Buatte v. Gencare Health Systems, Inc., No. 69962

CourtCourt of Appeal of Missouri (US)
Writing for the CourtRHODES RUSSELL
Citation939 S.W.2d 440
Docket NumberNo. 69962
Decision Date17 December 1996
PartiesLonnie and Theresa BUATTE, Respondents, v. GENCARE HEALTH SYSTEMS, INC., Appellant.

Page 440

939 S.W.2d 440
Lonnie and Theresa BUATTE, Respondents,
v.
GENCARE HEALTH SYSTEMS, INC., Appellant.
No. 69962.
Missouri Court of Appeals,
Eastern District,
Division Four.
Dec. 17, 1996.
Motion for Rehearing and/or Transfer to
Supreme Court Denied Feb. 5, 1997.
Application to Transfer Denied
March 25, 1997.

Theodore G. Pashos, Byrce M. Boswell, Amelung, Wulff & Willenbrock, St. Louis, for appellant.

Spencer E. Farris, Thomas C. Hullverson, The Hullverson Law Firm, St. Louis, for respondents.

Page 441

RHODES RUSSELL, Presiding Judge.

Gencare Health Systems, Inc. ("Gencare") appeals from the entry of summary judgment in favor of Lonnie and Theresa Buatte in their declaratory judgment action seeking interpretation of a subrogation provision of an insurance policy. The trial court found that state law governed and based the grant of summary judgment, in part, on Gencare's waiver of its right of subrogation. We find that federal law permitting subrogation preempted state law and that Gencare did not waive its right to subrogation. We reverse and remand.

In 1987 Lonnie and Theresa Buatte enrolled in the Sanus Health Benefit Plan ("Plan") 1 through Mr. Buatte's employment with the federal government. In 1990, while still enrolled in the Plan, Theresa Buatte was injured in a car accident involving a railroad company. As a result of the accident, she incurred $71,640.00 in medical expenses which were paid by Gencare.

The Buattes filed a personal injury action in the Circuit Court of the City of St. Louis against the railroad company. Gencare was informed about the suit and filed a petition to intervene in the action, however, it later withdrew its petition. The railroad settled the suit by paying $400,000 to the Buattes. Gencare requested that the Buattes reimburse it for the money it had spent on Theresa Buatte's medical expenses pursuant to the subrogation/reimbursement provisions of the Plan.

The Plan stated, in a section titled "Third Party Actions,":

If a covered person is injured through the act or omission of another, the Plan requires that it be reimbursed for the benefits provided, in an amount not to exceed the amount of the recovery or that it be subrogated to the person's rights to the extent of the benefits received under this Plan, including the right to bring suit in the person's name.

The Buattes refused to reimburse Gencare and filed a declaratory judgment action in the Circuit Court of the City of St. Louis seeking an interpretation of the Plan's subrogation provision. Gencare removed the action to the United States District Court. The district court remanded the case back to the state court stating that the action did not arise under federal law.

The Buattes filed a motion for summary judgment listing four grounds. First, they argued that Gencare had waived its right to subrogation by failing to intervene in the action against the railroad that was now settled. Second, they contended that their settlement with the railroad did not preclude Gencare from pursuing indemnification directly from the railroad. Third, they stated that there was no proof before the court that they were subject to any subrogation provision in the policy that covered them. Finally, they argued that the Plan's provision granting Gencare subrogation rights was contrary to the public policy of Missouri and void.

The trial court granted the motion for summary judgment based upon the Buattes' first three grounds and specifically found that Missouri law governed. Gencare now appeals the grant of summary judgment.

The standard of review for summary judgment cases is governed by ITT Commercial Finance Corp. v. Mid-America Marine Supply Corp. 854 S.W.2d 371 (Mo.banc 1993). When considering appeals from summary judgment, we review the record in the light most favorable to the party against whom judgment was entered. Id. The propriety of summary judgment is purely an issue of law. Our review is essentially de novo. Id. Summary judgments should only be maintained where facts are not in dispute, so that the prevailing party can be determined as a matter of law. Id.

In its first point on appeal, Gencare contends that the trial court erred in applying Missouri law, as the Federal Employees Health Benefits Act (FEHBA), 5 U.S.C.A. §§ 8901-8914, preempts state law where the provisions are inconsistent.

Missouri law, as a matter of public policy, does not allow an insurer to acquire part...

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11 practice notes
  • Nevils v. Grp. Health Plan, Inc., No. SC 93134.
    • United States
    • United States State Supreme Court of Missouri
    • February 4, 2014
    ...lien against Nevils's settlement of a personal injury claim. The trial court, consistent with Buatte v. Gencare Health Sys., Inc., 939 S.W.2d 440 (Mo.App.1996), entered summary judgment in favor of Respondents on grounds that 5 U.S.C. section 8902(m)(1) of the Federal Employee Health Benefi......
  • Aybar v. New Jersey Transit Bus Operations, Inc.
    • United States
    • New Jersey Superior Court – Appellate Division
    • October 14, 1997
    ...subrogation rights. Id. at 763. Accord Waller v. Hormel Foods Corp., supra, 950 F.Supp. at 945; Buatte v. Gencare Health Sys., Inc., 939 S.W.2d 440, 442 The State presents us with no case dealing with an anti-subrogation provision that holds such a provision is not preempted by FEHBA or ERI......
  • Helfrich v. Blue Cross & Blue Shield Ass'n & Blue Cross & Blue Shield of Kan. City, No. 13–2620–EFM–JPO.
    • United States
    • United States District Courts. 10th Circuit. United States District Courts. 10th Circuit. District of Kansas
    • August 5, 2014
    ...New Jersey Transit Bus Operations, 305 N.J.Super. 32, 701 A.2d 932, 937 (N.J.Super.Ct.App.Div.1997); Buatte v. Gencare Health Sys., Inc., 939 S.W.2d 440, 442 (Mo.App.1996). 25. Calingo v. Meridian Res. Co., LLC, 2013 WL 1250448, at *2, *4 (S.D.N.Y. Feb. 20, 2013) (unpublished). 26. Nevils v......
  • Helfrich v. Blue Cross & Blue Shield Ass'n, No. 13–2620–EFM–JPO.
    • United States
    • United States District Courts. 10th Circuit. United States District Courts. 10th Circuit. District of Kansas
    • August 5, 2014
    ...Jersey Transit Bus Operations, 305 N.J.Super. 32, 701 A.2d 932, 937 (N.J.Super.Ct.App.Div.1997) ; Buatte v. Gencare Health Sys., Inc., 939 S.W.2d 440, 442 (Mo.App.1996).25 Calingo v. Meridian Res. Co., LLC, 2013 WL 1250448, at *2, *4 (S.D.N.Y. Feb. 20, 2013) (unpublished).26 Nevils v. Group......
  • Request a trial to view additional results
11 cases
  • Nevils v. Grp. Health Plan, Inc., No. SC 93134.
    • United States
    • United States State Supreme Court of Missouri
    • February 4, 2014
    ...lien against Nevils's settlement of a personal injury claim. The trial court, consistent with Buatte v. Gencare Health Sys., Inc., 939 S.W.2d 440 (Mo.App.1996), entered summary judgment in favor of Respondents on grounds that 5 U.S.C. section 8902(m)(1) of the Federal Employee Health Benefi......
  • Aybar v. New Jersey Transit Bus Operations, Inc.
    • United States
    • New Jersey Superior Court – Appellate Division
    • October 14, 1997
    ...subrogation rights. Id. at 763. Accord Waller v. Hormel Foods Corp., supra, 950 F.Supp. at 945; Buatte v. Gencare Health Sys., Inc., 939 S.W.2d 440, 442 The State presents us with no case dealing with an anti-subrogation provision that holds such a provision is not preempted by FEHBA or ERI......
  • Helfrich v. Blue Cross & Blue Shield Ass'n & Blue Cross & Blue Shield of Kan. City, No. 13–2620–EFM–JPO.
    • United States
    • United States District Courts. 10th Circuit. United States District Courts. 10th Circuit. District of Kansas
    • August 5, 2014
    ...New Jersey Transit Bus Operations, 305 N.J.Super. 32, 701 A.2d 932, 937 (N.J.Super.Ct.App.Div.1997); Buatte v. Gencare Health Sys., Inc., 939 S.W.2d 440, 442 (Mo.App.1996). 25. Calingo v. Meridian Res. Co., LLC, 2013 WL 1250448, at *2, *4 (S.D.N.Y. Feb. 20, 2013) (unpublished). 26. Nevils v......
  • Helfrich v. Blue Cross & Blue Shield Ass'n, No. 13–2620–EFM–JPO.
    • United States
    • United States District Courts. 10th Circuit. United States District Courts. 10th Circuit. District of Kansas
    • August 5, 2014
    ...Jersey Transit Bus Operations, 305 N.J.Super. 32, 701 A.2d 932, 937 (N.J.Super.Ct.App.Div.1997) ; Buatte v. Gencare Health Sys., Inc., 939 S.W.2d 440, 442 (Mo.App.1996).25 Calingo v. Meridian Res. Co., LLC, 2013 WL 1250448, at *2, *4 (S.D.N.Y. Feb. 20, 2013) (unpublished).26 Nevils v. Group......
  • Request a trial to view additional results

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