Grandelli v. Companion Life Insurance Company

Filing 59

ORDER denying 39 Motion for Partial Summary Judgment; denying 26 Motion for Partial Summary Judgment; denying 58 Motion for Partial Summary Judgment by Judge R. Brooke Jackson on 4/28/15.(jdyne, )

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLORADO
Judge R. Brooke Jackson
Civil Action No. 13-cv-02162-RBJ-MEH
BRIAN GRANDELLI,
Plaintiff,
v.
COMPANION LIFE INSURANCE COMPANY,
Defendant.

ORDER

This case comes before the Court on Plaintiff’s Motion for Partial Summary Judgment
Re: Application of Contracted Medical Rates [ECF No. 26] and Defendant’s Cross-Motion for
Partial Summary Judgment Re: Application of Contracted Medical Rates [ECF No. 39]. Plaintiff
invokes jurisdiction pursuant to 28 U.S.C. § 1332. The cross-motions are denied.
The Court will also take a moment at the end to address the plaintiff’s latest motion,
entitled Plaintiff’s Motion for Partial Summary Judgment Re: Second Policy Purported
Misrepresentation Defense [ECF No. 58]. Although the defendant’s time to respond has not
expired, it is evident on the face of the motion (and given the Court’s knowledge of the case
through the several other dispositive motions that have been filed) that there is a genuine dispute
of material fact that requires the denial of that motion as well.
BACKGROUND
On May 10, 2012, the plaintiff Brian Grandelli injured his spine while moving equipment
as part of his employment as manager of a restaurant. His workers’ compensation carrier

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covered the treatment costs associated with this spinal injury. During the course of treatment, it
was determined that Mr. Grandelli had developed cancer on certain vertebrae of his spine, and he
began receiving radiation treatment and chemotherapy to kill the cancer cells. Mr. Grandelli
submitted the charges associated with the radiation treatment and chemotherapy to Companion,
his health insurance provider.
While certain payments remain outstanding and in dispute in this action, these crossmotions for partial summary judgment concern payments already made by Companion to two
treatment providers: Presbyterian St. Luke Medical Center (“PSL”) and Rose Medical Center
(“RMC”). There is no dispute that Companion made payments to PSL and RMC, and that the
only amounts the hospitals consider outstanding are Mr. Grandelli’s deductible and co-insurance
obligations. The matter at issue is whether Companion was permitted by law to make discounted
payments pursuant to agreements with the hospitals, or whether it was obligated to pay the full
bill originally issued.
STANDARD OF REVIEW
“Summary judgment is appropriate ‘if the pleadings, the discovery and disclosure
materials on file, and any affidavits show that there is no genuine issue as to any material fact
and that the movant is entitled to judgment as a matter of law.’” Utah Lighthouse Ministry v.
Found. for Apologetic Info. & Research, 527 F.3d 1045, 1050 (10th Cir. 2008) (quoting Fed. R.
Civ. P. 56(c)). When deciding a motion for summary judgment, the Court considers “the factual
record, together with all reasonable inferences derived therefrom, in the light most favorable to
the non-moving party . . . .” Id. The moving party has the burden of producing evidence
showing the absence of a genuine issue of material fact. Celotex Corp. v. Catrett, 477 U.S. 317,
325 (1986). In challenging such a showing, the non-movant “must do more than simply show

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that there is some metaphysical doubt as to the material facts.” Matsushita Elec. Indus. Co. v.
Zenith Radio Corp., 475 U.S. 574, 586 (1986). “Only disputes over facts that might affect the
outcome of the suit under the governing law will properly preclude the entry of summary
judgment.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). A dispute of a genuine
fact is material if “the evidence is such that a reasonable jury could return a verdict for the
nonmoving party.” Id.
ANALYSIS
I. Cross Motions for Partial Summary Judgment Re: Application of Contracted Medical
Rates [ECF Nos. 26, 39]
This issue comes before the court because Companion made payments to PSL and RMC
at a discounted rate as opposed to at the “reasonable and customary” rate, i.e., the amount
originally billed. Mr. Grandelli argues that Companion was not legally permitted to pay PSL or
RMC at discounted rates and asks this Court to require Companion “to make full payment of all
treatment charges which were reduced.” [ECF No. 26 at 11]. Yet, neither hospital contests the
payments it received or is attempting to secure the balance of the original bills from Mr.
Grandelli. [See ECF Nos. 39-6, 46-1]. To be frank, it is unclear why this matter is before the
Court at all. Mr. Grandelli has no authority to bring a claim on behalf of PSL or RMC, and the
Court is aware of no injury directly befalling Mr. Grandelli.
“[T]hose who seek to invoke the jurisdiction of the federal courts must satisfy the
threshhold requirement imposed by Article III of the Constitution by alleging an actual case or
controversy.” City of Los Angeles v. Lyons, 461 U.S. 95, 101 (1983) (citations omitted). “[T]he
irreducible constitutional minimum of standing contains three elements.” Lujan v. Defenders of
Wildlife, 504 U.S. 555, 560 (1992). First, the plaintiff must suffer an “injury in fact” that is (a)

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concrete and particularized and (b) actual or imminent, not conjectural or hypothetical.
Whitmore v. Arkansas, 495 U.S. 149, 155 (1990). Second, there must be a causal connection
between the injury and the conduct complained of. Lujan, 504 U.S. at 560. Finally, it must be
likely, not merely speculative, that the injury will be redressed by a favorable decision. Id. at
561.
Standing is “an indispensable part of the plaintiff’s case” such that “each element must be
supported in the same way as any other matter on which the plaintiff bears the burden of proof,
i.e., with the manner and degree of evidence required at the successive stages of the litigation.”
Id. At the summary judgment stage, the plaintiff “must set forth by affidavit or other evidence
‘specific facts’” supporting standing. Id. (citing Fed. R. Civ. P. 56(e)). “A federal court is
powerless to create its own jurisdiction by embellishing otherwise deficient allegations of
standing.” Whitmore, 495 U.S. at 155–56.
The plaintiff fails to show that he has suffered an “injury in fact.” “Abstract injury is not
enough.” Lyons, 461 U.S. 95 at 101. “The plaintiff must show that he ‘has sustained or is
immediately in danger of sustaining some direct injury’ . . . and the injury or threat of injury
must be both ‘real and immediate,’ not ‘conjectural’ or ‘hypothetical.’” Id. at 101–02 (citations
omitted). Mr. Grandelli has filed no affidavit alleging and has put forth no other evidence
showing that he has sustained or is in immediate danger of sustaining some direct injury. In fact,
the only argument concerning injury is made by plaintiff’s counsel in its brief to the Court, and it
is conjectural at best. In particular, Mr. Grandelli’s counsel argues that if PSL or RMC should
one day contest the reduced payments each received, Mr. Grandelli would be liable for the
difference between the discounted rates and the billed amount. [See ECF No. 26 at 9–10].
Further, counsel argues that Mr. Grandelli has “an affirmative obligation” to inform the hospitals

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about the allegedly incorrect payments they received, lest he be “complicit in the method of
conducting business utilized by Companion.” Id. at 10.
Mr. Grandelli is free to communicate with the hospitals about whatever he so chooses.
Simply because he believes he has a legal or moral duty to disclose information to them—
information which seems to have already been disclosed considering the affidavits prepared by
PSL and RMC representatives [See ECF Nos. 39-6, 46-1]—does not mean that he also has
standing to seek the relief requested. Mr. Grandelli has suffered no “actual injury,” and future
injury is conjectural at best.
Because the plaintiff does not have standing to bring this motion, Companion’s crossmotion for summary judgment is moot.
II. Plaintiff’s Motion for Partial Summary Judgment Re: Second Policy Purported
Misrepresentation Defense [ECF No. 58]
Just before issuing this order it came to my attention that the plaintiff filed yet another
motion for partial summary judgment in this action. As both parties know, trial is fast
approaching. While this motion was filed prior to the dispositive motions filing deadline (April
30, 2014), the motions that have been filed to date have been replete with genuine disputes of
material fact. This most recent motion is no different. In it, the plaintiff asserts that Companion
knew of his medical condition such that he could not be held accountable for allegedly providing
false information in his policy application. I have no doubt that Companion will deny this
allegation, and will instead provide documents of its own purporting the opposite. The
arguments, like those raised in the past, are a classic “he said, she said” dispute. Disagreements
over what the parties subjectively knew at what time are not apt for resolution on summary
judgment, and instead must be heard by the trier of fact.

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In this latest motion the plaintiff indicates that he will be filing yet another motion for
partial summary judgment before the filing deadline. [See ECF No. 58 at 3]. Filing a stream of
motions for summary or partial summary judgment creates expenditures of time by the defendant
and additional attorney’s fees on both sides. Accordingly, unless the plaintiff (or the defendant)
can present an issue of law to be decided by the Court on truly undisputed facts—which hasn’t
happened yet—I request that no additional dispositive motions be filed.
ORDER
For the foregoing reasons, all three Motions for Partial Summary Judgment [ECF Nos.
26, 39, 58] are DENIED.
DATED this 28th day of April, 2014.

BY THE COURT:

___________________________________
R. Brooke Jackson
United States District Judge

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