Dameron Hospital Association v. State Farm Mutual Automobile Insurance Company
Filing
72
TENTATIVE RULING signed by Judge Garland E. Burrell, Jr. on 9/7/2012 GRANTING sua sponte summary judgment in favor of Defendant. (Zignago, K.)
1
2
3
4
5
IN THE UNITED STATES DISTRICT COURT
6
FOR THE EASTERN DISTRICT OF CALIFORNIA
7
8
9
DAMERON HOSPITAL ASSOCIATION, a
California Non-Profit
Association,
10
11
12
)
)
)
)
)
)
)
)
)
)
)
)
)
Plaintiff,
v.
13
STATE FARM MUTUAL AUTOMOBILE
INSURANCE COMPANY,
14
Defendant.
________________________________
2:10-cv-03396-GEB-JFM
TENTATIVE RULING GRANTING SUA
SPONTE SUMMARY JUDGMENT IN
FAVOR OF DEFENDANT
15
16
In reviewing the pending cross-motions for summary judgment,
17
it appears “the undisputed facts entitle [Defendant State Farm Mutual
18
Automobile Insurance Company (‘State Farm’)] to judgment as a matter of
19
law” on Plaintiff Dameron Hospital Association’s (“Dameron”) complaint
20
for a reason not briefed by the parties. Portsmouth Square, Inc. v.
21
S’holders Prot. Comm., 770 F.2d 866, 869 (9th Cir. 1985). Therefore, for
22
the reasons stated below, the Court tentatively grants summary judgment,
23
sua sponte, in favor of State Farm.
24
Dameron alleges in its complaint that it provided emergency
25
medical treatment to three individuals who were involved in automobile
26
accidents and had uninsured motorist coverage through Defendant State
27
Farm Mutual Insurance Company (“State Farm”). Dameron alleges each
28
individual assigned his or her uninsured motorist benefits to Dameron;
1
1
Dameron notified State Farm of the assignments; and State Farm refused
2
to pay Dameron. Dameron seeks money damages in the amount of $44,714
3
plus interest and declaratory relief concerning State Farm’s alleged
4
failure to honor the assignments of benefits. Dameron also seeks an
5
injunction against State Farm under California’s Unfair Competition Law
6
(“UCL”), California Business and Professions Code section 17200 et seq.,
7
concerning State Farm’s failure to honor the assignments. State Farm
8
seeks summary judgment on both of Dameron’s claims. Dameron seeks
9
summary judgment on its failure to honor assignments claim.
10
I. LEGAL STANDARD
11
“District courts unquestionably possess the power to enter
12
summary judgment sua sponte, even on the eve of trial.” Norse v. City of
13
Santa Cruz, 629 F.3d 966, 971 (9th Cir. 2010). As prescribed in Federal
14
Rule
15
reasonable time to respond, the court may . . . consider summary
16
judgment on its own after identifying for the parties material facts
17
that may not be genuinely in dispute.”
18
of
Civil
Procedure
56(f)(3):
“[a]fter
giving
notice
and
a
II. UNCONTROVERTED FACTS
19
This case concerns the following Dameron patient accounts and
20
corresponding State Farm policy numbers: Michael G., Dameron account
21
number *****0549 ($4,764.00), State Farm policy number 1147-196-55
22
(“Insured One”); Irma P., Dameron account number *****6610 ($37,768.39),
23
State Farm policy number 1843-278-05A (“Insured Two”); and Dep. N.,
24
Dameron account number *****5185 ($2,181.46), State Farm policy number
25
112 9678-C25-55B (“Insured Three,” and collectively, “Insureds”). (State
26
Farm’s Statement of Undisputed Facts in Support of Summ. J. (“State
27
Farm’s SUF”) # 17-18, 29-30 & 45-46; Dameron’s Statement of Add’l Facts
28
in Support of Opp’n (“Dameron’s SAF”) # 3.)
2
1
“Insured One . . . was involved in an automobile accident on
2
April
3
$50,000/$100,000” on that date. (State Farm’s SUF # 17-18.) “Insured One
4
complained of pain to the top of his head” at the scene of the accident
5
and “was taken by ambulance . . . to Dameron.” Id. # 20-21. “At Dameron,
6
Insured One signed [Dameron’s] Conditions of Admission form.” Id. # 22-
7
23. “[He] was diagnosed with a concussion . . . [and] Dameron noted that
8
[he] had ‘mild intoxication clinically.’” (State Farm’s Statement of
9
Additional Facts in Support of Opp’n (“State Farm’s SAF”) # 17-18.)
10
However, a physician stated that Insured One “was oriented . . . to
11
person, place and time.” (Genicoff Test. 23:8-11, Mar. 30, 2012.)
29,
2009”
and
had
“uninsured
motorist
coverage
of
12
“On August 13, 2009, Dameron advised State Farm of its claim
13
that all of Insured One’s insurance benefits, of any kind, had been
14
assigned
15
provision contained [in] the Conditions of Admissions form.” (State
16
Farm’s SUF # 25.) “Dameron requested that if any uninsured motorist
17
funds are recoverable that State Farm make direct payment to Dameron for
18
its charges of $4,764.00 for medical services rendered to Insured One.”
19
Id. # 26. “On April 15, 2010, State Farm settled Insured One’s uninsured
20
motorist claim for $25,000, inclusive of any and all liens[,]” and
21
“issued the settlement draft of $25,000 [on the same day], made payable
22
to Insured One and his attorney, Dean Cooper.” Id. # 27-28.
23
directly
to
Dameron
based
on
the
Assignment
of
Benefits
“Insured Two . . . was involved in an automobile accident on
24
August
25
$30,000/$60,000.” Id. # 29-30. “At the scene of the accident, the
26
officer described in the police report [Insured Two’s] injuries as
27
follows: ‘Laceration to back of head, abrasions to right arm, right
28
hand, and complaint of pain to all body.’” Id. #32. Insured Two was
6,
2008”
and
had
“uninsured
3
motorist
coverage
of
1
taken by ambulance to Dameron, where she “was diagnosed as follows:
2
‘Head injury with concussion unknown loss of consciousness (unknown
3
LOC), ADDITIONAL: Cervical strain (whiplash), Hand contusion/ABRASION,
4
Scalp laceration. Subarachnoid hemorrhage–traumatic.’” Id. # 34 & 37.
5
“At Dameron, Insured Two signed the Conditions of Admission form.” Id.
6
# 36.
7
“On February 2, 2010, Insured Two’s attorney, Walter Wroten
8
[(‘Wroten’),] wrote to State Farm and stated that Insured Two ‘[would]
9
satisfy any and all liens in this matter and . . . ask[ed] that State
10
Farm issue payment of the policy limits of $30,000.00 immediately.”
11
(State Farm’s SUF # 41.) “On February 15, 2010, Dameron advised State
12
Farm of its claim that all of Insured Two’s insurance benefits, of any
13
kind, had been assigned directly to Dameron based on the Assignment of
14
Benefits provision” and that “it agreed to compromise its assignment
15
claim from $37,768.39 to $15,000.00 for payment upon settlement of
16
Insured Two’s uninsured motorist claim.” Id. # 39-40. “On February 16,
17
2010, State Farm issued the settlement draft in the amount of $30,000,
18
made payable to Insured Two and her attorney, in settlement of Insured
19
Two’s uninsured motorist claim.” Id. # 43.
20
“Insured Three . . . was involved in an automobile accident on
21
April 22, 2006.” Id. # 45. Insured Three had “uninsured motorist
22
coverage of $250,000/$500,000” and “medical payments coverage of $5,000
23
per person.” Id. # 46-47. Insured Three complained of pain to her neck,
24
chest, and back, and was taken by ambulance to Dameron. Id. # 48-49. “At
25
Dameron, Insured Three was presented with the Conditions of Admission
26
form,” but “Dameron’s admitting staff member noted on the . . . form
27
that Insured Three was ‘unable’ to sign [it].” Id. # 50-51. “Insured
28
Three’s emergency room record from Dameron stated that she is non4
1
English speaking.” Id. # 52. “On July 25, 2006, Attorney Julie Pulliam
2
[(‘Pulliam’)] sent correspondence to State Farm[,] . . . advised that
3
she represented Insured Three[, and] . . . specifically requested that
4
any payments be made to her and Insured Three . . . ‘[regardless of any]
5
assignment of benefits[.]’” Id. # 55-56. In 2007, State Farm paid
6
Insured Three’s medical payments coverage limit of $5,000.00 and an
7
additional $5,000.00 as settlement for her uninsured motorist claim to
8
Insured Three and her attorney. Id. # 60-62. On October 8, 2009,
9
“Dameron advised State Farm of its claim that all of Insured Three’s
10
first party benefits had been assigned to Dameron under the Conditions
11
of Admission.” Id. # 54; Letter from Dameron to State Farm, Oct. 8,
12
2009, Pl.’s Evidence Ex. 21.
13
III. DISCUSSION
14
Dameron argues it “has established all [the elements of an
15
assignment for each Insured] through competent evidence.” (Dameron’s
16
Mot. 7:22-27.) State Farm argues, inter alia, “Dameron’s assignment of
17
benefits provision is unenforceable.” (State Farm’s Opp’n 6:12-13; State
18
Farm’s Mot. for Summ. J. 9:10-11.) State Farm also moves for summary
19
judgment in its favor on Dameron’s UCL
20
“[An] assignee may recover from the debtor of the assignor
21
with notice, upon allegation and proof that the debtor, after notice,
22
paid the assignor.” St. Paul Fire & M. Ins. Co. v. James I. Barnes
23
Const. Co., 29 Cal. 2d 691, 692 (1963). “The burden of proving an
24
assignment falls upon the party asserting rights thereunder.” Cockerell
25
v. Title Ins. & Trust Co., 42 Cal. 2d 284, 292 (1954) (citations
26
omitted). “While no particular form of assignment is necessary, [an]
27
assignment, to be effectual, must be a manifestation to another person
28
by the owner of the right indicating his intention to transfer, without
5
1
further action or manifestation of intention, the right to such other
2
person, or to a third person.” Cockerell, 42 Cal. 2d at 291. “In
3
determining whether an assignment has been made, ‘the intention of the
4
parties as manifested in the instrument is controlling.’” Cal. Ins.
5
Guarantee Ass’n v. Workers Comp. Appeals Bd., 203 Cal. App. 4th 1328,
6
1335 (2012) (quoting Nat’l. Reserve Co. of Am. v. Metro. Trust Co. of
7
Cal., 17 Cal. 2d 827, 832 (1941)). Further, “the evidence must not only
8
be sufficient to establish the fact of assignment when that fact is in
9
issue[,] but the measure of sufficiency requires that the evidence of
10
assignment be clear and positive to protect an obligor from any further
11
claim by the primary obligee.” Cockerell, 42 Cal. 2d at 291 (citations
12
omitted).
13
Dameron argues “[e]ach patient . . . assented to a [Conditions
14
of Admission agreement] that contains an enforceable assignment of all
15
insurance benefits to Dameron.” (Dameron’s Mot. 5:11-12.) The Assignment
16
of Benefits provision in the Conditions of Admission form states in
17
full:
18
ASSIGNMENT OF INSURANCE BENEFITS
19
The undersigned authorizes, whether he/she signs as
agent or as patient, direct payment to the hospital
and the physicians specifically associated with the
patient’s medical care, of any insurance benefits
otherwise payable to or on behalf of the
undersigned for this hospitalization or for these
outpatient services, outpatient observation care,
including emergency services if rendered, at a rate
not to exceed the provider’s regular charges. It is
agreed that payment to the hospital, pursuant to
this authorization, by an Insurance company shall
discharge said Insurance company of any and all
obligations under a policy to the extent of such
payment. It is understood by the undersigned that
he/she is financially responsible for charges not
covered by this agreement.
20
21
22
23
24
25
26
27
28
6
1
(State Farm’s SUF # 4-5, 14-15; State Farm’s Evid. in Support of Summ.
2
J. Ex. 4-6.)
3
“Under California law, the interpretation of a contract is a
4
question of law[.]” In re Bennett, 298 F.3d 1059, 1064 (9th Cir. 2002)
5
(citation omitted). California civil Code section 1638 prescribes: “The
6
language of a contract is to govern its interpretation, if the language
7
is clear and explicit, and does not involve an absurdity.” In addition,
8
“[a] written contract must be read as a whole and every part interpreted
9
with reference to the whole.” Shakey’s Inc. v. Covalt, 704 F.2d 426, 434
10
(9th Cir. 1983) (citation omitted).
11
Dameron argues the provision above operates as an assignment
12
of an insured’s right to payment of his or her uninsured motorist
13
benefits. However, the words “assign” or “transfer” or some variation
14
thereof do not appear in the text of the provision. Cf. Nat’l Reserve
15
Co. of Am. v. Metro. Trust Co. of Cal., 17 Cal. 2d 827, 831 (1941)
16
(finding “language of assignment” in a provision that stated “the
17
undersigned hereby assigns and transfers all of his right, title and
18
interest in and to the hereinabove property”) (emphasis in original);
19
Whiteside v. Tenet Healthcare Corp., 101 Cal. App. 4th 693, 699 (2002)
20
(involving a provision similar to the one in this case: “The undersigned
21
assigns and hereby authorizes . . . direct payment to the hospital of
22
all insurance and plan benefits”).
23
Rather, the provision “authorizes . . . direct payment to
24
[Dameron or its physicians.]” (State Farm’s Evid. in Support of Summ. J.
25
Ex. 4-6.) The term “authorize” means “to give a right or authority to
26
act
27
‘permitted[.]’” BLACK ’S LAW DICTIONARY 133 (6th Ed. 1990). The meaning of
28
the provision on which Dameron relies is “clear and explicit”: State
.
.
.
[and
it]
is
sometimes
7
construed
as
equivalent
to
1
Farm
2
contract language does not evince an “intention to transfer, without
3
further action or manifestation of intention, the right” to receive
4
payment of uninsured motorist benefits. Cockerell, 42 Cal. 2d at 291
5
(emphasis added).
has
its
insured’s
permission
to
pay
Dameron.
Therefore,
the
6
The contract language on which Dameron relies does not operate
7
as an assignment. Since State Farm moves for summary judgment on this
8
claim based on its argument that the provision is not an enforceable
9
assignment of benefits, summary judgment is granted in favor of State
10
Farm on Dameron’s failure to honor assignment of benefits claim.
11
In addition, Dameron’s UCL claim is based on its argument that
12
State Farm has engaged in an “unlawful,” “unfair and systematic scheme
13
to violate the assignment of first-party insurance benefits to Dameron.”
14
(Dameron’s Opp’n 10:27-11:4.) Since this claim is based on the failure
15
to honor assignments claim, summary judgment is entered in favor of
16
State Farm on this claim as well.
17
Any party may file and serve written objections to any part of
18
this tentative ruling no later than fourteen (14) days after the date on
19
which this order is filed. Any objection must specify the requested
20
correction, addition, and/or deletion. If no objection is filed, this
21
tentative ruling will become final without further order of this Court,
22
and the Clerk of Court will be directed to enter judgment for Defendant.
23
Dated:
September 7, 2012
24
25
26
GARLAND E. BURRELL, JR.
Senior United States District Judge
27
28
8
Disclaimer: Justia Dockets & Filings provides public litigation records from the federal appellate and district courts. These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia.
Why Is My Information Online?