State v. Doppler
2013 ND 54
| N.D. | 2013Background
- Todd Hayden sustained severe brain injuries in an all-terrain vehicle accident on June 12, 2009.
- He was insured under a Blue Cross Blue Shield of Texas group policy; Billings Clinic and Medcenter One treated him in Montana and North Dakota.
- Hospitals billed over $1 million combined; BCBS TX began and then halted payments for coverage of the injuries.
- Haydens, as Todd’s co-conservators/guardians, and their law firm entered a contingency-fee agreement to pursue insurance coverage in federal court.
- Federal suit was filed in 2010; in 2011 BCBS TX began discounted payments to providers; Haydens paid COBRA to keep policy alive.
- In 2012 the Haydens and law firm sued medical providers in state court seeking reimbursement for expenses and fees under theories of unjust enrichment, quantum meruit, equitable estoppel, and common fund; district court granted summary judgment for providers, dismissing all claims.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Unjust enrichment viability | Haydens claim providers were unjustly enriched by insurance payments. | Providers were entitled to full payment; no unjust enrichment from third-party payments. | No unjust enrichment as a matter of law. |
| Quantum meruit viability | Haydens should recover the value of services under implied promise to pay. | No implied contract or expectation of payment by providers. | Dismissed quantum meruit claim as matter of law. |
| Equitable estoppel viability | Provider actions misled Haydens into believing a claim would succeed, triggering estoppel. | No affirmative deception; estoppel cannot create a contract. | District court did not err in dismissing equitable estoppel claim. |
| Common fund doctrine applicability | Medical providers should share in a common fund created by the litigation. | Common fund doctrine does not apply to hospital liens or similar scenarios here. | Common fund doctrine not applicable; funds were not created by Haydens’ suit for the providers' benefit. |
Key Cases Cited
- Wilson v. Sisters of St. Francis Health Servs. Inc., 952 N.E.2d 793 (Ind. Ct. App. 2011) (hospital not contractually bound to pay for insured's attorney fees; no unjust enrichment)
- Lynch v. Deaconess Med. Ctr., 776 P.2d 681 (Wash. 1989) (attorney fees not recovered from hospital; incidental benefit not enough)
- Zuger v. North Dakota Ins. Guar. Ass'n, 494 N.W.2d 135 (N.D. 1992) (no unjust enrichment where services contracted with insurer; recipient not liable)
- Wendling v. Illinois Hosp. Servs., 950 N.E.2d 646 (Ill. 2011) (hospital liens not sharing in common fund treatment; majority rule applied)
- Lochthowe v. C.F. Peterson Estate, 692 N.W.2d 120 (N.D. 2005) (indisputably, recoveries against third parties do not create stand-alone obligations to pay by others)