Trustees of Mease Hosp., Inc. v. Velardocchia, 90-1299-CIV-T-17.
| Decision Date | 13 November 1991 |
| Docket Number | No. 90-1299-CIV-T-17.,90-1299-CIV-T-17. |
| Citation | 777 F. Supp. 1569 |
| Parties | TRUSTEES OF MEASE HOSPITAL, INC., d/b/a Mease Health Care, Plaintiff, v. Anthony VELARDOCCHIA and Nancy Velardocchia, his wife, Defendants, v. PRUDENTIAL INSURANCE COMPANY OF AMERICA, Third Party Defendant. |
| Court | U.S. District Court — Middle District of Florida |
Joseph Giambalvo, Giambalvo & Stolz, Clearwater, Fla., for plaintiff Trustees of Mease Hosp., Inc.
Thomas D. Masterson, St. Petersburg, Fla., for defendants Anthony and Nancy Velardocchia.
John Charles Lenderman, Harris, Barrett, Mann & Dew, St. Petersburg, Fla., for defendant Prudential Ins. Co. of America.
This cause is before the Court on cross-motions for summary judgment filed by Defendants, Anthony Velardocchia and Nancy Velardocchia, and Third Party Defendant, Prudential Insurance Company of America ("Prudential"). Both Defendants and Third Party Defendants filed supplemental memoranda in support of the pending motions.
This circuit clearly holds that summary judgment should only be entered when the moving party has sustained its burden of showing the absence of a genuine issue as to any material fact when all the evidence is viewed in the light most favorable to the nonmoving party. Sweat v. The Miller Brewing Co., 708 F.2d 655 (11th Cir.1983). All doubt as to the existence of a genuine issue of material fact must be resolved against the moving party. Hayden v. First National Bank of Mt. Pleasant, 595 F.2d 994, 996-7 (5th Cir.1979), quoting Gross v. Southern Railroad Co., 414 F.2d 292 (5th Cir.1969). Factual disputes preclude summary judgment.
Id. at 322, 106 S.Ct. at 2552, 91 L.Ed.2d at 273.
The Court also said, "Rule 56(e) therefore requires that nonmoving party to go beyond the pleadings and by her own affidavits, or by the `depositions, answers to interrogatories, and admissions on file,' designate `specific facts showing there is a genuine issue for trial.'" Celotex Corp., at 324, 106 S.Ct. at 2553, 91 L.Ed.2d at 274.
On July 12, 1988, Defendant, Nancy Velardocchia, was injured when her motor vehicle, which was sitting in a line of traffic, was struck from the rear by a vehicle operated by Martin B. Gonzalez. Dkt. 19. At the time of the accident, Nancy Velardocchia was employed by NCR Corporation ("NCR") and was a beneficiary of NCR's Employee Welfare Benefit Plan (the "Plan"). Dkt. 13 at 1. The Plan was administered by Third Party Defendant, Prudential. No insurance indemnity contract was involved. Dkt. 8 at 3.
In August, 1989, as a result of injuries sustained in the automobile accident, Nancy Velardocchia was hospitalized at Mease Hospital, Inc. Subsequently, Mease Hospital, Inc., Plaintiff, rendered hospital bills for the aforementioned hospitalization to Defendant, Nancy Velardocchia. Dkt. 19 at 2. Defendant's medical bills totalled $16,803.86. Dkt. 20 at 2 and Dkt. 19, attachment.
Nancy Velardocchia filed an action against Martin B. Gonzalez in Circuit Court of Pinellas County. An additional claim for loss of consortium was filed by her husband, Anthony Velardocchia. These claims were eventually settled for a total of $25,000.00, Martin B. Gonzalez's policy limit. Dkt. 19 at 3. In addition, Nancy Velardocchia exhausted her personal injury protection, medical payments coverage, and uninsured/underinsured motorist coverage under a motor vehicle insurance policy with Allstate Insurance Company. Dkt. 19 at 2.
Defendant, Nancy Velardocchia, eventually submitted the unpaid balance of her medical bills to Third Party Defendant, Prudential. Defendant's claim was denied on the basis of the following exclusion contained in the Employee Welfare Benefit Plan:
Any charges for services in connection with an accident or illness, as defined in SECTION 2, paragraph (E) of this PART, to the extent to which payments as a judgment, settlement or otherwise are made or may be expected to be made by any person or persons considered responsible for the condition(s), or by their insurers. This exclusion shall not operate to withhold regular Plan benefits if the Employee agrees in writing to reimburse the Company all benefits paid in connection with such illness or accident.
Defendants failed or refused to execute an agreement assigning to NCR "any payment received by or expected to be received by court judgment, settlement or otherwise from the person responsible or from such person's liability insurance in an amount up to the payments made by NCR...." Dkt. 19 and attached assignment agreement. Defendants contend that Florida Statutes, Section 627.7372, prevented Nancy Velardocchia from recovering her medical expenses from the party who was at fault. Dkt. 15 at 6.
Defendants, Anthony Velardocchia and Nancy Velardocchia, do not question that the pre-emption clause of ERISA results in pre-emption of "any and all state laws insofar as they may now or hereinafter relate to any employee benefit plan." Dkt. 16, p. 7. However, Defendants later restricted their concession regarding ERISA's pre-emption to "when there is a conflict between ERISA and state law."
In California Federal Savings and Loan Association v. Guerra, 479 U.S. 272, 107 S.Ct. 683, 93 L.Ed.2d 613 (1987), the Supreme Court of the United States discussed the ways in which a federal law can pre-empt a state statute. The Court said:
Federal law may supersede state law in several different ways. First, when acting within constitutional limits, Congress is empowered to pre-empt state law by so stating in express terms. Second, congressional intent to pre-empt state law in a particular area may be inferred where the scheme of federal regulation is sufficiently comprehensive to make reasonable the inference that Congress "left no room" for supplementary state regulation.... As a third alternative, in those areas where Congress has not completely displaced state regulation, federal law may nonetheless pre-empt state law to the extent it actually conflicts with federal law. Citations omitted.
Id. at 280-81, 107 S.Ct. at 689. Stating that it was Congress' clear intent to exempt ERISA employee benefit plans from direct state insurance regulation, the Supreme Court held in FMC Corporation v. Holliday, ___ U.S. ___, 111 S.Ct. 403, 112 L.Ed.2d 356 (1990), that ERISA pre-empted Pennsylvania's Motor Vehicle Financial Responsibility Law.
As stated in FMC, "Three provisions of ERISA speak expressly to the question of pre-emption:
Id. ___ U.S. at ___, 111 S.Ct. at 407.
In Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 107 S.Ct. 1549, 95 L.Ed.2d 39 (1987), the mechanics of the pre-emption provisions of ERISA were summarized as follows:
If a state law "relates to ... employee benefit plans," it is pre-empted. Section 514(a). The saving clause excepts from the pre-emption clause laws that "regulate insurance." Section 514(b)(2)(A). The deemer clause makes clear that a state law that "purports to regulate insurance" cannot deem an employee benefit plan to be an insurance company. Section 514(b)(2)(B).
In Shaw v. Delta Air Lines, Inc., 463 U.S. 85, 98, 103 S.Ct. 2890, 2900, 77 L.Ed.2d 490 (1983), the Court concluded, "A law `relates to' an employee benefit plan, in the normal sense of the phrase, if it has a connection with or reference to such a plan." The Court added that Congress used the words "`relate to' in section 514(a) the pre-emption clause in their broad sense." Id.
Florida's collateral source statute, Section 627.7372, Florida Statutes, provides:
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...that any overpayment ... shall be reimbursed by the individual." Danowski Aff. exhibit B, at 49. 15 See also Trustees of Mease Hosp. v. Velardocchia, 777 F.Supp. 1569 (M.D.Fla.1991) (in suit by hospital to recover unpaid bills, in which Plan's insurer was made a third-party defendant, Flori......