FOR PUBLICATION
ATTORNEY FOR APPELLANTS: ATTORNEY FOR APPELLEES
INDIANA DEPARTMENT OF INSURANCE,
DAVID W. HOLUB SALLY McCARTY (Individually and as
Ruman, Clements & Holub, P.C. Commissioner), MARJORIE McGINN,
Hammond, Indiana DONNA D. BENNETT, and JOHN MORTEL:
STEVE CARTER
Attorney General of Indiana
DAVID L. STEINER
Deputy Attorney General
Indianapolis, Indiana
IN THE COURT OF APPEALS OF INDIANA
KARL LINDEN and MARY LINDEN, Individually )
and on Behalf of all Other Class Members, )
)
Appellants-Plaintiffs, )
)
vs. ) No. 45A05-0306-CV-275
)
HEALTH CARE 2000, INC., et al., )
)
Appellees-Defendants. )
__________________________________________ )
)
KARL LINDEN and MARY LINDEN, Individually )
and on Behalf of all Others Similarly Situated, )
)
Appellants-Plaintiffs/Cross-Appellees, )
)
vs. )
)
INDIANA DEPARTMENT OF )
INSURANCE, et al., )
)
Appellees-Defendants/Cross-Appellants. )
INTERLOCUTORY APPEAL AND CROSS APPEAL FROM THE LAKE SUPERIOR COURT
The Honorable Robert A. Pete, Judge
Cause No. 45D05-9711-CP-2113
June 11, 2004
OPINION - FOR PUBLICATION
BROOK, Senior Judge
Id. No cease and desist order was ever issued.
In a letter to Kasprzaks counsel dated June 13, 1996, DOI Chief Counsel
Briget Polichene acknowledged the DOIs receipt of an application for a certificate of
authority to establish and operate an HMO and stated that the application did
not meet statutory standards.
Id. at 24.
See footnote
Polichene detailed several concerns
raised by the application and reiterated that a company may not act as
a health maintenance organization
in the absence of a certificate of authority
issued by [the DOI]. Id. at 24, 25. Polichene also noted
that the DOI had received numberous [sic] complaints from enrollees regarding timeliness of
claim payments and the services provided by the HMO. Id. at 25.
Finally, Polichene stated that the DOI would preliminarily deny the application if
Kasprzak did not comply with the terms of the letter by June 28,
1996. Id.
In a letter dated June 20, 1996, Polichene responded to questions raised by
Kasprzaks counsel and stated,
The Department advises you again that a company may not act as a
health maintenance organization
in the absence of a certificate of authority issued
by the Department. As you know, the Department has not issued a
certificate of authority to the Applicant because the Applicant has not yet demonstrated
compliance with the statutory requirements for issuance of a certificate of authority.
We are increasingly concerned about the Applicants disregard for Indiana law (as evidenced
by its continued operation without a certificate of authority) and representations that [it]
is able to act as a health maintenance organization.
Id. at 29. On May 12, 1997, DOI Acting Commissioner Sally McCarty
denied Health Care 2000s application for a certificate of authority to operate an
HMO. On December 19, 1997, the Marion Circuit Court ordered the liquidation
of Health Care 2000.
On April 8, 1999, Appellants filed their third amended class action complaint against,
inter alia, Health Care 2000, Kasprzak, the DOI, and McCarty in her official
and individual capacities, as well as Maginn, Bennett, and John Mortel. In
Counts VII, VIII, and IX of their complaint, Appellants alleged that the DOI
(including McCarty and DOI employees in their official capacity) was negligent in that
it failed to take reasonable and prudent actions to protect the Healthcare 2000
enrollees from harm, including (but not limited to) issuing a cease and desist
order, notifying the insureds of the Corporate Defendants[] lack of authority to sell
insurance products, etc.; that the DOI negligently, recklessly, willfully, wantonly, or intentionally provided
[members of the public] with false and/or misleading information, indicating that Healthcare 2000
was a viable insurer and authorized to provide HMO coverage; and that the
DOI failed to exercise reasonable care in performing its investigating duties and/or failed
to exercise reasonable care to regulate [Health Care 2000] and/or make reasonable efforts
to resolve any problems disclosed as a result of their investigation of said
complaints. Appellants App. at 61-65.
In Count X of their complaint, Appellants sought damages pursuant to 42 USC
§ 1983 and related statutes against the DOI Commissioners individually, alleging that they
had not only failed to stop [Health Care 2000s] illegal operation, they affirmatively
and knowingly, albeit inaccurately, informed those seeking guidance as to the HMOs status
that it was operating in accordance with the laws and had fulfilled all
of the legal requirements, where their records disclosed that the facts were not
consistent with that statement.
Id. at 66-67. Appellants further alleged that
the Commissioners actions, being so inconsistent with Indiana law and so inconsistent with
any professed desire to protect the general public, suggest that the respective Commissioners
may have been motivated by undisclosed influences, perhaps originating from those involved in
the HMO operation, either directly or indirectly, especially when that failure to act
occurred under four different administrations[,] and that the non-governmental defendants were able
to deprive the class members of their property under color of state law,
by taking their property (insurance premiums) without due process of law. Id.
at 67.
On December 11, 2002, Appellants filed a motion for partial summary judgment against
only the DOI on the issue of liability. On February 10, 2003,
the Attorney General filed a memorandum in opposition to Appellants motion and in
support of summary judgment for all State defendants. The Attorney General asserted
that all State defendants were immune from liability by virtue of the Indiana
Tort Claims Act
and are entitled to summary judgment. Appellees App.
at 1. On February 18, 2003, Appellants filed a reply memorandum and
a motion to strike those portions of the Attorney Generals memorandum that deal
with the liability of parties not addressed in [Appellants motion for partial summary
judgment]. Appellants App. at 287. On March 19, 2003, the trial
court held a hearing on the parties motions for summary judgment. On
April 7, 2003, the trial court entered an order summarily denying Appellants motion
to strike and denying both parties motions for summary judgment.
See footnote This interlocutory
cross-appeal ensued.
Indiana Dept of Fin. Insts. v. Worthington Bancshares, Inc., 728 N.E.2d 899, 901-02
(Ind. Ct. App. 2000) (some citations omitted), trans. denied. The fact that
the parties filed cross-motions for summary judgment does not alter our standard of
review. Instead, we must consider each motion separately to determine whether the
moving party is entitled to judgment as a matter of law. GKN
Co. v. Starnes Trucking, Inc., 798 N.E.2d 548, 551 (Ind. Ct. App. 2003)
(citation omitted).
Specifically, Appellees contend that the trial court should have determined that they were
immune from liability under the Indiana Tort Claims Act (the Act). The
Act allows suit against government entities for torts committed by their agencies or
employees, but grants immunity under the specific circumstances enumerated in [Indiana Code Section]
34-13-3-3.
Gibson v. Evansville Vanderburgh Bldg. Commn, 725 N.E.2d 949, 952 (Ind.
Ct. App. 2000), trans. denied. [W]hether a governmental entity is immune from
liability under the Act is a question of law for the courts, although
it may include an extended factual development. Minks v. Pina, 709 N.E.2d
379, 382 (Ind. Ct. App. 1999), trans. denied (2000).
The essential inquiry is whether the legislature intended acts such as those challenged
to enjoy immunity. Because the Act is in derogation of common law,
it is narrowly construed against the grant of immunity. The party seeking
immunity bears the burden of proving that its conduct falls within the Act
and is, thus, shielded from liability.
Gibson, 725 N.E.2d at 952-53 (citations omitted). Immunity assumes negligence but denies
liability. The purpose of immunity is to ensure that public employees are
able to perform their duties without threat of civil litigation. Worthington Bancshares,
728 N.E.2d at 902. If immunity exists, Appellees simply are not liable;
the degree of their culpability and the nature of their tortious conduct are
not relevant considerations. Bd. of Commrs of County of Harrison v. Lowe,
753 N.E.2d 708, 711 (Ind. Ct. App. 2001), trans. denied (2002).
Indiana Code Section 34-13-3-3 reads in pertinent part,
A governmental entity of an employee acting within the scope of the employees
employment is not liable if a loss results from the following:
.
(8) The adoption and enforcement of or failure to adopt or enforce
a law (including rules and regulations), unless the act of enforcement constitutes false
arrest or false imprisonment.
Appellees contend that Appellants losses resulted from Appellees failure to enforce laws prohibiting
Health Care 2000 from operating as an HMO without a certificate of authority
and that they are therefore immune from liability.
See footnote We agree.
Our supreme court has explained that the scope of enforcement is limited to
those activities in which a governmental entity or its employees compel or attempt
to compel the obedience of another to laws, rules or regulations, or sanction
or attempt to sanction a violation thereof. Mullin v. Mun. City of
S. Bend, 639 N.E.2d 278, 283 (Ind. 1994). Effective July 1, 1994,
Indiana Code Section 27-13-2-2 provided that [a] person may not establish or operate
a health maintenance organization without obtaining a certificate of authority under this article.
Effective July 1, 1994, Indiana Code Section 27-13-28-4 provided that the DOI
commissioner may issue an order directing: (1) a health maintenance organization; or
(2) a representative of a health maintenance organization; to cease and desist from
engaging in any act or practice that violates this article. Also as
of that date, Indiana Code Section 27-13-28-5 provided, In the case of a
violation of this article, if the commissioner elects not to issue a cease
and desist order, or in the event of noncompliance with a cease and
desist order issued under [Indiana Code Section 27-13-28-4], the commissioner may institute a
proceeding to obtain injunctive relief or other appropriate relief in the Marion County
circuit court.
See footnote
In their complaint, Appellants alleged that Health Care 2000 was grossly underfunded and
negligently managed and that as a result of its alleged misappropriation of funds,
they lost their premium payments(s) and, in addition, have suffered indebtedness for medical
services provided (that would otherwise have been covered by insurance) and mental or
emotion[al] distress from these losses[.] Appellants App. at 55. The DOI
commissioner never issued a cease and desist order or sought to obtain injunctive
relief once it was learned that Health Care 2000 was illegally operating as
an HMO without a certificate of authority. If the commissioner had enforced
the law, then Health Care 2000 would have ceased operating as an HMO,
thereby preventing Appellants alleged losses.
Appellants rely on
Drake v. Mitchell Community Schools, 628 N.E.2d 1231 (Ind. Ct.
App. 1994), affd in relevant part, 649 N.E.2d 1027 (Ind. 1995), to support
their contention that Appellees had an independent duty to warn them of Health
Care 2000s illegal activities. Appellants Br. at 14. In Drake, a
student contracted histoplasmosis as a result of being exposed to pigeon droppings in
[a] grain elevator that was used as a haunted house. Drake, 628
N.E.2d at 1233. The defendant school claimed immunity under the Act for
its failure to make an inspection, or making an inadequate or negligent inspection
of the grain elevator. Id. at 1233-34 (quoting what is now Ind.
Code § 34-13-3-3(12)). The Drake court noted that Indiana law imposes on
school authorities a duty to exercise reasonable care for the safety of their
students and that the plaintiffs injuries were not caused by any failure to
make an inspection or by an inadequate or negligent inspection. The inspection
revealed that the grain elevator posed a risk to the students health.
Id. at 1234. In holding that the school was not entitled to
immunity under the Act, the Drake court concluded, Under the particular facts of
this case, the Schools knowledge of the specific danger in question, and accordingly,
its duty to exercise reasonable care to protect its students from this danger,
was independent of any duty it may have had to inspect the grain
elevator. Id. at 1234-35.
We believe that Appellants reliance on
Drake is misplaced. Here, Appellants alleged
losses resulted from Appellees failure to shut down Health Care 2000 once they
learned that it was operating without a certificate of authority, not from Appellees
subsequent failure to warn Appellants of Health Care 2000s illegal activities. In
other words, Appellees duty to enforce the law encompassed any subsequent duty to
warn.
See footnote
See Minks, 709 N.E.2d at 383 (holding that police officers were
entitled to immunity for failing to arrest intoxicated driver who later collided with
plaintiffs vehicle; [W]e decline to establish a bright line rule that any actions
after an officer determines not to arrest an individual are no longer considered
enforcement.). To conclude that an independent duty to warn existed in this
case would be to eviscerate the Acts law enforcement immunity provision.
Our supreme court recently stated that
case law has held that the [Act] expresses a legislative policy to protect
the States finances and also to ensure that public employees can exercise their
independent judgment necessary to carry out their duties without threat of harassment by
litigation or threats of litigation over decisions made within the scope of their
employment.
King v. Northeast Security, Inc., 790 N.E.2d 474, 483 (Ind. 2003) (citations omitted).
Here, Deputy Commissioner Reddick acknowledged that the DOI did not enforce the
law against Health Care 2000 so that it could successfully apply and be
licensed as an HMO[,] whereupon its unauthorized sales of HMO policies would basically
be no harm, no fault [sic] at that point[.] Appellants App. at
101.
See footnote
In other words, Appellees exercised their independent judgment not to enforce
the law against Health Care 2000. Although in retrospect this judgment might
appear to be less than sound, it is precisely the sort of governmental
decisionmaking that the legislature sought to protect from judicial second-guessing under the Act.
See Peavler v. Bd. of Commrs of Monroe County, 528 N.E.2d 40,
44 (Ind. 1988) (The policy underlying governmental immunity is the fundamental idea that
certain kinds of executive branch decisions should not be subject to judicial review.
The separation of powers doctrine forecloses the courts from reviewing political, social
and economic actions within the province of coordinate branches of government.). Accordingly,
we conclude that Appellees are entitled to immunity under Indiana Code Section 34-13-3-3(8)
for failing to enforce the law against Health Care 2000 and that the
trial court erred in denying their motion for summary judgment on this ground.
See footnote
Appellants also contend, however, that Appellees misled them regarding Health Care 2000s licensing
status. We disagree. The record establishes that Appellees consistently stated in
response to inquiries that Health Care 2000 [did] not hold a certificate of
authority to act as an insurance company or a health maintenance organization (HMO);
that Health Care 2000 [had] applied to the Department of Insurance for a
certificate of authority to act as an HMO; that the DOI was reviewing
the application; and that Health Care 2000 [was] not authorized to operate as
an HMO until a certificate of authority is issued. Appellants App. at
157 (letter from DOI Attorney Amy Strati); see also id. at 165-168, 171-72
(letters from Strati containing similar language and stating, Any information received will be
considered in the review of [Health Care 2000s] pending application.). Appellants characterization
of Health Care 2000s application as so deficient that it was always pending
denial disregards the fact that Appellees never misled the public as to Health
Care 2000s licensing status.
See footnote
In summary, we reverse the trial courts denial of Appellees motion for summary
judgment and remand with instructions to enter judgment in favor of Appellees with
respect to Counts VII, VIII, IX, and X of Appellants third amended complaint.
KARL LINDEN and MARY LINDEN, Individually )
and on Behalf of all Other Class Members, )
Appellants-Defendants, )
)
vs. ) No. 45A05-0306-CV-275
)
HEALTH CARE 2000, INC., et al., )
Appellees-Defendants. )
__________________________________________)
)
KARL LINDEN and MARY LINDEN, Individually )
and on Behalf of all Others Similarly Situated, )
Appellants-Plaintiffs/Cross-Appellees, )
)
vs. )
)
INDIANA DEPARTMENT OF )
INSURANCE, et al., )
Appellees-Defendants/Cross Appellants. )
SULLIVAN, Judge, concurring
During the some four years that Health Care 2000 operated without authority and
collected premiums from unsuspecting and innocent policy purchasers, DOI had full access to
the nature of the operation and the lack of financial stability of the
HMO. It certainly had the investigative tools and authority to acquire
the very information which in 1997 led the Marion Circuit Court to liquidate
Health Care 2000. The conduct, or lack thereof, by DOI is indefensible.
It is nevertheless insulated against civil liability by I.C. § 34-13-3-3(8), and
for this reason, I concur in the reversal of the trial courts denial
of Appellees motion for summary judgment.