Summary
Judy White sued Valir Physical Therapy over whether Valir improperly sought payment from a tortfeasor's automobile insurer instead of White's medical insurer. The Oklahoma Supreme Court held that reasonable minds could differ regarding the parties' agreement under the Assignment of Benefits provision, reversed summary judgment on the contract claim, and remanded for discovery and further proceedings. The court affirmed summary judgment on White's fraud and tort theories, concluding that the dispute was contractual.
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Practice areas
Questions Presented
- Whether summary judgment was proper on White's contract claim concerning Valir's right to bill and recover from the tortfeasor's automobile insurer rather than White's medical insurer.
- Whether summary judgment was proper on White's fraud and tort theories.
- Whether the Assignment of Benefits provision could support specific performance and declaratory relief if Valir had a contractual relationship with White's medical insurer requiring acceptance of adjusted billing amounts as payment in full.
Holdings
- Summary judgment was improper on the contract aspect of White's claim because reasonable minds could differ concerning the source and amount of payment Valir agreed to accept under the Assignment of Benefits provision.
- Summary judgment was proper on White's fraud and tort theories because the dispute was, in substance, a contract dispute.
- If discovery establishes that Valir had a contractual relationship with White's medical insurer requiring it to accept adjusted billing amounts as payment in full, White would be entitled to specific performance of the Assignment of Benefits provision and declaratory relief that Valir had no lien or other claim to proceeds from the tortfeasor's insurer.
Key quotations
“Considering the fact that Valir drafted the Assignment of Benefits provision, and did not disclose the claimed option to bill a tortfeasor's insurer, rather than the patient's medical insurer, in cases like Ms. White's case, reasonable minds could differ over the source and amount of payment Valir agreed to accept for the services provided to Ms. White.” (¶ 5)
“This case presents nothing more than a contract dispute and, therefore, summary judgment was proper on Ms. White's fraud and "tort" theories of recovery.” (¶ 8)
Factual background
Valir Physical Therapy provided services to Judy White after she was injured in an automobile accident. White signed an Assignment of Benefits provision that addressed payment by Medicare or private insurers, responsibility for unpaid or noncovered amounts, and payment of charges by a third-party payer. White expected Valir to bill her medical insurer and accept any adjusted payment required by its contractual relationship with that insurer, while Valir claimed it could instead seek payment from the tortfeasor's automobile insurer. The record did not resolve the source or amount of payment Valir had agreed to accept.
Procedural history
Judy White sued Valir Physical Therapy over its handling of billing and payment for physical therapy services. The District Court of McClain County granted Valir summary judgment. The Oklahoma Supreme Court affirmed the judgment on the fraud and tort theories, reversed it on the contract claim, and remanded for discovery and further proceedings.
Remand instructions
Allow White to conduct discovery and determine whether Valir had a contractual relationship with her medical insurer to adjust billing rates, whether payment of adjusted billing amounts would constitute payment in full, and what basis Valir had to assert a lien or other claim against proceeds from the tortfeasor's insurance. If the contractual relationship and payment-in-full conditions are established, the trial court should consider specific performance of the Assignment of Benefits provision and declaratory relief that Valir had no lien or other claim to the tortfeasor-insurance proceeds. The fraud and tort theories remain resolved in Valir's favor.