John Hargett v. Blue Cross Blue Shield of Alabama

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REL: 2/11/2011 Notice: T h i s o p i n i o n i s s u b j e c t t o f o r m a l r e v i s i o n b e f o r e p u b l i c a t i o n i n t h e advance s h e e t s o f Southern R e p o r t e r . R e a d e r s a r e r e q u e s t e d t o n o t i f y t h e R e p o r t e r o f D e c i s i o n s , A l a b a m a A p p e l l a t e C o u r t s , 300 D e x t e r A v e n u e , M o n t g o m e r y , A l a b a m a 3 6 1 0 4 - 3 7 4 1 ((334) 2 2 9 - 0 6 4 9 ) , o f a n y t y p o g r a p h i c a l o r o t h e r e r r o r s , i n o r d e r t h a t c o r r e c t i o n s may b e made b e f o r e t h e o p i n i o n i s p r i n t e d i n Southern R e p o r t e r . ALABAMA COURT OF CIVIL APPEALS OCTOBER TERM, 2010-2011 2100015 John Hargett v. Blue Cross Blue S h i e l d o f Alabama Appeal from Lauderdale C i r c u i t Court (CV-09-287) THOMAS, J u d g e . John H a r g e t t a p p e a l s the Lauderdale Circuit f r o m a summary Court S h i e l d o f A l a b a m a ("BCBS"). subject-matter jurisdiction. i n favor judgment e n t e r e d by of Blue Cross Blue We d i s m i s s t h e a p p e a l f o r l a c k o f 2100015 Hargett had a long-term-care i n s u r a n c e p o l i c y w i t h BCBS. The p o l i c y , i s s u e d u n d e r c e r t i f i c a t e number 1116963, p r o v i d e d H a r g e t t w i t h a d a i l y b e n e f i t o f $120 a n d a b e n e f i t d u r a t i o n o f 1,825 days. February Hargett's monthly premium was $112.03. In 2006, H a r g e t t e l e c t e d t o change h i s d a i l y b e n e f i t t o $90, w h i l e k e e p i n g h i s b e n e f i t d u r a t i o n o f 1,825 d a y s , which resulted 2006, i n a new m o n t h l y premium o f $84.02. I n May H a r g e t t a g a i n e l e c t e d t o change h i s l o n g - t e r m - c a r e Hargett completed long-term-care a new a p p l i c a t i o n insurance policy. for a benefits. lifetime-benefit Because H a r g e t t sought a l i f e t i m e - b e n e f i t d u r a t i o n , BCBS r e q u i r e d H a r g e t t t o a health review survey and conducted of the p o l i c y a full application. complete medical underwriting As a r e s u l t of Hargett's a n s w e r s on t h e h e a l t h s u r v e y a n d a r e v i e w o f i t s u n d e r w r i t i n g guidelines, eligible which BCBS determined Hargett was no longer f o r a 1 0 % p r e f e r r e d - h e a l t h d i s c o u n t on h i s p o l i c y , he h a d b e e n r e c e i v i n g . 1 that BCBS i n f o r m e d Consequently, 1 BCBS determined Hargett: "Our d e c i s i o n t o a p p l y t h e s t a n d a r d r a t e f o r t h i s p o l i c y i s b a s e d on y o u r h i s t o r y o f h y p e r t e n s i o n which i s treated with Atenolol and Lotrel. According to the e s t a b l i s h e d underwriting guidelines y o u r r e s p o n s e t o Q u e s t i o n #8 i n t h e H e a l t h S t a t u s 2 2100015 t h a t H a r g e t t ' s m o n t h l y premium f o r t h e new p o l i c y , w h i c h BCBS i s s u e d u n d e r c e r t i f i c a t e number 1117715, was $124.53. On A u g u s t 13, 2008, H a r g e t t f i l e d a s t a t e m e n t the small-claims division In h i s statement a yet-to-be-determined of the Lauderdale of claim i n District Court. o f c l a i m , H a r g e t t a l l e g e d t h a t BCBS owed h i m sum o f money a n d r e q u e s t e d that the d i s t r i c t c o u r t a w a r d h i m a " [ p ] r e m i u m r e d u c t i o n o f $12.01 p e r month s i n c e i n c e p t i o n o f [ i n s u r a n c e p o l i c y ] c e r t i f i c a t e number 1117715." Following judgment a bench i n favor trial, o f BCBS judgment, t h e d i s t r i c t the d i s t r i c t on August court determined court 20, 2009. entered Ini t s that, "per t h e unambiguous p r o v i s i o n s o f t h e Group E n r o l l m e n t Agreement, [ B C B S ] p r o p e r l y performed f u l l m e d i c a l u n d e r w r i t i n g a t t h e time [ H a r g e t t ] chose t o upgrade h i s l o n g - t e r m care coverage to lifetime benefits. When a r e v i e w o f [ H a r g e t t ' s ] h e a l t h h i s t o r y r e v e a l e d t h a t [ H a r g e t t ] was n o t e n t i t l e d t o a d i s c o u n t e d premium f o r t h i s u p g r a d e d coverage, [BCBS] c o r r e c t l y a d j u s t e d h i s monthly insurance premium. A c c o r d i n g l y , t h i s C o u r t f i n d s t h a t [ B C B S ] has c o m m i t t e d no w r o n g d o i n g i n c o n n e c t i o n w i t h calculating [ H a r g e t t ' s ] monthly long-term care s e c t i o n o f t h e a p p l i c a t i o n d i s q u a l i f i e d you f o r t h e preferred rate. One must answer No t o q u e s t i o n s 1 t h r o u g h 11 i n t h i s s e c t i o n i n o r d e r t o q u a l i f y f o r the p r e f e r r e d r a t e . " 3 a 2100015 i n s u r a n c e premium a n d [ H a r g e t t ' s ] C o m p l a i n t i s due t o be d i s m i s s e d . " Hargett the c i r c u i t then appealed t o the c i r c u i t court. c o u r t f o r a summary j u d g m e n t . BCBS moved The c i r c u i t court e n t e r e d a summary j u d g m e n t i n f a v o r o f BCBS on J u l y 19, 2010. I n i t s summary j u d g m e n t , t h e c i r c u i t court determined: " T h i s C o u r t d e t e r m i n e s as a m a t t e r o f l a w t h a t , p e r t h e unambiguous p r o v i s i o n s o f t h e c o n t r a c t s a t issue, [BCBS] p r o p e r l y performed full medical u n d e r w r i t i n g a t t h e time [ H a r g e t t ] chose t o upgrade h i s long-term care coverage t o l i f e t i m e b e n e f i t s . When a r e v i e w o f [ H a r g e t t ' s ] h e a l t h h i s t o r y r e v e a l e d t h a t [ H a r g e t t ] was n o t e n t i t l e d t o a d i s c o u n t e d premium f o r t h i s u p g r a d e d c o v e r a g e , [ B C B S ] c o r r e c t l y a d j u s t e d h i s m o n t h l y i n s u r a n c e premium. T h i s C o u r t a l s o f i n d s t h a t t h e c l e a r and e x p r e s s p r o v i s i o n s o f t h e C e r t i f i c a t e do n o t p r e c l u d e BCBS f r o m r e q u i r i n g new premiums to accompany new coverage. Accordingly, this Court f i n d s t h a t [ B C B S ] has committed no wrongdoing in connection with calculating [Hargett's] monthly long-term care i n s u r a n c e premium f o r C e r t i f i c a t e No. 1117715 a n d [ H a r g e t t ' s ] C o m p l a i n t i s due t o be d i s m i s s e d . " Hargett f i l e d a postjudgment motion, which the c i r c u i t denied. Hargett Although subsequently neither appealed party to this addresses court court. this court's j u r i s d i c t i o n o v e r t h i s a p p e a l , we may t a k e n o t i c e o f a l a c k o f jurisdiction ex mero Thornton, 866 So. abrogated on o t h e r 2d motu. See 564, 568-69 Ruzic v. ex ( A l a . C i v . App. g r o u n d s b y F.G. v. S t a t e 4 State r e l . 2003), Dep't o f Human 2100015 Res., of 988 claim sought a So. 2d 555 that Hargett filed his premium in policy issued r e q u e s t e d t h a t the 2007). i n the reduction insurance insurance ( A l a . C i v . App. by district district for BCBS. court In the In statement court, his Hargett long-term-care essence, i n t e r p r e t the Hargett terms of his p o l i c y and d e c l a r e t h e amount o f h i s premium payment according to the requested that provisions the district of the court policy. order BCBS Hargett to also reimburse H a r g e t t f o r t h e amount o f t h e a l l e g e d e x c e s s i n premiums t h a t he had already n a t u r e o f an Section Declaratory 1975, paid. As such, action seeking 6-6-223, a declaratory Ala. Judgment A c t , Hargett's § Code a c t i o n was the judgment. 1975, a et seq., 6-6-220 in part of the Alabama Code provides: "Any p e r s o n i n t e r e s t e d under a deed, will, w r i t t e n c o n t r a c t , or o t h e r w r i t i n g s c o n s t i t u t i n g a c o n t r a c t o r whose r i g h t s , s t a t u s , o r o t h e r l e g a l relations are a f f e c t e d by a statute, municipal ordinance, contract, or franchise may have d e t e r m i n e d any q u e s t i o n o f c o n s t r u c t i o n o r v a l i d i t y a r i s i n g under the i n s t r u m e n t , statute, ordinance, c o n t r a c t , o r f r a n c h i s e and o b t a i n a d e c l a r a t i o n o f r i g h t s , s t a t u s or other l e g a l r e l a t i o n s thereunder." In t h i s case, Hargett sought a j u d i c i a l insurance i n t e r p r e t a t i o n of the p o l i c y and a d e c l a r a t i o n o f h i s r i g h t s and o f BCBS's 5 2100015 rights under premiums the upon Actions policy a seeking regarding change an of BCBS's Hargett's interpretation of recalculation benefit the of elections. p r o v i s i o n s of i n s u r a n c e p o l i c y f a l l u n d e r t h e D e c l a r a t o r y Judgment A c t . an See, g e n e r a l l y , H a r t f o r d Cas. I n s . Co. v. M e r c h a n t s & F a r m e r s Bank, 928 So. 2d 1006 So. 2d 822 ( A l a . 2005); ( A l a . 1997); A l a b a m a , I n c . , 631 Res. Ins. Co., So. 544 2d 975 So. statement Hargett v. A l l s t a t e Hutchinson 2d S t u y v e s a n t L i f e I n s . Co., Although Tate H i c k s v. ( A l a . 1989); 291 A l a . 716, requested a and Antram 287 So. 2d 837 monetary of American v. (1973) . award in o f c l a i m , t h a t does n o t p r e c l u d e H a r g e t t ' s from b e i n g a d e c l a r a t o r y - j u d g m e n t 692 v. A t t o r n e y s I n s . Mut. ( A l a . 1994); 952 I n s . Co., his action action. " S e c t i o n 6-6-230, Code o f A l a b a m a 1975, p r o v i d e s t h a t f u r t h e r r e l i e f may be g r a n t e d i n d e c l a r a t o r y j u d g m e n t a c t i o n s 'whenever n e c e s s a r y o r p r o p e r . ' T h i s a u t h o r i z e s a c o u r t t o g r a n t s u c h r e l i e f as i s n e c e s s a r y t o e f f e c t u a t e the d e c l a r a t o r y judgment e v e n t h o u g h s u c h s u p p l e m e n t a r y r e l i e f may c o n s i s t o f t h e g r a n t i n g o f a money j u d g m e n t i n t h e c a s e . " U n i t e d Servs. Auto. Civ. App. 334, 161 A s s ' n v. Pons , 383 So. 2d 166, 1 9 7 9 ) ( c i t i n g C l a r k v. E x c h a n g e I n s . A s s ' n , So. 2d 817 (1964)). Our stated: 6 supreme court 169 (Ala. 276 A l a . has also 2100015 "The mere f a c t t h a t p e c u n i a r y i n t e r e s t s were i n v o l v e d does n o t d e p r i v e t h e d e c l a r a t o r y j u d g m e n t act of a f i e l d of o p e r a t i o n . I n most l i t i g a t i o n i n v o l v i n g t h e l e g a l r i g h t s o f t h e p a r t i e s , some u n d e r l y i n g economic advantage or l o s s w i l l r e s u l t from the d e t e r m i n a t i o n of those l e g a l r i g h t s . " Broadwater (Ala. v. Blue & Gray P a t i o Club, 403 So. 2d 209, 212 1981). S e c t i o n 1 2 - 1 2 - 3 0 ( 3 ) , A l a . Code 1975, "[a]ctions matter seeking jurisdiction district d e c l a r a t o r y judgments" of the from the subject- d i s t r i c t court. Therefore, the the jurisdiction v. district over H a r g e t t ' s Pate, judgment w i l l 3 So. 3d not support v. C o l b u r n , ( q u o t i n g Vann v. 14 Cook, Consequently, jurisdiction court lacked complaint, 835, 838 appeal So. the So. i t s judgment i s v o i d . and "A void 'an a p p e l l a t e c o u r t from such a v o i d judgment.'" 3d 176, 989 subject-matter ( A l a . 2008). an a p p e a l , must d i s m i s s an a t t e m p t e d 2008)). over action. Because Colburn excludes c o u l d d i d n o t have s u b j e c t - m a t t e r j u r i s d i c t i o n Hargett's Riley expressly 2d 179 556, circuit ( A l a . C i v . App. 559 court 2009) (Ala. Civ. never App. acquired o v e r H a r g e t t ' s a p p e a l , and t h a t c o u r t c o u l d t a k e no a c t i o n o t h e r t h a n t o d i s m i s s H a r g e t t ' s a p p e a l . See Ex p a r t e Smith, 438 So. 2d 766, 768 (Ala. 1983)(opining 7 that, "on 2100015 appeal [for a trial subject matter jurisdiction judgment over which de novo], the c i r c u i t to consider the d i s t r i c t court court more than lack[s] a had s u b j e c t final matter jurisdiction"; c i t i n g S t a t e v. P o l l o c k , 251 A l a . 603, 38 So. 2d 870 a n d C r a i g v. R o o t , 247 A l a . 479, 25 So. 2d 147 (1948), (1946)). void. Because court So. Therefore, the c i r c u i t lacks j u r i s d i c t i o n 3d a t 179. instruct their the c i r c u i t Thus, the c i r c u i t court's we court dismiss APPEAL DISMISSED WITH P . J . , and judgment judgment over Hargett's appeal. Hargett's i s also i s void, this Colburn, appeal, and t h e d i s t r i c t c o u r t r e s p e c t i v e judgments i n t h i s Thompson, court's to 14 a n d we vacate case. INSTRUCTIONS. Pittman, concur. 8 Bryan, and Moore, J J . ,

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