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The Tort Times  
August 2011
Volume 192

HOSPITAL IS ALLOWED TO MAINTAIN ITS LIEN AGAINST MEDICARE ELIGIBLE
  Speegle v. Harris Methodist Health System, 303 S.W.3d 32 (Tex.App.–Fort Worth 2009). Mr. Speegle was in a motor vehicle accident with Mr. Guzman, an employee of a construction company. The construction company had a commercial auto policy through Zurich American In. Co.

  Mr. Speegle was taken by CareFlite to Harris Methodist Hospital in Fort Worth where he was admitted and treated for approximately a month. The Hospital’s total charges for his care were $142,915.01. The Hospital filed a notice of hospital lien soon after Mr. Speegle was released.

  Mr. Speegle was Medicare eligible. However, the Hospital did not bill Medicare or receive payment from it for its treatment of Mr. Speegle.
Approximately two years later, Mr. Speegle and his wife entered into a settlement agreement with Mr. Guzman and his employer, calling for $1.25 million to be paid. The agreement called for $391,064.43 to be paid to Mr. Speegle, the Hospital, a Medicare contractor, and Mr. Speegle’s attorneys. This dollar amount was the exact total of the Hospital’s lien plus Medicare’s lien amount.

  Mr. Speegle did not pay the Hospital its $142,915.01. Instead, he filed a declaratory judgment suit arguing that the hospital lien was invalid because the Hospital supposedly failed to comply with Chapter 146 of the Texas Civil Practice & Remedies Code by not billing Medicare for Mr. Speegle’s treatment.
Both the Hospital and Mr. Speegle moved for summary judgment. The trial court ruled that Mr. Speegle had to pay the hospital lien in the amount of $142,915.01.

  The Court of Appeals analyzed 42 U.S.C. § 1395, which was the secondary payer statute in effect at the time of Mr. Speegle’s treatment. It noted that this statute expressly prohibits Medicare from paying if a liability insurer has already paid or is reasonably expected to pay “promptly.” It noted that according to the regulations adopted by the Healthcare Financing Administration, “promptly” is defined as within 120 days of the earlier of the date a lien is filed against a potential liability settlement or the date of discharge. Therefore, Medicare is a secondary payer in situations where a Medicare beneficiary’s hospital lien is covered by liability insurance, and Medicare is prohibited from paying during the 120-day “promptly” period.

  What are the rights of healthcare providers after expiration of the “promptly” period? The Court noted that in 1995 the Healthcare Financing Administra-tion issued a memorandum providing that the provider or supplier of services “may, but is not required to, bill Medicare for conditional payment if the liability insurance claim is not finally resolved. The successor entity, Centers for Medicare and Medicaid Services, has published the same construction in its Medicare Secondary Payer Manual. This Manual, among other things, provides that if a provider of medical services bills Medicare, then the provider must accept the Medicare payment as full satisfaction of the bill. However, if the provider pursues recovery from a liability insurer, it may charge the actual charges, up to the amount of the proceeds of the liability insurance, less applicable procurement costs. However, it may not collect from the beneficiary until after the proceeds of the liability insurance are available to the beneficiary.

   Therefore, under all applicable regulations, after the 120-day “promptly” period ends, whenever services provided to a Medicare beneficiary are also covered by a liability insurance policy, medical providers have the right either to bill Medicare or to maintain a lien against a potential liability insurance settlement. The Court held that the Hospital was entitled to recover the full amount of its lien. 

   Mr. Speegle argued that the hospital lien was invalid because the Hospital supposedly failed to comply with § 146.002(c) of the Texas Civil Practice & Remedies Code. This statute includes a requirement that healthcare service providers timely bill third party payers, including Medicare, whenever they are “authorized” to do so. The Court determined that Chapter 146 requires medical care providers to bill Medicare for services received by Medicare eligible patients when providers are permitted – such as after the 120-day “promptly” period. In such circumstances, however, the Court noted that Chapter 146 conflicts with federal law requiring Medicare to be regarded as a secondary payer and granting hospitals the option of maintaining a hospital lien, even if they are authorized to bill Medicare instead.

  The Court analyzed this conflict between state and federal law and determined that state law is preempted by federal law under these circumstances. Therefore, Mr. Speegle’s argument was overruled.
The Hospital was entitled to recover the full amount of its lien.

In this issue. . .

Hospital Is Allowed To Maintain Its Lien Against Medicare Eligible Plaintiff

Merely Shipping Goods Through Texas Does Not Establish Jurisdiction

Homeowner’s Policy Held To Cover Mold Damage To Contents, But Not Dwelling

Dates Of Birth Of State Employees Are Confidential

Is Church Vicariously Liable For The Intentional Wrongdoing Of Its Employee?

Lessons Learned From A Recent Trial In Collin County



MERELY SHIPPING GOODS THROUGH TEXAS DOES NOT ESTABLISH JURISDICTION

  Zinc Nacional, S.A. v. Bouche Trucking, Inc., 53 Tex.Sup.Ct.J. 574. Zinc Nacional is a Mexican company which sells paper to a company in New Mexico. Zinc uses third-party shippers to move the paper through Texas to New Mexico. It has no offices, agents or employees in Texas and does not advertise its paper products in Texas. Zinc does sell other products to Texas manufacturers, but not the paper.

  One day Zinc loaded several rolls of paper on to a trailer owned by an independent shipping company. At the border in Laredo, Texas, the trailer was handed over to a truck operated by Bouche Trucking, Inc. for delivery to New Mexico.
During this trip, and while the truck was still in Texas, the rolls of paper shifted and the truck overturned, injuring the driver, Mr. Arrellano.
Mr. Arrellano brought a negligence action against Bouche. Bouche, in turn, brought a third-party petition against Zinc seeking indemnity and contribution.

  Zinc took the position that the Texas court did not have personal jurisdiction over it and made a special appearance to contest that jurisdiction. The trial court denied the special appearance, and the Court of Appeals affirmed. The Court of Appeals held that Zinc had purposefully availed itself of Texas benefits by hiring the shipping company, and held that Zinc had thereby established sufficient minimum contacts for purposes of specific jurisdiction.

  The Supreme Court said that the mere fact that goods have traveled into Texas, without more, does not establish the minimum contacts necessary to subject a manufacturer to personal jurisdiction within the state. It said that a merchant’s decision to ship its goods with a third-party shipper that will travel through Texas to a recipient outside of Texas does not, by itself, constitute purposeful availment of the benefits of doing business in the state.

  The Supreme Court held that Zinc lacked the minimum contacts with Texas necessary to establish specific jurisdiction. It reversed the decision of the Court of Appeals and the trial court.

 

HOMEOWNER’S POLICY HELD TO COVER MOLD DAMAGE TO CONTENTS, BUT NOT DWELLING

  State Farm Lloyds, et al. v. Page, 53 Tex.Sup.Ct.J. 826. Ms. Page had a standard homeowner’s insurance policy (Form B) with State Farm. The policy separately provided coverage for the dwelling (Coverage A) and its contents (Coverage B) and included exclusions of coverage in certain areas. Section 1.f.’s exclusion stated that there was no coverage for loss caused by “rust, rot, mold or other fungi.”

  The policy also provided that under Coverage B there was insurance against “accidental discharge, leaking or overflow of water or steam from within a plumbing, heating or air conditioning system or household appliance.” The policy also said that exclusions 1.a. through 1.h. under Section I do not apply to loss caused by “misperil.” This particular exclusion is commonly known as the “Exclusion Repeal Provision.”

  Ms. Page discovered plumbing leaks and associated damage in her home. She contacted State Farm, who sent a claims specialist, Ms. Strachan, to inspect the damage. Thereafter, State Farm paid for extensive physical repair and mold remediation, but eventually State Farm refused to replace Ms. Page’s carpet due to alleged mold damage.

  Ms. Page sued State Farm and Ms. Strachan alleging claims of breach of contract, breach of the duty of good faith and fair dealing, violation of the Texas Deceptive Trade Practices Act, fraudulent misrepresentation and Insurance Code violations. The trial court granted summary judgment in favor of State Farm and Ms. Strachan. However, the Court of Appeals reversed the judgment of the trial court and remanded the case for further proceedings.

  The Texas Supreme Court reviewed the case and said, “To construe the exclusion repeal provision to reinstate mold coverage for Ms. Page’s dwelling would wholly ignore the structure of the policy.” The Court went on to say that when a plumbing leak results in mold contamina-tion, the policy covers mold damage to personal property, but not to the dwelling.

  The Court also examined the dismissal of Ms. Page’s extra-contractual claims and said that to the extent such claims are based on State Farm’s denial of coverage for mold damage to her dwelling, they cannot survive. However, the Court said that to the extent those claims were based on denial of her claim for mold damage to the contents of her home, that they should be remanded to the trial court for further proceedings.

  The Supreme Court reversed the decision of the Court of Appeals in part, affirmed in part, and remanded the case to the trial court.


DATES OF BIRTH OF STATE EMPLOYEES ARE CONFIDENTIAL

  Texas Comptroller of Public Accounts v. Attorney General of Texas, 54 Tex.Sup. Ct.J. 245. The Dallas Morning News submitted a request to the Comptroller of Public Accounts for an electronic copy of the Texas State Employee Database under the provisions of the Texas Public Information Act.

  The Comptroller requested the Texas Attorney General to give an opinion on whether parts of the database were protected from disclosure. The Attorney General concluded that the dates of birth of public employees are not protected from disclosure.
The Comptroller then brought a declaratory judgment suit, seeking a judicial declaration that it did not have to disclose the date of birth of state employees.

  The Dallas Morning News intervened, seeking a partial summary judgment that State employees dates of birth are not protected by the act, or by the common law right of privacy, nor by Constitutional privacy rights. The trial court ruled in favor of the Dallas Morning News, and the Comptroller appealed. The Court of Appeals affirmed.

  The Supreme Court noted that § 552.102(a) of the Texas Public Information Act exempts information from a “personnel file, the disclosure of which would constitute a clearly unwarranted invasion of personal privacy.” The Court said that there must be a balancing of the employee’s right to privacy against the basic purpose of the statute making the information accessible.

  The Court concluded that the State employees have a “nontrivial privacy interest” in their dates of birth. It held that the employees’ privacy interest substantially outweighed the negative public interest in disclosure in this situation. It concluded that disclosing employee birth dates constitutes a clearly unwarranted invasion of personal privacy, making them exempt.


IS CHURCH VICARIOUSLY LIABLE FOR THE INTENTIONAL WRONG-DOING OF ITS EMPLOYEE?


  Hyde Park Baptist Church v. Turner, 53 Tex.Sup.Ct.J. 765. Mr. and Mrs. Turner had a child who received child care at Hyde Park Baptist Church. They discovered that the child had been physically and emotionally mistreated at the church and sued the church and the child’s teacher, alleging damages including medical costs, psychological therapy and mental anguish.

  The jury found that the teacher’s intentional act or acts proximately caused injury to the child and that the church’s negligence contributed to his injuries. The jury further allocated 80% of the responsibility to the church and 20% to the teacher. The jury awarded $3,582 for past medical expenses, $34,980 for future medical expenses, $25,000 for past physical pain and mental anguish, and $100,000 for future mental anguish.

  The Court of Appeals examined the evidence and said that it could not conclude the jury’s allocation of proportionate responsibility was so against the great weight and preponderance of the evidence as to be manifestly unjust. It affirmed the judgment of the trial court.


LESSONS LEARNED FROM A RECENT TRIAL IN COLLIN COUNTY



  
Recently, Downs*Stanford, P.C. lawyers tried a case in Collin County, Texas involving claims of damage to real estate. Our client was a real estate developer working on a residential project. It hired an independent contractor to do excavation, demolition and haul-off work at the beginning of the development.

  One adjacent property owner made a deal with the independent contractor for debris and dirt from the development to be used to fill a low area on his property. A second adjacent property owner had a low area that he wanted filled as well. That’s where things got confusing. The second property owner said he told our client that he wanted clean fill dirt. Our client said it never gave any instructions to the independent contractor to move anything on to the property of either the first or second adjacent property owners. The first adjacent owner said that he told the independent contractor that the second owner wanted his property filled as well. The independent contractor said it didn’t move any dirt or fill onto the property of the second owner.

  At any rate, something was moved onto the property of the second adjacent owner and covered over with a layer of dirt. Later, the second owner sold his property to the Plaintiffs. Still later, when the Plaintiffs decided to dig an ornamental pond, they encountered a lot of debris such as tree trunks, a car chassis, chunks of concrete, and parts of demolished buildings. They sued the developer, the independent contractor, and the people who sold them the property, claiming fraud, negligent misrepresentation, breach of contract, and civil conspiracy. As damages, they claimed that an environmental hazard had been created and that their property had been turned into an unlawful landfill which would cost $1 million to clean up. They had paid $290,000 for the property.

  After the trial had commenced, we moved for judgment on the pleadings, arguing that the Plaintiffs had no standing to recover from our client. We relied on a body of case law holding that in order for a party to sue for damage to real property, he must have been the owner of the real property at the time the damage was done or he must have received an assignment of causes of action from the party that owned at the time of the damage. The court sustained our motion and gave the same relief to the independent contractor. The jury found in favor of the people who sold the property to the Plaintiffs. The net result was that the Plaintiffs lost resoundingly on every possible issue in the case.

  The main lesson to be learned from this case is to make sure that you understand the proper measure of damages that the plaintiff must prove. Then, consideration should be given to resisting the temptation to move for summary judgment. Such a motion telegraphs where you are going to the plaintiff, gives him time to figure out the weaknesses in his case and to try to do something about them. In addition, most trial judges are appropriately reluctant to grant summary judgment, knowing that about half of them are going to reversed on appeal anyway. By waiting until the plaintiff had announced ready during the trial, and then asking the court to render judgment on the pleadings (or moving for instructed verdict at the appropriate time), the plaintiff was caught completely off-guard and ill-prepared to respond.

  This trial also gave us an updated look at Collin County juries and they are still very conservative. The plaintiff has to prove his case there. They will not connect any of the dots for the plaintiff and hold him to his burden of proof.

 

 

 

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