200 Conn.App. 742
Conn. App. Ct.2020Background
- Silver Hill Hospital provided inpatient and outpatient care to Dawn Kessler from April 22–June 6, 2014; total charges were $59,291.50.
- Medicare initially paid the bill but later rescinded $17,087.15 after determining some charges were covered by workers’ compensation; the hospital refunded that amount to Medicare.
- The hospital informed Kessler (and family) and asked her to contact Medicare to resolve the coordination-of-benefits dispute; Kessler declined and made no payment.
- The hospital sued (May 1, 2017) to collect the $17,087.15. Kessler answered with multiple special defenses; the court struck all but a non compos mentis defense.
- Case was tried before an attorney fact finder, who found Kessler owed $17,087.15 and that her non compos mentis defense failed; the trial court adopted the report and entered judgment for the hospital.
- On appeal Kessler argued (1) the fact finder’s conclusions lacked evidentiary support, (2) the fact finder should have considered whether the hospital had a duty to pursue Medicare/was statutorily barred from collecting, (3) the trial court erred in overruling her objections, and (4) Conn. Gen. Stat. § 19a-673d barred collection. The appellate court affirmed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Were the fact finder’s conclusions supported by evidence? | Hospital: record proves services rendered, Medicare rescission, refund, and unpaid balance. | Kessler: fact finder did not reference trial witnesses/exhibits; conclusions unsupported. | Affirmed — fact finder’s findings were supported by the evidence and not clearly erroneous. |
| Was the hospital required to contact Medicare / resolve coordination-of-benefits as a defense? | Hospital: no such duty was pleaded; pleadings, not after-the-fact assertions, frame legal issues. | Kessler: hospital had responsibility (and federal regs/statute) to dispute Medicare’s secondary-liability claim. | Held for hospital — duty/ statutory-bar claim was not pleaded as a special defense and thus was irrelevant to the fact finder. |
| Did the trial court err in denying Kessler’s objections to the fact finder’s report? | Hospital: court properly confined review to issues raised in pleadings; subordinate facts supported recommendations. | Kessler: objections raised new legal issues that should have been considered. | Affirmed — trial court correctly overruled objections because the new legal issues were not pleaded and fact finder had no obligation to decide them. |
| Does Conn. Gen. Stat. § 19a-673d bar the hospital’s collection action? | Hospital: Kessler failed to preserve or plead §19a-673d; issue first raised on appeal. | Kessler: §19a-673d (and federal regs) prohibit collection and compel judgment for defendant. | Not reviewed — §19a-673d was not pleaded or distinctly raised below; claim is unpreserved and inadequately briefed. |
Key Cases Cited
- Walpole Woodworkers, Inc. v. Manning, 126 Conn. App. 94 (Conn. App. 2011) (standard of review for attorney fact finder: factual findings supported by evidence; review for clear error)
- LPP Mortgage, Ltd. v. Lynch, 122 Conn. App. 686 (Conn. App. 2010) (trial court reviewing fact finder may not retry case or reassess witness credibility)
- Wilcox Trucking, Inc. v. Mansour Builders, Inc., 20 Conn. App. 420 (Conn. App. 1989) (appellate authority may not substitute its findings for the trier of fact)
- Pawlinski v. Allstate Ins. Co., 165 Conn. 1 (Conn. 1973) (distinction between general denial and matter that must be specially pleaded)
- DuBose v. Carabetta, 161 Conn. 254 (Conn. 1971) (failure to perform contractual or legal duty must be alleged as a special defense)