Champion Billiards Cafe, Inc. v. Hall

EYLER, Judge. Although two distinct issues are raised on appeal, the primary issue presented by this case is whether an employer may be held liable in tort for economic losses, ie., medical expenses, incurred by an employee because the employer failed to forward timely the employee’s application for health insurance coverage to the provider after undertaking to do so. We affirm the judgment in favor of the employee for reasons set forth below. Facts Appellee, Jill K. Hall, was employed as a bartender by appellant, Champion Billiards Cafe, Inc. Appellee attended a meeting of appellant’s employees in September 1994, at which time appellant offered to enroll employees in a group insurance program provided by Optimum Choice, Inc. (“Optimum Choice”), a health insurance provider.

Appellant would contribute no money towards the insurance, but offered to deduct premiums from employee paychecks and forward the money to Optimum Choice. Along with other employees, appellee completed the necessary applications and authorizations, including an authorization for payroll deductions to pay the premiums; chose one of the coverage options provided; and designated a primary physician from a list supplied by Optimum Choice. All of the completed employee applications were -accepted by appellee’s supervisor to be sent by facsimile to Optimum Choice. Appel ⁵⁶⁴ lee believed that she had health insurance as of October 1, 1994.

Unknown to appellee, her supervisor did not send her application along with those of the other employees. There was conflicting testimony as to whether this was done accidentally or purposefully. The trial court determined that the supervisor knowingly withheld appellee’s application because the supervisor believed that appellee’s employment might be terminated. Appellee was hit by a motor vehicle while riding her bicycle on October 21, 1994 and incurred medical expenses in the amount of $15,846.86.

She submitted a claim to Optimum Choice, but it was denied. Through her supervisor, she learned that Optimum Choice had never received her application. The supervisor then submitted her application, but Optimum Choice refused reimbursement for expenses incurred prior to November 1, 1994, the effective date of coverage. Appellee filed a complaint on May 4, 1992 in the Circuit Court for Montgomery County against appellant and Optimum Choice, the count against Optimum Choice being voluntarily dismissed prior to trial.

Appellee sued appellant for breach of contract, negligence, negligent misrepresentation, and fraud, alleging that appellant had a duty both in contract and in tort to forward her insurance application to the provider. A bench trial was held on January 23 and 24, 1996 and, at the close of appellee’s case, the trial court granted appellant’s motion for judgment with respect to the fraud claim. By order filed January 31, 1996, the trial court found in favor of appellee on the negligence claim and entered judgment in appellee’s favor in the amount of $15,636.36, the amount that Optimum Choice would have paid had appellee been insured. Issues The issues presented to us by appellant, as rephrased by us for clarity, are as follows: ⁵⁶⁵ 1.

Did the trial court err in admitting certain documents into evidence? 2. Did the trial court err in finding the existence of a tort duty owed by appellant to appellee? Discussion A. The Admission of Appellee’s Medical Records Over appellant’s objection, appellee introduced into evidence various medical bills and collection letters from health care providers who rendered medical treatment to appellee. Appellee did not produce expert testimony from the various providers who generated the bills, nor did appellee provide testimony from medical experts that the expenses incurred were reasonable and necessary.

Appellant contends that the trial court erred in admitting into evidence the medical bills and collection letters, asserting that: (1) the documents were not authenticated; (2) they were not proved to be business records and, thus, contained hearsay; and (3) there was no expert testimony that the bills were fair and reasonable. Appellee takes the position that the documents were properly admitted because the proof necessary was not that which would be required in a personal injury action; rather, the question before the trial court was whether the bills would have been covered under the health insurance policy, if it existed. Additionally, appellee contends that the documents, if improperly admitted, constituted harmless error because there was testimony concerning the same information as was contained in the documents and that information was legally sufficient to support the judgment. We do not perceive any error on the part of the trial judge.

First, the documents were sufficiently authenticated. Appellee identified the bills as having been received by her and their authenticity was not disputed by Optimum Choice. “The requirement of authentication or identification as a condition precedent to admissibility is satisfied by evidence sufficient to support a finding that the matter in question is what its proponent claims.” Rule 5-901(a). ⁵⁶⁶ Second, with respect to the hearsay objection, the trial court did not state a reason for ruling in favor of admissibility, but the nature of the documents and the surrounding circumstances constituted sufficient circumstantial evidence to conclude that they were business records. Testimony from the author or all custodians of a document is not always necessary to support a finding of admissibility, as there are instances where “a court may ‘conclude from the circumstances and the nature of the document involved that it was made in the regular course of business.’ ” Attorney Grievance Comm’n v. Keister, 327 Md. 56, 75 , 607 A.2d 909 (1992) (citing Pine Street Trading Corp. v. Farrell Lines, Inc., 278 Md. 363, 373 , 364 A.2d 1103 (1976)); Thomas v. Owens, 28 Md. App. 442, 447 , 346 A.2d 662 (1975); Md. Rule 5-803(b)(6). 1 See Md.Code Ann., Cts. & Jud. Proc. art., § 10-101 (1995 Repl.

Vol.). Third, the issue before the trial court was not the extent of damages appellee incurred due to her accident, but the extent of damages she incurred due to her lack of insurance. Witnesses testified as to the amount of the bills, that they were usual and customary for the services rendered, and that they would have been paid to the extent described below, assuming coverage. Because of the nature of the claim, appellee need only show that Optimum Choice would have paid the invoices as reasonable and customary according to its own reimbursement guidelines, if they had been submitted.

All but one of the providers were participating providers in accordance with Optimum Choice’s reimbursement schedule. One of Optimum Choice’s representatives calculated that Optimum Choice would have paid $12,872 to the providers; that appellee would have been responsible for $67.50; that a bill in the amount of $145 from a non-participating provider ⁵⁶⁷ would not have been covered; and that the remainder of the bills would have been written off by the providers pursuant to participation agreements with Optimum Choice. The judgment entered by the trial court was in the amount of the bills, $15,846.86, less the $145 bill from the non-participating provider and the $67.50 that would have been the responsibility of appellee, producing the judgment figure of $15,636.36. Dale Adamson, Manager of Cost Containment for Optimum Choice, testified that the charges by the providers were usual and customary for the services rendered.

Lee Royen, a nurse coordinator in Optimum Choice’s Cost Containment Department, testified to essentially the same information. The cumulative weight of this testimony supports appellee’s burden of proof concerning her economic losses. Fourth, the above testimony was not challenged. Consequently, the admission of the documents, if assumed to be in error, was harmless.

B. The Existence of the Employer’s Duty Appellant contends that it owed no tort duty to appellee under the facts in this case and asserts that the trial court, in finding a duty, improperly relied upon