Bowmaster ex rel. Bowmaster v. Clair

• Decision Date: 15 August 2007
• Citation: 933 A.2d 86
• Parties: Emily D. BOWMASTER, an Incapacitated Person, by and Through Donna BOWMASTER and James R. Bowmaster, Jr., Court-Appointed Guardians of The Estate and Person Emily D. Bowmaster, Appellant. v. Gerald CLAIR and Centre Community Hospital, A Corporation. Appeal of Emily D. Bowmaster.
• Court: Pennsylvania Superior Court

933 A.2d 86

Emily D. BOWMASTER, an Incapacitated Person, by and Through Donna BOWMASTER and James R. Bowmaster, Jr., Court-Appointed Guardians of The Estate and Person Emily D. Bowmaster, Appellant. v. Gerald CLAIR and Centre Community Hospital, A Corporation Appeal of Emily D. Bowmaster.

Superior Court of Pennsylvania.

Argued May 1, 2007.

Filed August 15, 2007.

Reargument Denied October 25, 2007.

Paul A. Hilko, Pittsburgh, for appellant.

Lisa B. Dees, Harrisburg, for Pa. Dept. of Public Welfare, appellee.

BEFORE: STEVENS, KLEIN, and PANELLA, JJ.

OPINION BY STEVENS, J.:

¶ 1 Emily D. Bowmaster, "Emily" an incapacitated person, by and through Donna and James R. Bowmaster, Jr., "parents", Court appointed guardians of her Estate and Person, and collectively referred to as "Appellants", appeal the November 6, 2006 order of the Court of Common Pleas of Centre County, which ordered that the Trustee of the Special Needs Trust for the benefit of Emily Bowmaster reimburse the Pennsylvania Department of Public Welfare, "DPW", in the amount of $56,517.81 in satisfaction of DPW's subrogation lien. We reverse and remand for a determination as to what extent medical benefits were paid subsequent to the minor reaching the age of majority. The motion to seal portions of the record filed by Appellee, Centre Community Hospital, is denied as moot.

¶ 2 The relevant facts and procedural history, as stated by the trial court, are as follows:

On October 11, 1985, [Appellant] Emily Bowmaster was born with severe birth defects, including mental retardation.

On August 14, 2003, [Appellants] filed a Complaint against Defendants, alleging Defendants' negligence was the proximate cause of Emily's injuries.

After the commencement of the suit, [Appellants] contacted [DPW]. [Appellants] informed DPW of the litigation and inquired as to any lien that DPW may be asserting, since Emily had been receiving Medical Assistance ("MA") benefits. DPW provided [Appellants] with a statement of claim, which indicated $86,092.53 had been spent on Emily's medical care. However, DPW later issued a new statement of claim, in which it amended the amount spent on Emily's medical expenses to $79,193.12. The first statement of claim erroneously included Emily's educational expenses.

On July 25, 2006, [Appellants] negotiated a settlement of their claim against Defendants.

On August 31, 2006, [Appellants] filed a Petition for Leave to Settle an Incapacitated Person's Case. [The trial court] signed an Order settling the case. The Order required $56,517.81 to be set aside until [the trial court] determined the amount, if any, which must be repaid to DPW to satisfy its lien. This figure was arrived at based on the amount DPW asserted it had spent on Emily's medical care, reduced by applicable attorneys' fees and costs.

[Appellants] and DPW both submitted Briefs to [the trial court] on the issue of DPW's lien. Based on the arguments advanced in the Briefs, [the trial court] issued an Opinion and Order dated November 6, 2006, which directed the Trustee of the Special Needs Trust for the benefit of Emily Bowmaster to reimburse DPW in the amount of $56,517.81.

On November 16, 2006, [Appellants] filed a Notice of Appeal of [the trial court's] November 6, 2006 Opinion and Order. [Appellants] also filed a "Statement of Matters Complained of on Appeal."

Trial Court Opinion Pursuant to Pa.R.A.P. 1925(a) 11/27/06 at 1-2.

¶ 3 Appellant presents the following issues for our review:

(1) Pennsylvania law recognized that medical expenses incurred before a minor-plaintiff reaches age eighteen can be recovered only by the parents of the minor-plaintiff. Emily's parents' potential claim for past medical expenses was time barred because no claim was filed within two years of Defendants' negligent acts. As a result, did the court err in concluding that DPW has a viable subrogation claim for medical services provided to Emily as a minor?

(2) DPW's subrogation rights were legislatively limited to its actual expenditures under the medical assistance program. Some of Emily's medical expenses were paid by a managed care organization to which DPW paid a monthly capitation rate. DPW's subrogation lien is limited to the capitation rate. Was the trial court's application of recent legislation changing this principle to the present case an impermissible retroactive application of the amendment and thus an error of law?

Brief of Appellant at 4.¹

¶ 4 Appellants claim that DPW was not entitled to the reimbursement of medical expenses to the extent the reimbursement covered amounts paid during Appellant's, Emily's, minority. Appellants argument is based on a novel issue in this case. The parties do not dispute that the parents did not bring an action to recover medical expenses for the period covering Emily's minority. However, a dispute arises as to how provisions found in the Fraud and Abuse Control Act, 62 P.S. § 1401 et seq., are to be applied in such a situation.

¶ 5 In order to reach the underlying merits of the issue presented, we must necessarily set forth certain general principles governing the payment and collection of benefits paid on behalf of a minor. Relevantly, with regard to the statute of limitations, this Court has stated:

The statute of limitations begins to run as soon as the right to institute and maintain a suit arises. The statute of limitations required aggrieved individuals to bring their claims within a certain time of the injury, so that the passage of time does not damage the defendant's ability to adequately defend against claims made. Once the prescribed statutory period for commencing a cause of action has expired, the complaining party is barred from bringing suit.

Bowe v. Allied Signal, Inc., 806 A.2d 435, 439 (Pa.Super.2002) (citations omitted).

¶ 6 [42 Pa.C.S.A. § 5533(b) provides:]

(b) Infancy.—If an individual entitled to bring action is an unemancipated minor at the time the cause of action accrues, the period of minority shall not be deemed a portion of the time period within which the action must be commenced. Such person shall have the same time for commencing an action after attaining majority as is allowed to others by the provisions of this subchapter. As used in this subsection the term "minor" shall mean any individual who has not yet attained the age of 18.

...

Under Pennsylvania Law personal injury to a minor gives rise to two separate and distinct causes of action, one the parents claim for medical expenses and loss of the minor's services during minority, the other the minor's claim for pain and suffering and for losses after minority.

Parents may pursue their claims . . . even where the child's claim is barred. If both the parent and the child have claims against a defendant for injury to the child, the parents may prevail while the child loses. The claims of [parents] are not derivative of their [child's] claim. Their claim may be barred while [the child's] is still assertable.

Hathi v. Krewstown Park Apartments, 385 Pa.Super. 613, 561 A.2d 1261, 1262 (1989) (citations and quotation marks omitted). In Hathi, this Court determined that the parents in that case were not entitled to use infancy tolling provisions so that the statute of limitations operated to bar their claims. See also Fancsali v. University Health Center of Pittsburgh et al., 563 Pa. 439, 761 A.2d 1159 (2000) (holding statute of limitations runs on parents' medical malpractice action within two years of when suit could have been brought but statute does not apply during child's minority so that child could bring action two years after age of majority reached).

¶ 7 Based on these principles, it is clear Emily could not have asserted a claim for medical expense in her own right during her time of minority. Further, parents did not assert the claim during the applicable time allotted so that parents were time-barred from raising the claims when the suit commenced in 2003. Therefore, we must decide whether DPW would still be entitled to any amount of the settlement obtained by Emily.

¶ 8 Appellants claim DPW should not be allowed to collect medical expenses paid during Emily's minority because Emily could not, and parents did not, recover such medical expenses so that none of the funds set forth within the settlement agreement pertained to those expenses. DPW refutes this claim citing to provisions found in 62 P.S. § 1409(b)(1), (7), (9) and (11). These sections provide as follows:

(b)(1) When benefits are provided or will be provided to a beneficiary under this section because of an injury for which another person is liable, or for which an insurer is liable in accordance with the provisions of any policy of insurance issued pursuant to Pennsylvania insurance laws and related statutes the department shall have the right to recover from such person or insurer the reasonable value of benefits so provided. The Attorney General or his designee may, at the request of the department, to enforce such right, institute, and prosecute legal proceedings against the third person or insurer who may be liable for the injury in an appropriate court, either in the name of the department or in the name of the injured person, his guardian, personal representative, estate or survivors.

(7) In the event of judgment, award or settlement in a suit or claim against such third party or insurer:

(i) If the action or claim is prosecuted by the beneficiary alone, the court or agency shall first order paid from any judgment or award the reasonable litigation expenses, as determined by the court, incurred in preparation and prosecution of such action or claim, together with reasonable attorney's fees, when an attorney has been retained. After payment of such expenses and attorney's fees the court or agency shall, on the application of the department, allow as a first lien against the amount of such judgment of award, the amount of the expenditures for the benefit of the...