Guarantee Trust Life Ins. Co. v. Gavin

• Decision Date: 05 September 1989
• Docket Number: No. 88-3542,88-3542
• Citation: 882 F.2d 178
• Parties: GUARANTEE TRUST LIFE INSURANCE COMPANY, Plaintiff-Appellee, v. Edward M. GAVIN, D.C., d/b/a Gavin Chiropractic Clinic, Defendant-Appellant.
• Court: U.S. Court of Appeals — Fifth Circuit

Page 178

882 F.2d 178

GUARANTEE TRUST LIFE INSURANCE COMPANY, Plaintiff-Appellee, v. Edward M. GAVIN, D.C., d/b/a Gavin Chiropractic Clinic,

Defendant-Appellant.

No. 88-3542.

United States Court of Appeals, Fifth Circuit.

Sept. 5, 1989.

Rehearing Denied Oct. 5, 1989.

John R. Martzell, Jane C. Ettinger, New Orleans, La., for defendant-appellant.

Donald E. Casey, Chicago, Ill., Daniel A. Reed, Gary E. Dienstag, Kenneth E. Barnette, Baton Rouge, La., for plaintiff-appellee.

Charles R. Davis, Jackson, Miss., Earl N. Vaughan, New Orleans, La., for amicus curiae-Golden Rule Ins. Co.

Appeal from the United States District Court for the Middle District of Louisiana.

Before GEE, REAVLEY and JOLLY, Circuit Judges.

GEE, Circuit Judge:

Facts

In 1984 and 1985, Dr. Gavin, a chiropractor, provided care to various Louisiana State University students who assigned to him their benefits under an insurance policy issued to them by Guarantee Trust through the University. In processing the claims, Guarantee Trust limited payment to Dr. Gavin pursuant to a policy provision restricting reimbursement for the kind of treatment he provided to eighty percent of the claim, up to $100 per month, with an annual limit of $1,000. Thereafter, Dr. Gavin attempted to recover the fees denied him, arguing that the policy provision discriminated against chiropractors and thus violated Louisiana law.

Guarantee Trust then filed an action against Gavin in federal court, seeking a declaratory judgment. Guarantee asked that a policy of insurance issued to LSU be found in compliance with La.Rev.Stat. 22:668, which prohibits discrimination against chiropractors. Gavin filed an answer and counterclaim, asserting that as an assignee of the various claims under the policy, he was due reimbursement for unpaid claims and penalties for delayed payments. Moreover, he claimed that the policy language is null and void under the Louisiana law because it discriminates against chiropractors. Guarantee moved for summary judgment on the issue of discrimination. Without oral argument, the district court by minute entry granted the motion for summary judgment on behalf of Guarantee. 678 F.Supp. 1250. A Rule 54 judgment was entered on March 4, 1988.

Gavin filed a number of postjudgment motions, all of which were either withdrawn or denied. He then filed a timely notice of appeal from the grant of summary judgment in favor of Guarantee and from the denial of postjudgment motions. On appeal, Gavin contends that the district court erred in holding that Guarantee's policy provision did not violate Louisiana law or the equal protection provisions of the state and federal constitutions. In addition, he contends that the district court erred in holding that no material facts were in dispute, in failing to consider directives issued by the Louisiana Commissioner of Insurance and in failing to stay the issue pending disposition of a similar case filed in state court. We affirm.

Analysis

Since 1974, the Louisiana legislature has enacted several laws guaranteeing equitable treatment for chiropractors. In 1974, chiropractic became a legalized health-care profession in Louisiana by statute, regulated by a board of governors similar to that which governs the practice of medicine there. In two statutes, La.Rev.Stat. 22:668 and 40:1299.65, the Louisiana legislature has sought to provide for equal treatment of medical doctors and chiropractors performing the same kinds of services for patients. Furthermore, article 1, section 3 of the 1974 Louisiana Constitution guarantees equal protection by saying "no person shall be denied the equal protection of the laws." Paradoxically, however, Louisiana law still prohibits chiropractors from performing their work in hospitals; and that provision of law is not attacked by Dr. Gavin.

La.Rev.Stat. 668 A(1) states:

Notwithstanding any provision of any policy or contract of insurance or health benefits issued after the effective date of this section [1975], whenever such policy or contract provides for payment or reimbursement for any service, and such service may be legally performed by a chiropractor licensed in this state, such payment or reimbursement under such policy or contract shall not be denied when such service is rendered by a person so licensed. Terminology in such policy or contract deemed discriminatory against any such person or method of practice shall be void. (Emphasis added.)

Gavin contends that this statute is violated by a provision in Guarantee's policy which states

Outpatient treatment in connection with the detection or correction by manual or mechanical means of structural impalance, distortion or subluxation in the human body for purposes of removing nerve interference as a result of or related to distortion, misalignment or subluxation of or in the vertebra column, with the following limitations: we will pay eighty percent of eligible charges incurred. The said expenses not to exceed $100 for any insured person per calendar month. (Emphasis added.)

Gavin contends that the above policy language singles out chiropractors for discriminatory treatment. He argues that it does so essentially by structuring the provision to cover generally the kind of treatment provided by orthopedic surgeons, internists, and general practitioners as well as by chiropractors, but then effectively eliminating the medical practitioners from its restrictions by applying them to outpatient treatment alone. According to Gavin, since chiropractors may not treat in Louisiana hospitals they always administer treatment on an outpatient basis, whereas medical doctors, by contrast, may administer treatment in a hospital. Consequently, Gavin points out medical doctors can obtain full reimbursement for the same service for which chiropractors can obtain only eighty percent reimbursement simply by performing that service in a hospital. Furthermore, he maintains, although section 668 A(1) speaks in terms of discrimination against chiropractors by denying reimbursement for their services, the statute also reaches lesser included discriminatory conduct such as the discriminatory limitation of reimbursement.

The district court concluded that the policy provision did not violate La.Rev.Stat. 668 A(1) because the "policy does not exclude payment for chiropractic services; on the contrary, it specifically covers such services, but limits the amounts which will be paid for them, just as it limits the amounts which will be paid for other covered services." Gavin does not claim, however, that the policy violates La.Rev.Stat. 668 A(1) because it limits reimbursement for chiropractic services. Rather, Gavin contends that the policy violates this statute because it provides for limited reimbursement to chiropractors while providing for full reimbursement to medical doctors providing the same services. The district court's conclusion that the policy provides some coverage for chiropractic services fails to address Gavin's contention that the policy violates the statute by treating chiropractors differently from medical doctors. We therefore disagree with the district court's reasoning. Nonetheless, we do agree with the district court's conclusion that the policy does not violate the...