Opinion
Civ. No. 98-442 (DRD).
November, 1998
Richard A. Cole, M.D., Newburyport, MA, Pro se Plaintiff.
Charles A. Reid, III, Esq., H. Lockwood Miller, III, Esq., Shanley Fisher, P.C., Morristown, N.J., Attorneys for Defendants.
O P I N I O N
In this ERISA action a doctor is suing a health insurer for allegedly covered charges which former patients received. The health insurer, defendant Prudential Insurance Company (Prudential"), moves for summary judgment pursuant to Fed.R.Civ.P. 56. For the reasons set forth below, Defendant's motion will be granted.
I. BACKGROUND
Plaintiff, Dr. Richard Cole ("Plaintiff" or "Cole"), was a licensed physician who practiced in Erie, Pennsylvania until the early 1990s. See Amended Complaint ¶ 1. In or about November 1991, a grand jury for the United States District Court for the Western District of Pennsylvania indicted Cole on 561 counts of, inter alia, improper distribution of methamphetamine in the form of Dexedrine and mail fraud in connection with the submission of bills to patients and/or claims to insurance carriers. See Cole Dep. 143:10-145:6. On November 9, 1992, Cole signed a plea agreement on behalf of himself and his professional corporation admitting to the commission of the acts outlined in the indictment. Id. 149:6-150:13. On December 31, 1992, the Pennsylvania State Board of Medicine issued a "Notice of Automatic Suspension" and ordered Cole to cease and desist from the practice of medicine within the state of Pennsylvania. Id. 163:5-164:14.
Prior to his suspension from the practice of medicine, Cole allegedly provided various treatments to several patients who, he contends, were covered under one or more employee benefit plans issued by Prudential.See Amended Complaint. Cole contends that he did not receive payment from Prudential as to nine of these patients. The allegedly unpaid services that Cole rendered to these patients are the subject matter of this action. The nine patients and the last dates they allegedly received treatment from Cole are Margarett Betts (March 25, 1991), Sarah Caprino (January 28, 1990), Carolyn Jenkins (December 2, 1991), Charlotte Judy (October 24, 1990), Kirk Price (October 19, 1992), Wanda Skelly (May 17, 1990), Beverly Thorstenson (January 6, 1990), Kathleen Vantassel (October 24, 1990), and John Waterhouse (April 2, 1990). See Cole Dep. 45:21-24, 54:24-55:3, 63:21-23, 77:16-18, 91:20-22, 100:21-23, 114:7-9, 118:13-15, 122:12-14.
Prior to instituting the present action, Cole filed collection suits against several of these patients in Pennsylvania state court seeking to recover the cost of his services. Id. 59:19-60:1, 85:9-15, 100:4-10. The state courts dismissed these suits for various reasons including real-party-in-interest grounds and statute of limitations grounds. See,e.g., Cole v. Lawrence, 701 A.2d 987 (Pa.Super.Ct. 1997). Additionally, the Pennsylvania Attorney General filed suit against Cole seeking civil penalties for Cole's untimely suits against his former patients and for an order permanently enjoining Cole from filing any more collection suits in state court. See Pennsylvania v. Cole, 709 A.2d 994 (Pa.Commw.Ct. 1998).
Thereafter, on November 10, 1997, Cole filed a complaint in the New Jersey Superior Court (the "Complaint"). Prudential filed a notice of removal with this court, alleging federal question jurisdiction under the Employee Retirement Income Security Act, as amended, 29 U.S.C. § 1002et seq. ("ERISA"). See 29 U.S.C. § 1132(e)(1). Cole's Complaint alleged breach of contract, unjust enrichment, and fraud claims against Prudential. Cole sought to have Prudential satisfy the alleged outstanding claims of Carolyn Jenkins, Charlotte Judy, and Kirk Price.See Complaint ¶ 5. On February 13, 1998, Cole filed an amended complaint (the "Amended Complaint") in which he asserted similar claims against Prudential. See Miller Aff. ¶ 3. The theories of recovery asserted by Cole in the Amended Complaint were the same as the Complaint but additional patients were added. The Amended Complaint seeks payment for the alleged services rendered to Margaret Betts, Sarah Caprino, Wanda Skelly, Beverly Thorstenson, Kathleen Vantassel, John Waterhouse, as well as the three individuals named in the original Complaint. See Amended Complaint ¶ 5.
II. DISCUSSION
Prudential has moved for summary judgment and seeks dismissal of Plaintiff's Amended Complaint in its entirety. Prudential argues that Cole is barred from pursuing his action against it because the applicable Pennsylvania statute of limitations expired well before Cole filed the Complaint. Cole opposes the motion and argues that the applicable statute of limitations is the six year New Jersey breach of contract statute instead of the four year Pennsylvania statute. Additionally, Cole contends that because he has not received a formal denial of payment from Prudential, the statute of limitations has not yet started to run.
A. Summary Judgment Standard
The Court may grant summary judgment when, drawing all inferences in favor of the non-moving party, the pleadings, supporting papers, affidavits, and admissions on file, demonstrate that there is no genuine issue of material fact and that the movant is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c); see Todaro v. Bowman, 872 F.2d 43, 46 (3d Cir. 1989); Davis v. Portline Transportes Maritime Internacional, 16 F.3d 532, 536 n. 3 (3d Cir. 1994); Chipollini v. Spencer Gifts, Inc., 814 F.2d 893, 896 (3d Cir.) (in banc), cert. dismissed, 483 U.S. 1052, 108 S.Ct. 26, 97 L.Ed.2d 815 (1987). The Court's function is not to weigh the evidence and discern the truth of the matter, but to determine whether there is a genuine issue of material fact for trial. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986);Petruzzi's IGA v. Darling-Delaware, 998 F.2d 1224, 1330 (3d Cir.), cert.denied, 510 U.S. 994, 114 S.Ct. 554, 126 L.Ed.2d 455 (1993). An issue is "genuine" if a reasonable jury could possibly hold in the non-movant's favor with regard to that issue. Anderson, 477 U.S. at 248; Miller v. Indiana Hospital, 843 F.2d 139, 143 (3d Cir.), cert. denied, 488 U.S. 870, 109 S.Ct. 178, 102 L.Ed.2d 147 (1988). A fact is material if it influences the outcome of the action under the governing substantive law. Anderson, 477 U.S. at 248.
The moving party bears the burden of establishing that there are no genuine issues of material fact for trial regardless of who bears the ultimate burden of proof at trial. Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). Where the non-moving party bears the burden of proof at trial, as Plaintiff does here, the moving party may satisfy its burden on a motion for summary judgment by showing that the non-moving party has failed to adduce evidence sufficient to establish an essential element that the non-movant would have to prove at trial. Id.
Once that burden is met, the non-moving party "may not rest upon the mere allegations" of its complaint to raise a genuine issue of fact, but must submit evidence specifically showing that there is a genuine issue for trial. Fed.R.Civ.P. 56(e); Robin Const. Co. v. United States, 345 F.2d 610, 614-15 (3d Cir. 1965). If the party opposing the motion fails to do so, the "factual record will be taken as presented by the moving party and judgment will be entered as a matter of law." United States v. City of Hoboken, 675 F. Supp. 189, 192 (D.N.J. 1987).
If the Court determines that there is no genuine issue of material fact and that the movant is entitled to judgment as a matter of law, then summary judgment may be granted.
B. Issue Preclusion
Because the present action was preceded by a state court action arising from the same events, the first question is whether Cole's claims are precluded by his prior Pennsylvania lawsuit. Claim preclusion, also known as collateral estoppel, bars relitigation of issues adjudicated in a prior action. Untracht v. West Jersey Health Sys., 803 F. Supp. 978, 984 (D.N.J. 1992), aff'd, 998 F.2d 1006 (3d Cir. 1993). Federal courts are required to give preclusive effect to state court judgments by virtue of the Full Faith and Credit Act, which provides that "[a]cts, records and judicial proceedings . . . shall have the same full faith and credit in every [federal] court . . . as they have by law or usage in the courts of such State . . . from where they are taken." 28 U.S.C. § 1738;Swineford v. Snyder County, 15 F.3d 1258, 1266 (3d Cir. 1994).
In Pennsylvania, issue preclusion is appropriately invoked when four conditions are met. See Rue v. K-Mart Corp., 456 Pa. Super. 641, 646, 691 A.2d 498, 500 (Pa.Super.Ct.), aff'd, 713 A.2d 82 (Pa. 1997). First, the issue determined in the prior action is identical to that presented in the subsequent action. Id. Second, the previous judgment is final on the merits. Id. Third, the party against whom the defense is invoked was a party or in privity with a party in the first action. Id. Finally, the party against whom estoppel is asserted had a full and fair opportunity to litigate the issue on its merits in the prior action. Id.; see also Bortz v. W.C.A.B., 546 Pa. 77, 82, 683 A.2d 259, 261 (1996); Balent v. City of Wilkes-Barre, 542 Pa. 555, 564, 669 A.2d 309, 313 (1995); Safeguard Mut. Ins. Co. v. Williams, 463 Pa. 567, 345 A.2d 664, 668 (1975); Shaffer v. Smith, 543 Pa. 526, 528-30, 673 A.2d 872, 874 (1996). Issue preclusion can be invoked in a subsequent action even though the cause of action is different from the one previously litigated. Balent, 542 Pa. at 564, 669 A.2d at 313. As long as the issue is identical and the other factors are met, a party may be precluded from arguing that issue again.Id.
Cole's Pennsylvania action was based on claims of breach of express oral agreements, quantum meruit, and unjust enrichment. Although this Court has jurisdiction over the case at bar under ERISA, the underlying claims filed against Prudential are for breach of contract, quantum meruit, and unjust enrichment.
The issue litigated previously in the Pennsylvania action was whether the statute of limitations had run on Cole's claims to collect fees for services rendered to former patients. Applying the four part issue preclusion test annunciated by the Pennsylvania courts to this present case, it is clear that Cole is precluded from arguing that the case at bar is timely. First, the issue of whether the statute of limitations has run on Cole's right to collect fees for services rendered was decided by the Pennsylvania courts. See Cole v. Lawrence, 701 A.2d 987, 989 (Pa.Sup.Ct. 1997); see also Pennsylvania v. Cole, 709 A.2d 994 (Pa.Commw.Ct. 1998). Second, the previous judgment is valid and final on the merits. See Pennsylvania v. Cole, 709 A.2d 994 (Pa.Commw.Ct. 1998). Third, the party against whom the defense is invoked, Cole, was a party in the first action. See Cole v. Lawrence, 701 A.2d 987, 989 (Pa.Sup.Ct. 1997). Finally, the party against whom estoppel is asserted had a full and fair opportunity to litigate the issue on its merits in the prior action. Cole had the opportunity to litigate the timeliness of his lawsuits in two separate cases which were both appealed and subsequently affirmed. Clearly Plaintiff has had a full and fair opportunity to litigate this issue. Therefore, Cole is collaterally estopped from arguing this issue before this Court which is bound to accept the decision of the Pennsylvania courts. See 28 U.S.C. § 1738. Accordingly, his Amended Complaint will be dismissed with prejudice.
Because ERISA does not have a statute of limitations for these types of claims, federal courts will look to the most analogous state statute of limitations in order to determine the appropriate limitations period. Agency Holding Corp. v. Malley-Duff Assocs., Inc . , 483 U.S. 143, 146-47, 107 S.Ct. 2759, 2762, 97 L.Ed.2d 121 (1987); Star v. JCI Data Processing, Inc . , 767 F. Supp. 633, 638 (D.N.J. 1991). Although the general federal rule is that the forum state's statute of limitations be applied, to avoid rewarding forum shopping, see Champion Int'l Corp. v. United Paperworkers Int'l Union , 779 F.2d 328, 334 (6th Cir. 1985), the more appropriate result would be to apply a Pennsylvania statute. Accordingly, the most analogous state statute of limitation would be the four year Pennsylvania statute for breach of contract. See , e.g . , Duchek v. Blue Cross and Blue Shield of Nebraska , 153 F.3d 648, 649 (8th Cir. 1998).
III. CONCLUSION
For the reasons set forth above Prudential's motion for summary judgment will be granted and Cole's Amended Complaint will be dismissed with prejudice. An appropriate order will issue.
O R D E R
Prudential Insurance Company ("Defendant"), having moved for summary judgment pursuant to Fed.R.Civ.P. 56, and in accordance with this Court's opinion of even date;
IT IS, this day of November, 1998, hereby
ORDERED that Defendant's motion for summary judgment be and hereby is GRANTED; and it is further
ORDERED that Plaintiff's Amended Complaint be and hereby is DISMISSED with prejudice.