Clauer v. Lafayette County
| Decision Date | 18 September 1997 |
| Docket Number | Nos. 95-3424,96-3670,s. 95-3424 |
| Citation | 570 N.W.2d 910,213 Wis.2d 483 |
| Parties | NOTICE: UNPUBLISHED OPINION. RULE 809.23(3), RULES OF CIVIL PROCEDURE, PROVIDE THAT UNPUBLISHED OPINIONS ARE OF NO PRECEDENTIAL VALUE AND MAY NOT BE CITED EXCEPT IN LIMITED INSTANCES. Penny L. CLAUER, Petitioner, WESTERN WISCONSIN LEGAL SERVICES, and Thomas J. Kelly, Appellants, v. LAFAYETTE COUNTY and Lafayette County Department of Human Services, Respondents-Respondents. |
| Court | Wisconsin Court of Appeals |
APPEAL from judgments of the circuit court for Lafayette County: William D. Johnston, Judge. Reversed.
Before DYKMAN, P.J., VERGERONT and ROGGENSACK, JJ.
Western Wisconsin Legal Services and Attorney Thomas J. Kelly appeal from judgments entered against them for attorney fees incurred by Lafayette County. The trial court concluded that Attorney Charles Kreimendahl, an attorney employed by Western Wisconsin Legal Services, advanced frivolous claims on behalf of Penny Clauer by requesting judicial review of the decision of Lafayette County Department of Social Services denying her claim for general relief medical benefits. 1 The court also concluded that Kreimendahl and Attorney Thomas Kelly 2 advanced frivolous claims in moving for relief from judgment. We conclude the attorneys did not advance frivolous claims in either instance and therefore reverse both judgments awarding attorney fees.
On February 9, 1994, Clauer filed an application for general relief with Lafayette County Department of Human Services. She was twenty-three years old at the time, unemployed, had no income, and lived with her parents. Her parents' total income was $1,433 from a veteran's pension and Supplemental Security Income benefits. Her application stated that she was unable to work due to lower back pain and numbness in her legs. It also stated that her parents were paying a monthly premium of $154 for HMO coverage for her. By checking off certain listed items, Clauer requested general relief payment for "medical/dental, $125 per month for shelter, and for other needs." When she applied, Clauer was given a copy of "County General Relief Program, Policies and Procedures" which stated in pertinent part that "upon determination of eligibility, an applicant may be qualified for one or more categories of aid ... medical/dental services (prior authorization system unless emergency medical/dental situation) ..." and that
On February 23, 1994, the County sent her a notice of denial:
This correspondence is to inform you that the Lafayette County General Relief Program has reviewed your application form and rendered a determination pertaining to eligibility for maintenance benefits. (shelter, food, utilities, etc.)
You are ineligible for benefits under the county General Relief Program due to the fact that the household income and asset level exceeds the allowable standard for a three member household for purposes of eligibility. Income guidelines for a three member household are $353/mo.
You may qualify for emergency medical benefits, should you need this service in the future.
Clauer appealed on the ground that the County improperly considered her parents' income. At the hearing on March 16, 1994, before an administrative review panel, Clauer testified that she lived with her parents and had an agreement to pay between $100-$150 in rent to them; she ate separately from her parents and purchased her own food; she had no income and had gone without food, household/personal items and dental care; her parents were paying for her health insurance, and she had applied for social security disability. The review panel upheld the County's decision. It concluded that Clauer was ineligible for nonmedical benefits because of excess income and that she had health insurance, and therefore no medical needs.
Apparently Clauer appealed this decision to the circuit court, and after subsequent litigation and negotiation, the County found Clauer eligible for shelter benefits for February through September of 1994, but reaffirmed its denial of medical benefits for that time period. 3 The review panel held another hearing on November 7, 1994, to address this issue.
At the hearing, Clauer argued that § 49.01(5)(m), STATS., 4 states that general relief covers medical and dental services and that § 49.043, STATS., 5 allows the County to pay the premiums for health insurance policies for unemployed persons. Clauer testified that her parents paid $154 per month for an HMO insurance premium for her and after the County denied her benefits in February of 1994, her parents continued the payment as a loan to her. Clauer testified that although the notice of denial stated that she might qualify for medical relief, no one told her to report her medical appointments or expenses and she did not report them because she did not think she was eligible. She submitted bills for $744.21 for medical expenses that she incurred between February and September of 1994, all but $25 of which was paid by insurance. Clauer also stated that although she lives in her parents' home, she was independent of her parents and had no access to their income.
The County, however, argued that when Clauer applied for general relief benefits she showed no medical needs and did not submit any medical bills. The County stated that at the time of her application Clauer received a general relief policy and procedure manual which stated that non-emergency medical needs had to be preauthorized. The County repeated its previous contention that Clauer did not have a need for medical benefits because she was covered by an HMO. The County argued that although § 49.043, STATS., states that the County "may pay for health insurance for unemployed residents," the word "may" means may or may not, and it has elected not to pay for insurance premiums as part of its general relief cost containment plan, which was submitted and approved by the state. The County did not point to anything in writing, in the policy and procedure manual or otherwise, that expressed this election by the County.
The panel upheld the County's decision to deny medical benefits to Clauer. Because Clauer had insurance under an HMO, the panel found that she had no medical need.
Clauer sought judicial review of the November 7, 1994 administrative decision. 6 Kreimendahl's brief on her behalf argued that the County was obligated under § 49.02(1m), STATS., 7 to furnish general relief to eligible persons, and the definition of "general relief" in § 49.01(5m), STATS., included "medical treatment" and "medicine" which are "reasonable and necessary under the circumstances." She had demonstrated a need for medical care assistance because she had no income and needed certain medical treatments and medications. 8 The County should have either approved her application for medical assistance, explaining what she needed to do to get her medical needs authorized and paid for under the general relief program, or paid the HMO premiums, which it is authorized to do under § 49.043, STATS., as an alternative to paying directly for medical treatment. The brief argued that the County was putting Clauer in a "Catch 22": it initially denied her eligibility for all types of assistance because of her parents' income, leaving her no choice but to continue to have her parents pay the HMO premiums as a loan so that she could get the medical care she needed; then, when the County finally acknowledged that her parents' income was not a bar to her eligibility, it denied her assistance for medical treatment and medicine because she had HMO coverage.
Clauer's brief cited Clark v. Milwaukee County, 188 Wis.2d 171, 524 N.W.2d 382 (1994), in support of her position that the County was putting her in an impermissible "Catch 22" situation. In that case, the court held that a general relief program could not limit shelter payment to those applicants with a paid receipt to show evidence of current need and refuse to recognize a prospective rental statement as evidence of current need. 188 Wis.2d at 184, 524 N.W.2d at 387.
Clauer's brief also argued that § 49.043, STATS., authorized the payment of health insurance premiums, that the County had no written policy precluding this, and that under the circumstances of this case, the medical insurance premiums were expenses for medical care and medicine that were "reasonable and necessary under the circumstances." According to Clauer, the County could not rely on its unwritten policy of never paying health insurance premiums, since § 49.02(1m), STATS., required that the County "establish written criteria ... to determine dependency and ... establish written standards of need ... to determine the type and amount of general relief...."
The County argued in its brief, as it had at the administrative hearing, that it was within the County's discretion under § 49.043, STATS., not to pay health insurance premiums, and it had chosen not to, as part of its cost containment plan, and the state had approved that. Clauer was not being "singled out," the County contended, because the health insurance premium benefit she requested was simply unavailable in the County. Moreover, Clauer had not shown a need because she had not shown that her parents would discontinue paying or could no longer pay, so the only reasonable conclusion was that they would continue to pay for her health insurance.
The court affirmed the agency's decision. It concluded that § 49.043, STATS., did not require the County to purchase health insurance for Clauer and that the County had the stat's approval to not purchase health insurance as a cost of saving factor. The court held that it was clear and unambiguous that § 49.02(1m), STATS., did not cover insurance premiums. Further, the court reasoned that an applicant for...
To continue reading
Request your trial