The testimony of defendant’s attorney, and the representations made by plaintiff’s attorney, as an officer of the court, agree that there was a fifty percent chance that defendant would be held liable to plaintiff and if found liable “a verdict of $1,000,000 or more was likely”. The settlement for $100,000 was for the amount of the insurance coverage. According to plaintiff’s attorney, the $100,000 amount was accepted because of two factors: (1) the fifty percent chance that defendant would be found liable and (2) information that most of defendant’s assets were in Mexico, making it unlikely that a judgment in excess of the insurance coverage would be collectable.

H.S.S.D. introduced no evidence to the contrary. Its position was that the information in the preceding paragraph had no legal significance in connection with its repayment claim. It asserted the only significant fact was that it made medical assistance payments and it was entitled to one hundred percent repayment. The amount of the H.S.S.D.’s payments were a few dollars short of $39,000.

The trial court applied equitable concepts and awarded H.S.S.D. less than one hundred percent of its claim. H.S.S.D. appeals.

Section 13-1-20.1, supra, states:

A. The health and social services department shall make reasonable efforts to ascertain any legal liability of third parties who are or may be liable to pay all or part of the medical cost of injury, disease or disability of an applicant or recipient of medical assistance.
B. When the department makes medical assistance payments in behalf of a recipient, the department is subrogated to any right of the recipient against a third party for recovery of medical expenses to the extent that the department has made payment.

This statute pertains to the recovery of medical assistance payments made by H.S.S.D.; the statute pertains to the recovery of such payments from third parties; it pertains to the recovery of such payments from third parties legally liable for the payments made by H.S.S.D. The statute does not pertain to the recovery of payments from the recipient or beneficiary of such payments; in this case, the plaintiff. Compare § 13-1-20, N.M.S.A. 1953 (Repl. Vol. 3, pt. 1).

Defendant was a third party; it is not disputed that defendant was legally liable for the medical payments to the extent of the settlement money paid. See definition of “legal liability” in Black’s Law Dictionary (1951). Section 13-1-20.1, supra, is the applicable statute.

H.S.S.D. states that the “intent” of both federal and state law is for states to be reimbursed for medicaid payments from third party sources. H.S.S.D. states: “The legislative intent ... is expressed in terms that can leave no doubt that states are mandated by Act of Congress to secure reimbursement of medicaid costs.”

42 U.S.C.A. 1396a(a)(25) (1974) provides that a state plan for medical assistance must:

(25) provide (A) that the State or local agency administering such plan will take all reasonable measures to ascertain the legal liability of third parties to pay for care and services (available under the plan) arising out of injury, disease or disability, . . and (C) that in any case where such a legal liability is found to exist after medical assistance has been made available on behalf of the individual, the State or local agency will seek reimbursement for such assistance to the extent of such legal liability[.]

The federal statute does show an intent that medical assistance payments be reimbursed; it requires a state to “seek reimbursement” to the extent of the legal liability of a third party. This statute does not, however, show an intent that a state is to receive one hundred percent reimbursement from a legally liable third party, regardless of the facts. As to the amount of reimbursement, this statute says nothing.

Similarly, § 13-1-20.1, supra, shows an intent that medical assistance payments be repaid. Similarly, the state statute says nothing as to one hundred percent repayment to H.S.S.D., regardless of the facts.

Section 13-1-20.1(B), supra, states that H.S.S.D. “is subrogated to any right of the recipient against a third party for recovery of medical expenses to the extent the department has made payment.” H.S. S.D. seems to argue that “to the extent . [of] payment” indicates a legislative intent of one hundred percent repayment, regardless of the facts of the case. Such an argument ignores the words “subrogated to any right . . . against a third party for recovery”. The statute is to be read to give effect to all of its provisions. Keller v. City of Albuquerque, 85 N.M. 134, 509 P.2d 1329 (1973).

Subrogation, historically, is an equitable remedy. United States Fidelity & G. Co. v. Raton Nat. Gas Co., 86 N.M. 160, 521 P.2d 122 (1974). “ ‘Subrogation’ is a term of legal art which we assume would not be employed by the drafters of the statute unless they intended it to be construed in its normal sense.” United States v. Greene, 266 F.Supp. 976 (D.C.Ill.1967). In its normal sense, subrogation gives the payor a right to collect what it has paid from the party who caused the damage. Herrera v. Springer Corporation, 85 N.M. 6, 508 P.2d 1303 (Ct.App.1973), rev’d on other grounds, 85 N.M. 201, 510 P.2d 1072 (1973). This right to collect, being an equitable remedy, is subject to equitable principles. United States Fidelity & G. Co. v. Raton Nat. Gas Co., supra.

Absent a clearly expressed legislative intent requiring otherwise, “subrogated” is to be given its usual, ordinary meaning. Tafoya v. New Mexico State Police Board, 81 N.M. 710, 472 P.2d 973 (1970).

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Bluebook (online)
585 P.2d 331, 92 N.M. 187, Counsel Stack Legal Research, https://law.counselstack.com/opinion/white-v-sutherland-nmctapp-1978.