PETER J. MESSITTE, UNITED STATES DISTRICT JUDGE.
Montgomery County, Maryland (the "County") sues Managed Care Innovations, LLC ("MCI"), alleging that, over the time that MCI provided third-party claims administration services to the County, it mismanaged dozens of claims against the County, a self-insurer, to the considerable detriment of the County.
Focusing on the largest of those allegedly mismanaged claims, MCI filed a Motion for Summary Judgment (ECF No. 36), to which the County filed a Response in Opposition and Cross-Motion for Summary Judgment (ECF No. 42). The Court held a hearing on June 8, 2017, at which it granted the County's Cross-Motion for Summary Judgment as to the issue of liability only, and took all remaining issues in the cross-motions under advisement. ECF Nos. 56-58.
For the reasons set forth in this Memorandum Opinion, the County's Cross-Motion for Summary Judgment (ECF No. 42) will now be
On April 30, 2007, the County and MCI entered into a written contract (the "Contract") requiring MCI, for the period of July 1, 2007 to June 30, 2009, to provide third-party claims administration services ("TPA Services") to the County. Excerpts of the Parties' Contract, the County's Cross-Mtn. for Summary Judgment, Exhibit 1, Appx. 1-6, ECF No. 44. The term of the Contract was later extended to June 30, 2015. The County's Cross-Mtn. for Summary Judgment 2, ECF No. 42.
The Contract authorized MCI to engage a subcontractor to perform relevant services and, from the start of the term until June 30, 2012, MCI engaged Gallagher Bassett as a subcontractor to perform the TPA Services for the County.
The County's Request for Proposal ("RFP"), which was incorporated by reference into the Contract, laid out the parties' obligations. Excerpts of the Parties' Contract at Appx. 2; Extract from Request for
On November 24, 2015, the County filed a Complaint against MCI in the Circuit Court for Montgomery County, Maryland, alleging breach of contract, breach of express warranty, and indemnification. See Compl. On March 10, 2016, MCI answered the Complaint and removed the case to this Court. Notice of Removal, ECF No. 1. A Scheduling Order was issued on April 13, 2016. Scheduling Order, ECF No. 15.
Subsequently, the parties filed a Consent Motion to Alter/Amend the Scope of the Scheduling Order, indicating that while the County was alleging that MCI mismanaged some 25 claims as to which the County was self-insured, one claim (the "Christopher V. Claim") in particular constituted more than half of the County's alleged damages. ECF No. 23. Believing that resolution of the Christopher V. Claim (whether by dispositive motion, settlement, trial, or otherwise) might facilitate resolution of the entire suit, the parties sought to defer discovery and motion practice regarding the other 24 claims. Id. Accordingly, the parties requested that the Court modify its Scheduling Order so that discovery and motion practice regarding claims other than Christopher V. would be deferred until further order. The Court granted the Consent Motion. ECF No. 24.
The undisputed facts of the Christopher V. claim are as follows.
On Thursday, April 19, 2012 at 5:40 pm, Christopher V. — a volunteer firefighter with the Rockville Volunteer Fire Department, then aged 28 — was riding his motorcycle when he was involved in a severe accident. Excerpts of the Gallagher Bassett Claims Notes, Cross-Mtn. for Summary Judgment, Exhibit 7, Appx. 77-107, ECF No. 44. According to his supervisor, Christopher V. was traveling from his normal station, Fire Station 3 in Rockville, Maryland, to Fire Station 14 in Beallsville, Maryland to attend an assigned meeting. Email from Alan Hinde, MCI's Mtn. for Summary Judgment, Exhibit 3, App. 8, ECF No. 37. While traveling west on Darnestown Road in Montgomery County, Christopher V. attempted to pass five or six cars on the left — crossing a double yellow line in doing so — and ultimately collided with the lead car he was attempting to pass, as it was legally turning left in front of him onto Berryville Road. Police Report, Cross-Mtn. for Summary Judgment, Exhibit 5, Appx. 44-45, ECF No. 44.
The police report indicates that the driver of the car with which Christopher V. collided, Salem Abadi, did not contribute to the accident but that it was Christopher V. who caused the accident by failing to yield the right of way. Id. The County says photographs taken at the scene indicate
Christopher V. suffered devastating permanent injuries, was temporarily placed into an induced coma, and to this day suffers from serious brain damage. Excerpts of the Gallagher Bassett Claims Notes at Appx. 104-106.
On April 20, 2012, the day following the accident, Timothy Jones, President of Rockville Volunteer Fire Station 3, reported the accident to the County for workers compensation purposes. Id. On Sunday, April 22, 2102, MCI's subcontractor Gallagher Bassett assigned the claim to adjuster Nina Hill. Id. Over the course of the next two weeks, Hill communicated with representatives of the Rockville Fire Department (including Jones and Alan Hinde, Division Chief of the Volunteer Services of the Montgomery County Fire and Rescue Service) as well as County employees (including Terry Fleming and Lissa Bales, respectively the Chief and Claims Manager of the Montgomery County Division of Risk Management and Wendy Karpel, the Supervisor of the Workers Compensation Unit in the County's Office of County Attorney). Id. at 77-107. A key issue discussed among all these individuals was whether Christopher V. was on duty at the time of the accident. Id. at 94. Various means of assessing this fact were suggested to Hill. Id. at 77-107.
In an oral conversation with President Jones of Fire Station 3, Hill was advised that, although Christopher V. was not paid for his mileage to attend a meeting on April 19, 2012 (one of the means of assessing whether he was on duty that day), an entry on Fire Station 3's computer indicated that Christopher V. had logged onto the computer at Fire Station 3 on April 19, 2012 (suggesting that he "clocked in" at Fire Station 3 prior to the accident, another one of the means of assessing whether he was on duty that day). Email from Wendy Karpel, Mtn. for Summary Judgment, Exhibit 3, App. 14-16, ECF No. 37; Email from Lissa Bales, Mtn. for Summary Judgment, Exhibit 3, App. 18-20, ECF No. 37. Jones subsequently sent Hill an email in which he may have copied and pasted information from the Fire Station 3 computer's log-in system, which he suggested "show[ed] that [Christopher V.] signed in to attend the MCVFRA Meeting on April 19, 2012." Email from Lissa Bales, Mtn. for Summary Judgment, Exhibit 3, App. 18-20. Hill forwarded Jones' email to Bales at the County Division of Risk Management and asked Bales if she had a recommendation as to how she might secure a copy of the actual log. Id. Bales directed Hill to call President Jones again and "flesh out further what other evidence he can supply on this." Id.
On May 9, 2012, Hill received a copy of the police report and summarized it in her claim notes. Id. at 90. The notes mentioned that Christopher V. had illegally passed five or six vehicles proceeding outside a double yellow line. Id. Hill called Abadi (the driver of the lead car involved in the accident), but Abadi refused to speak with her. Id. at 90. Hill's claim notes indicate that she never discussed the potential implications of the police report, including the possible defense of willful misconduct on Christopher V.'s part, with her supervisor. See generally id.
On May 18, 2012, Maryland's Workers' Compensation Commission mailed a form to Gallagher Bassett noting that, on May 16, 2012, a formal claim had been filed on behalf of Christopher V. and that the "consideration date" — i.e., the deadline for an employer/insurer to notify the Commission and the claimant that the claim would be contested — was June 8, 2012. Id. at 86; Workers' Compensation Commission Information Form, Mtn. for Summary Judgment, Exhibit 8, App. 80, ECF No. 37; C-30 Form, Exhibit 13, Appx. 140, ECF No. 44. On June 13, 2012, five days after the consideration date, Gallagher Bassett filed a response form, raising no dispute with regard to the claim and effectively conceding its validity. C-40 Form, Exhibit 14, Appx. 143, ECF No. 44. Accordingly, on June 21, 2012, the Commission automatically entered an award of compensability in favor of Christopher V. Workers' Compensation Commission Award, Mtn. for Summary Judgment, Exhibit 9, App. 82, ECF No. 37.
Adjuster Hill and Gallagher Bassett had 15 days from the date of the automatic award to file for a rehearing and 30 days to file an appeal. See, Md. Code, Lab. & Empl. §§ 9-726, 9-737. There is no evidence, however, and more particularly no documentation in the claim file, to establish that Hill took any steps to even consider requesting a rehearing or appealing the award. See generally Excerpts of the Gallagher Bassett Claims Notes.
In late July 2012, Bales received a call from CareFirst, which was presumably providing medical services to Christopher V., inquiring about the claim, which prompted Bales to look into the claims notes in the County's system. Excerpts of the Deposition of Lissa Bales, Cross-Mtn. for Summary Judgment, Exhibit 9, Appx. 118, ECF No. 44. After viewing the notes regarding the police report, Bales became concerned that Hill had not considered the impact of that report on the claim nor the potential for a willful misconduct defense. Id. at 118-19. Bales also noticed that Hill had failed to discuss these potential issues with her supervisor or the County Attorney and had, moreover, failed to contact key witnesses. Id. When Bales contacted Hill's supervisor, Genise Thomas, to inquire about the status of the claim, Thomas admitted to Bales that the claim had been inadvertently accepted because the consideration date had been missed. Id.
According to the County, as of March 13, 2017, it had paid approximately $1,172,603.00 toward the Christopher V. claim. Cross-Mtn. for Summary Judgment at 17.
On June 8, 2017, the Court held a hearing to address the parties' cross-motions for summary judgment.
Under Rule 56(a), "[t]he court shall grant summary judgment if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(a). This does not mean, however, that "some alleged factual dispute between the parties" defeats the motion for summary judgment. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-48, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986) (emphasis in original). Rather, "the requirement is that there be no genuine issue of material fact." Id. (emphasis in original)." A party asserting that a fact cannot be or is genuinely disputed must support the assertion by (A) citing to particular parts of materials in the record, including depositions, documents, electronically stored information, affidavits or declarations, stipulations (including those made for purposes of the motion only), admissions, interrogatory answers, or other materials; or (B) showing that the materials cited do not establish the absence or presence of a genuine dispute, or that an adverse party cannot produce admissible evidence to support the fact." Fed. R. Civ. P. 56(c)(1).
At the June 8, 2017 hearing, counsel for MCI conceded that mistakes had been made in the handling of the Christopher V. claim. Transcript of Proceedings on June 8, 2017, 3, ECF No. 57 ("This claim was not handled properly. Further investigation should have been done, was requested to be done by the plaintiff, and the defendant is the agent charged with that responsibility."). MCI argued, however, that it was entitled to summary judgment because the Christopher V. claim was compensable in any event and, as a result, the County could not show that it would have prevailed even if the adjuster had contested the claim. Id. at 3-4. In other words, said MCI, even if it breached its duty in failing to contest the claim, the County suffered no damages. Id.
The Court rejected this argument, reasoning that it had no relation to whether there was a breach in the first place and that the question of damages could be deferred for future consideration. Id. at 2-5. See Taylor v. NationsBank, N.A., 365 Md. 166, 175, 776 A.2d 645, 651 (2001) ("To prevail in an action for breach of contract, a plaintiff must prove that the defendant owed the plaintiff a contractual obligation and that the defendant breached that obligation. It is not necessary that the plaintiff prove damages resulting from the breach, for it is well settled that where a breach of contract occurs, one may recover nominal damages even though he has failed to prove actual damages."). See also Hooton v. Kenneth B. Mumaw Plumbing & Heating Co., 271 Md. 565, 572, 318 A.2d 514, 518 (1974). Accordingly, the Court found that MCI breached the Contract with the County by reason of its clear negligence in the handling of the Christopher V. claim and in its Order issued following the hearing, the Court granted the County's Cross-Motion for Summary Judgment in part with respect to MCI's liability on Count I (the Breach of Contract claim).
The parties disagree as to what damages, if any, are owed to the County. The County contends that it was damaged at the time of MCI's breach because it lost the opportunity to defend what was quite possibly a non-compensable claim. According to the County, the damage accrued the moment it lost its opportunity to contest the claim. MCI, in contrast, asserts that the County would only have suffered harm if the claim was in fact determined to be non-compensable. And according to MCI, foreclosure of the County's opportunity to contest the Christopher V. claim could not have caused the County harm if the claim was in fact compensable. In other words, if the claim was compensable, the County's payments to Christopher V. would simply represent the County's necessary and ordinary statutory obligations.
The Court agrees with the County's position. It suffered damage at the time it was stripped of the opportunity to contest the Christopher V. claim, irrespective of whether the Workers' Compensation Commission might eventually have found the claim compensable. MCI's breach closed the door on every chance the County had to challenge Christopher V.'s claim as non-compensable.
As the Court sees it, the County's remedy lies, in part, in specific performance.
Due to MCI's failure to perform its contractual obligations, the County has become liable for life-long payments to Christopher V. In consequence, pursuant to the Contract's indemnification clause, MCI must bear the burden of its (and its subcontractor's) actions. See Namleb Corp.
A substantial part of the bargain underlying the County's Contract with MCI was ensuring that the County would not have to engage in post hoc litigation of unresolved questions of compensability. In exchange for monetary consideration, the County received a promise from MCI that the County would not have to investigate and gather evidence on claims and most certainly would not have to do so many years after the incidents underlying the claims occurred. To require the County to prove that the underlying claim was not compensable at this juncture would be fundamentally unfair. As a direct result of MCI's failure to adequately investigate and possibly contest the claim, evidence relevant to the compensability of Christopher V.'s claim (i.e., the set of facts relevant to whether he engaged in willful misconduct and/or was "on duty" at the time of the accident) has essentially become unavailable. As MCI would have it, MCI would end up the beneficiary of its own serious breach of contract. See Assaf v. Trinity Medical Center, 696 F.3d 681, 686 (7th Cir. 2012) ("[A] classic rule of contract law, is that a party should be prevented from benefitting from its own breach."); 23 Williston on Contracts § 63:8 (4th ed.); GenCorp, Inc. v. Am. Int'l Underwriters, 178 F.3d 804, 817 (6th Cir. 1999) ("In any event, it is also axiomatic that a party cannot benefit from its own breach."). Cf.
In sum, with the exception of the County's attorneys' fees,
Notwithstanding the foregoing analysis, if there are genuine disputes of material fact regarding any aspect of damages suffered by the County, to that extent summary judgment in favor of the County would have to be denied.
The County argues that there are no genuine disputes with regard to the damages it has incurred and will incur in relation to the Christopher V. claim. It points to the $1,172,603.00 it had actually paid toward the Christopher V. claim as of March 13, 2017 and anticipates future damages at $2,185,000.00 based on the Future Medical Cost Projection ("Projection") that was solicited and obtained by MCI's current subcontractor, CorVel.
MCI contends that there are material questions of fact regarding the amount of damages allegedly suffered and to be suffered by the County. First, MCI argues that the fees that have been paid to outside counsel to address disputes that arose between Christopher V. and the County as to particular items of medical and other benefits he claimed should not be included in the County's claimed damages.
The County disagrees. First, it notes that of the $1,262,920.27 it had paid on the Christopher V. claim as of April 7, 2017, only $12,517.00 had been spent on outside counsel fees to resolve disputes with Christopher V. regarding claimed benefits. Still, the County maintains that all those fees should be included in the damage award.
The Court concludes that there are no genuine issues of material fact as to some damages MCI owes to the County but there are genuine issues as to other damages owed.
First, the damages as to which there is no genuine issue of material fact:
As of April 7, 2017, the County paid Christopher V. a total of $1,250,403.27 not including outside counsel fees.
With regard to future estimated expenses, while, as stated above, MCI is obliged to indemnify the County, the amount it should have to pay is genuinely in dispute and cannot be fixed as a matter of law. MCI's monetary liability to the County will arise as the County makes each payment to Christopher V. as required pursuant to the workers' compensation award (i.e., "pay as it goes" indemnification). At the same time, the County is unquestionably entitled to have MCI's future obligation reduced to a current figure based upon the present day value of the future estimated expenses that it will face.
Just to note: "As concerns the grant of attorney fees, Maryland follows the common law `American Rule,' which states that, generally, a prevailing party is not awarded attorney's fees unless [] the parties to a contract have an agreement to that effect ..." Nova Research, Inc. v. Penske Truck Leasing Co., 405 Md. 435, 445, 952 A.2d 275, 281 (2008) (internal quotations and citations omitted). Here, the Contract's indemnification clause requires that MCI "indemnify and save the County harmless from any loss, cost, damage and other expenses, including attorney's fees and litigation expenses, suffered or incurred due to [MCI's] negligence or failure to perform any of its contractual obligations." (Emphasis supplied). At trial, the parties may argue what they will based on this language.
For the foregoing reasons, Montgomery County's Cross-Motion for Summary Judgment (ECF No. 42) is
A separate Order will