Maurer v. Wayne Cty. Bd. of Commrs.
2017 Ohio 6927
| Ohio Ct. App. | 2017Background
- Thomas Maurer was Wayne County Sheriff (2009–2013); his wife, Toni Maurer, was covered as his dependent under the county’s self-funded health plan.
- Toni developed Meniere’s disease and sought coverage for a cochlear implant; Aetna (the plan administrator) initially approved then reversed and denied coverage.
- The Maurers appealed once to Aetna; the first-level appeal denial letter informed them they could request a second-level appeal per the plan’s appeal procedures.
- The Maurers did not pursue the second-level internal appeal and instead filed a declaratory-judgment action in Wayne County Common Pleas court in June 2013 seeking coverage.
- The trial court granted summary judgment for the Wayne County Board of Commissioners based on failure to exhaust administrative remedies; the Maurers appealed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether plaintiffs were required to exhaust internal administrative appeals before suing | Maurer argued exhaustion was futile and thus not required | Wayne Cty argued the plan afforded a second-level appeal which plaintiffs did not pursue, so exhaustion is required | Court held plaintiffs failed to exhaust internal appeals; futility exception did not apply |
| Whether plan amendments excluding cochlear implants were lawful | Maurer argued changes excluding cochlear implants were not permitted by law (challenged validity) | Wayne Cty argued exclusion was proper under the plan | Court declined to address this issue as disposition on exhaustion was dispositive |
Key Cases Cited
- Grafton v. Ohio Edison Co., 77 Ohio St.3d 102 (de novo review of summary judgment)
- Temple v. Wean United, Inc., 50 Ohio St.2d 317 (summary judgment standard)
- Leber v. Smith, 70 Ohio St.3d 548 (declaratory judgment on insurance coverage is a question of law)
- Nationwide Mut. Fire Ins. Co. v. Guman Bros. Farm, 73 Ohio St.3d 107 (questions of law reviewed de novo)
- Karches v. Cincinnati, 38 Ohio St.3d 12 (futility exception to exhaustion doctrine)
- Nemazee v. Mt. Sinai Med. Ctr., 56 Ohio St.3d 109 (focus on administrative body’s authority for futility)
- State ex rel. Teamsters Local Union No. 436 v. Cuyahoga Cty. Bd. of Commrs., 132 Ohio St.3d 47 (vain-act language re: exhaustion)
- BP Communications Alaska, Inc. v. Cent. Collection Agency, 136 Ohio App.3d 807 (futility defined as lack of authority to grant relief)