Filed: Mar. 10, 2017
Latest Update: Mar. 10, 2017
Summary: NOT TO BE PUBLISHED OPINION AND ORDER NICKELL , Judge . Johnny Lawson appeals from the Bell Circuit Court's dismissal of his action seeking review of an administrative decision denying Medicaid coverage for an inpatient hospital stay. We affirm. The historical facts underlying the merits of the instant dispute, while fascinating, are mainly irrelevant to the issue on appeal, thereby requiring only a truncated summary. Lawson, a Medicaid beneficiary, was a patient at Harlan Appalachian Reg
Summary: NOT TO BE PUBLISHED OPINION AND ORDER NICKELL , Judge . Johnny Lawson appeals from the Bell Circuit Court's dismissal of his action seeking review of an administrative decision denying Medicaid coverage for an inpatient hospital stay. We affirm. The historical facts underlying the merits of the instant dispute, while fascinating, are mainly irrelevant to the issue on appeal, thereby requiring only a truncated summary. Lawson, a Medicaid beneficiary, was a patient at Harlan Appalachian Regi..
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NOT TO BE PUBLISHED
OPINION AND ORDER
NICKELL, Judge.
Johnny Lawson appeals from the Bell Circuit Court's dismissal of his action seeking review of an administrative decision denying Medicaid coverage for an inpatient hospital stay. We affirm.
The historical facts underlying the merits of the instant dispute, while fascinating, are mainly irrelevant to the issue on appeal, thereby requiring only a truncated summary. Lawson, a Medicaid beneficiary, was a patient at Harlan Appalachian Regional Hospital ("HARH") between September 13, 2013, and October 16, 2013. WellCare of Kentucky, Inc. ("WellCare"), contracts with the Cabinet for Health and Family Services ("CHFS") for the provision of managed care services to Medicaid recipients. WellCare rejected a request for coverage and disallowed payment for twelve days of Lawson's stay at HARH.
Pursuant to a purported authorization from Lawson, an employee of HARH instituted an administrative appeal of the denial of reimbursement. Lawson's appeal was ultimately dismissed as unauthorized because the authorization had not been executed by Lawson's legal guardian. Evidence was presented showing Lawson had previously been judicially declared wholly disabled in managing his personal affairs and financial resources by the Bell District Court pursuant to KRS1 Chapter 387, resulting in the appointment of a conservator and guardian. Lawson then sought judicial review in the Bell Circuit Court of the adverse administrative ruling. WellCare and CHFS moved to dismiss the action pursuant to CR2 17.03 as the action was not brought by Lawson's guardian. The trial court agreed Lawson did not have the legal capacity to bring an action in his own name and accordingly dismissed the petition for review. This appeal followed.
Lawson presents myriad arguments challenging the administrative process, attacking WellCare's decision to deny reimbursement, alleging due process violations, and raising procedural improprieties in seeking reversal of the trial court's decision. None of this is relevant to the singular issue decided by the trial court and properly before this Court for review—Lawson's capacity to bring a civil action on his own behalf after being declared incompetent.
The trial court dismissed Lawson's petition for review of the administrative decision on the basis that in Kentucky a person who has been declared incompetent cannot bring a legal action in this state. We agree.
The plain language of CR 17.03(1) requires "[a]ctions involving unmarried infants or persons of unsound mind shall be brought by the party's guardian or committee. . . ."
This rule is steeped in our common law and is based on studied experience. See generally Howard v. Howard, 87 Ky. 616, 9 S.W. 411 (1888) (providing an exhaustive history); see Miller v. Cabell, 81 Ky. 178 (Ky. 1883). Indeed, the codification of this rule can be traced back as far as 1876 in Section 35 and 36 of the Civil Code of Practice, the precursor of the Kentucky Rules of Civil Procedure. In 1953, our predecessor Court adopted Section 35 and 36 into what is now Civil Rule 17.03.
Reihle v. Reihle, 504 S.W.3d 7, 8 (Ky. 2016). As used in CR 17.03(1), "unsound mind" simply means a person has been so adjudicated. Straney v. Straney, 481 S.W.2d 292 (Ky. 1972).
It is undisputed Lawson was declared incompetent pursuant to KRS Chapter 387 and no efforts to remove that disability have been undertaken. It is also undisputed Lawson filed the present action individually and in his own right. CHFS and WellCare were entitled to have the action dismissed because existing law simply does not permit Lawson to bring a civil action in his own name. The trial court did not err.
Finally, presently pending before this Court are motions by CHFS and WellCare to strike Lawson's brief and/or dismiss the action. However, based on our resolution of the case as set forth herein, the motions are DENIED as MOOT.
For the foregoing reasons, the judgment of the Bell Circuit Court is AFFIRMED.
ALL CONCUR.
