Shanti v. Allstate Insurance Co.
356 S.W.3d 705
| Tex. App. | 2011Background
- Allstate sued Rehab Alliance entities and individual doctors for fraud, conspiracy, and unjust enrichment related to billing and referrals in auto-accident treatment schemes.
- Plaintiffs allege concealment of patient letters of protection and unavailable disclosures to insurers, and a cartel-like relationship among Rehab Alliance, doctors, and imaging/billing contractors.
- Defendants contend the claims are not health care liability claims because the core of the action is fraud/ conspiracy, not medical malpractice or deviation from professional standards of care.
- Allstate alleges misrepresentations about medical necessity and the involvement of attorneys in directing procedures.
- The trial court denied dismissal under Section 74.351, and defendants appeal via accelerated interlocutory appeal under Tex. Civ. Prac. & Rem. Code § 51.014(a)(9).
- Texas appellate court reviews de novo the question of whether the TMLA applies to the pleaded causes of action.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the suit is a health care liability claim under TMLA | Allstate's claims target misrepresentations tied to medical services and billing. | Defendants argue the core is fraud/conspiracy, not a health care liability claim. | Not a health care liability claim; TMLA does not apply. |
| Whether Allstate can be a claimant under TMLA | Allstate seeks damages arising from misrepresentations affecting insurance settlements. | Allstate did not suffer a bodily injury or death; not a claimant. | Allstate is not a claimant under the TMLA. |
| Whether Pallares controls, preventing a health care liability label | Plaintiff relies on Pallares to show broad fraudulent billing relates to medical treatment. | Pallares supports that fraud surrounding medical necessity can still be not a health care claim when it is tangential to medical services. | Pallares is applicable; the claim is not a health care liability claim. |
| Whether the absence of health care liability would foreclose other arguments | Non-TMLA theories remain viable if not health care claims. | Non-health care claims remain but must be independently pleaded. | Court preserves non-TMLA theories; but dismissal affirmed for lack of health care claim. |
| Whether the trial court erred in denying dismissal under 74.351 | Section 74.351 applies to health care claims, not to fraud claims. | The court should apply 74.351 to all asserted claims if related to health care. | No error; denial of dismissal affirmed. |
Key Cases Cited
- Pallares v. Magic Valley Elec. Coop., Inc., 267 S.W.3d 67 (Tex.App.-Corpus Christi 2008) (fraudulent billing not a health care liability claim)
- Yamada v. Friend, 335 S.W.3d 192 (Tex.2010) (look to underlying facts to determine health care liability claim)
- Diversicare Gen. Partner, Inc. v. Rubio, 185 S.W.3d 842 (Tex.2005) (in separable from rendition of medical services courts consider)
- Rose v. Garza, 156 S.W.3d 541 (Tex.2004) (assessment of whether medical expert testimony is required)
- Omaha Healthcare Ctr., LLC v. Johnson, 344 S.W.3d 392 (Tex.2011) (guides when essence of claim is not health care liability)
- Murphy v. Russell, 167 S.W.3d 835 (Tex.2005) (non-physical injuries can still involve health care liability)