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No. 32161 _ Michael
Angelucci v. Fairmont General Hospital, Inc., v. National Association of
Letter Carriers Health Benefit Plan
Albright, Chief Justice, and Starcher, Justice, dissenting:
We respectfully dissent to the decision of
the majority of this Court. This Court is obligated to provide plenary review
of a circuit court's grant of summary judgment. In so doing, the benefit
of the doubt is to be given to the nonmoving party. Taylor v. Culloden
Pub. Serv. Dist.,
214 W.Va. 639, 644, 591 S.E.2d 197, 202 (2003). Both the
circuit court and this Court must draw any permissible inference from the
underlying facts in the light most favorable to the party opposing the motion. Painter
, 192 W.Va. 189, 192, 451 S.E.2d 755, 758 (1994). If there
is any evidence in the record from any source from which a reasonable inference
in the nonmovant's favor may be drawn as to a material fact, the moving party
is not entitled to a summary judgment. Crain v. Lightner
, 178 W.Va.
765, 769, 364 S.E.2d 778, 782 (1987).
When utilizing the appropriate standard of
review, it does not appear that Fairmont General Hospital was properly granted
summary judgment in this matter. A valid debt was incurred based upon Mr. Angelucci's
receipt of services in late 1997, and the hospital provided ample evidence that
it made at least an initial attempt to submit Mr.
Angelucci's bills to the insurer. (See
Mr. Angelucci provided evidence that the insurer did
not receive many of the bills.
It is readily apparent that a communications
error had been made at some level. The mistake could potentially have been corrected
by resubmission of bills or by contact between the hospital billing office and
the insurer. The hospital alleges, however, that it neither had an actual contractual
duty nor voluntarily assumed the obligation to directly bill the insurer or to
pursue the issue of payment by the insurer. Mr. Angelucci contends that the hospital
had the obligation to directly submit bills to the insurer and maintains that
such obligation was created through two mechanisms: the hospital/patient contractual
relationship and the hospital's voluntary assumption of the responsibility of
communication and submission of bills to the insurer. Indeed, even absent an
express contractual duty, Mr. Angelucci contends that the voluntary assumption
of the responsibility created a continuing
obligation, implied if not express, on the part of the hospital to pursue the
payment issues with the insurer. The existence and extent of the hospital's
obligation to submit bills and pursue payment created a genuine issue of material
fact which should have precluded a grant of summary judgment. (See
When the insurer became aware of the outstanding
bills, it denied payment of those bills due to the excessive passage of time.
The record reflects that the hospital ultimately wrote off the outstanding bills
in 1999. Despite the fact that the hospital wrote off the bills in 1999, the
hospital sought payment from Mr. Angelucci in 2002 after he instituted the underlying
action based upon his realization that his credit report had been detrimentally
affected by the debt to the hospital.
This quandary represents a regrettable situation
encountered by patients receiving medical treatment and anticipating that the
medical provider will handle the submission of bills to the insurer and maintain
sufficient contact with the insurer to assure proper payment. It is surely the
hospital's underlying notion in this case that Mr. Angelucci's reliance on the
hospital in this regard was misplaced. Yet that contention leaves the patient
without recourse, as Mr. Angelucci currently finds himself. The hospital and
the insurer failed to resolve the payment issue, and after a sufficient passage
of time (See footnote 3) to
permit the insurer to deny payment, the patient is left with the monetary responsibility.
Three years after the hospital writes off the bill, the hospital is permitted
to recover the debt from the patient. There is something inherently inequitable
in that result, and if the facts had been properly presented to a jury, the result
may have been quite different. Neither this Court nor the lower court had a right
to try issues of fact; a determination can only be made as to whether there
are issues to be tried. Hanlon v. Chambers, 195 W.Va. 99, 105, 464
S.E.2d 741, 747 (1995). Based upon the majority's decision in this case, a jury
will not hear these facts, and the decision in favor of the hospital will stand.
We respectfully dissent.
As noted in the
majority opinion, subsequent to the filing of Mr. Angelucci's complaint against
the hospital, the hospital filed a Third Party Complaint against Mr. Angelucci's
insurer, the National Association of Letter Carriers Health Benefit Plan (hereinafter
NALC), alleging that it had failed to pay the $1,663.80 in medical bills which
the hospital had submitted. The insurer was thereafter dismissed pursuant to
Rule 12(b)(6) of the West Virginia Rules of Civil Procedure based upon a federal
preemption bar to the Third Party Complaint.
According to the record, the hospital was
a Preferred Provider Organization within the NALC health benefits plan. The arrangement
between the hospital, as medical provider, and the NALC apparently permitted
the hospital to provide services to NALC plan members at reduced rates.
See City of Indianapolis
v. Twin Lakes Enter., Inc.,
568 N.E.2d 1073, 1079 (Ind. App. 1991)
(While the question of whether a certain or undisputed state of facts
establishes a contract is one of law for the court, where the existence and
not the validity or construction of a contract or the terms thereof is the
point in issue, and the evidence is conflicting or admits of more than one
inference, it is for the jury to determine whether a contract in fact exists); AFSCME
Councils 6, 14, 65 & 96 v. Sundquist
, 338 N.W.2d 560, 567 (Minn.
1983) (Generally, whether implied contract exists and terms of contract are
questions of fact to be determined jury); Williams v. Precision Coil,
., 194 W.Va. 52, 62 n. 18, 459 S.E.2d 329, 339 n. 18 (1995) (While
the determination of what constitutes a contract under our relevant cases
is a question of law, the determination of whether particular circumstances
fit within the legal definition of a contract under our cases is a question
of fact); Frost Constr. Co. v. Lobo, Inc.
, 951 P.2d 390, 394
(Wyo. 1998) (holding that whether contract has been formed, exact terms of
contract, and whether there was breach of terms are questions of fact).
advanced bureaucracy is indistinguishable from molasses. Unknown author.