ÿWPC% …# VUNa %¯ 0cµU< w@T 4” ¨ · 0J¿ 0T 0^] 0h» 0r# 0|• 0† 0— 1u' 0dœ U>B)>DCg AMªU*÷ 0D!:e BŸv~¼vÓ: D3  0@@ AO€ÆÏ 0D• D/Ù B˜HP LaserJet 4SiHPPCL5MS,ü,,,,,ü0nLhÎ(ÈhH  Z 6Times New Roman RegularX(;cW$¡¡Ò°ÒÒ„°ÒÔ€XaBXXXÔ-šBu Z‹$Arrus BT Roman JDKDLDMUNîOUPDQURÓ€\¥Hœ$3|x\2 ÿÿ0Indent1Ô2ÔÔ3  Ô2" ÿÿ0Indent2à0 àÔ2ÔÔ3  Ô2, ÿÿ0Indent3à0 àà0 àÔ2ÔÔ3  Ô26 ÿÿ0Indent4à0 àà0 àà0 àÔ2ÔÔ3  Ô2@ ÿÿ0Indent5à0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2J ÿÿ0Indent6à0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2T ÿÿ0Indent7à0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô2^ ÿÿ0Indent8à0 àà0 àà0 àà0 àà0 àà0 àà0 àÔ2ÔÔ3  Ô ÿÿ?AGMSYaioIndent0I.A.1.a.(1)(a)i)a)P ÿÿ8Mac DefaultMac DefaultÓ ` °šXÓ< Œ 9p`(&Times New Roman% Line 7 d7Border 1dd€- Cþÿ << Gÿÿ< Œ 9p`(Arial(#Ã$òòÚ  Ú0Ú  Úóó 0Ý ƒ!ÝÑ  ÑÑ#€d#ÑÔ€ÔÒ  ÒÒ „ ÒÔ€ÔÝ  ÝÔ€"ÔÔ€"ÔÓ  Óò òÔ YYY ÔFILEDÔ€"XÔÌÌJulyÏ29,Ï1998ÌÌCecilÏW.ÏCrowsonÌAppellateÏCourtÏClerkÔ  Ôó ó dPtPtHHÚ(ÿáÿâùFG(üHHÚ(d'hStyl{WP}01•ÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃÃà Ãà Ãà Ãà Ãà ÃÃÃÃÃÃÃÃÃÃÃÐ ÐÐHHÐÐ  ÐÐ2ÐÐÿÿ¸æ$ÿÐÐHHÐÐÐÐÐÐÐÐ  ÐÐ ÐÐ ÐÑÑÑGenevaÑÑ ÑÑ € ÑÑ<Px–ÈÑÒÒÒ443!#4ÒÒ$ *$ÒÒ$*$ÒÒ ÿKK ÒÒ  Geneva ÒÒ  Geneva ÒÓ.,ÓÓÓÓ6ÓÓ ÓßßßßßßßßßßßßßßßßßßÑGenevaÑÑ ÑÒ  h HD: Geneva ÒÒ  h HD: Geneva Ò%%%%'ÿÿdxd("ÿÿ$££Ò  ÒÒ  Ò€-‚ƒCþÿ<< CÿÿƒLevel 1Level 2Level 3Level 4Level 5($$””ò òÚ  Ú1Ú  Úó ó„„'÷ÿ dxdüÿP PdÝ ƒ!ÝÔ . ÔÔ€ÔÒ  ÒÒ „ ÒÔ€ÔÝ  ÝÑ\R AØ'\ÑÑ7€̈XXdðdÈ7ÑÑ  ÑÓ  ÓÞ ÞÌà@ àIN€THE€COURT€OF€APPEALS€OF€TENNESSEEÌà@ àAT€NASHVILLEÌÙ€€ÙßR€!$ A1-j|Üÿï` à. `€€@ÿRßà àà à€€€€______________________________________________ÌÌÌÌÌÌÌÌò òBENNY€N.€BLANKENSHIP,€Ìand€SHEILA€BLANKENSHIP,€ó óÌÌà àPlaintiffs„Appellees,ÌÌandÌÌò òBLUECROSS€BLUESHIELD€OFÌTENNESSEE,€as€administratorÌof€TennCare€for€the€State€ofÌTennessee,€ó óÌÌà àPlaintiff€by€Intervention/Ìà àAppellant,ÌÌVs.à àà àà àà àà àà àà àSumner€Circuit€No.€15078„CÌà àà àà àà àà àà àà àC.A.€No.€01A01„9709„CV„00492Ìò òESTATE€OF€JOSHUA€D.€BAIN€andÌBOB€WILLIAMS€FORD€ÌLINCOLN„MERCURY,€ó óÌÌà àDefendants.Ì____________________________________________________________________________ÌÌà@ àFROM€THE€SUMNER€COUNTY€CIRCUIT€COURTÌà@ àTHE€HONORABLE€THOMAS€GOODALL,€JUDGEÌÌÌà@ àDavid€E.€High€of€NashvilleÌà@ àJohn€Pellegrin€of€GallatinÌà@ àFor€AppelleesÌÌà@ àJerome€J.€Cohen€of€NashvilleÌà@ àFor€AppellantÌÌÌà@ àò òòòREVERSED€AND€REMANDEDó óóóÌÌà@ àOpinion€filed:€€ÌÌÌÌÌÌà àà àà àà àà àà àà àà àò òW.€FRANK€CRAWFORD,Ìà àà àà àà àà àà àà àà àPRESIDING€JUDGE,€W.S.ÌÌCONCUR:ÌÌALAN€E.€HIGHERS,€JUDGEÌÌHOLLY€KIRBY€LILLARD,€JUDGEó óÌÑ „ ÑÑ „ Ñ›Ñ7€̈XXdðXXdð7ÑÑ  ÑÓÓà àThe€sole€issue€in€this€case€is€whether€the€statutory€subrogation€and/orÏassignment€provisions€of€the€Tennessee€TennCare€Program€are€subject€to€theÏcommon€law€ð ðmade€wholeðð€doctrine.Ìà àPlaintiffs,€Benny€Blankenship€and€Sheila€Blankenship,€were€enrolled€in€theÏTennCare€program€and€paid€monthly€premiums€for€the€health€care€coverage.€ÏOn€July€18,€1995,€Benny€Blankenship€was€seriously€injured€in€an€automobileÏaccident€due€to€the€negligence€of€Joshua€Bain,€who€was€killed€in€the€accident.€ÏBainððs€estate€was€insolvent€but€there€was€a€total€of€$125,000.00€liabilityÏinsurance€coverage€available€in€his€behalf.€€Blankenshipððs€medical€expensesÍtotaled€in€excess€of€$30,000.00,€and€TennCare,€through€its€administrator,ÏœBlueCross›€œBlueShield›€of€Tennessee,€paid€$20,713.83€of€the€said€medicalÏexpenses.Ìà àThe€Blankenships€filed€a€complaint€against€the€estate€and€the€owner€ofÏthe€vehicle€Bain€was€driving€to€recover€for€the€losses,€injuries,€and€damagesÏsustained.€€TennCareððs€administrator€was€allowed€to€intervene€to€pursue€itsÏsubrogation€claim,€and€the€plaintiffs€filed€a€ð ðPetition€to€Determine€the€ValidityÏand/or€the€Amount€of€the€Alleged€Subrogation€Claim.ðð€€The€petition€wasÏtreated€as€an€action€for€declaratory€relief€pursuant€to€Rule€57,€Tenn.R.Civ.P.€€ItÏis€undisputed€that€the€plaintiffsðð€tort€claims€were€clearly€worth€in€excess€of€theÏpolicy€limits€settlement€plaintiffs€received.€€The€trial€court€held€that€theÏadministratorððs€right€to€recover€pursuant€to€T.C.A.€ðð€71„5„117€(Supp.€1997)€wasÏsubject€to€the€Blankenships€first€being€made€whole,€and€since€they€had€not€beenÏmade€whole€by€virtue€of€the€settlement,€there€could€be€no€subrogation€recoveryÏby€the€administrator.Ìà àThere€are€no€material€factual€disputes;€the€sole€issue€is€purely€a€questionÏof€law.€€Therefore,€our€review€of€the€trial€courtððs€ruling€is€ò òòòde€novoó óóó€with€noÏpresumption€of€correctness.€€ò òòòMarriott€Employeesðð€Fed.€Credit€Union€v.€Harrisó óóó,Ï897€S.W.2d€723,€727€(Tenn.€App.€1994).Ìà àThe€medical€expense€payments€were€made€pursuant€to€TennesseeððsÍð ðMedical€Assistance€Act€of€1968,"€codified€as€T.C.A.€€ðððð€71„5„101,€òòet€seq.óó€(1995Ï&€Supp.€1997).€€The€1968€Act€is€intended€ð ðto€make€possible€medical€assistanceÏto€those€recipients€determined€to€be€eligible€under€this€chapter€to€receiveÏmedical€assistance€that€conforms€to€the€requirements€of€title€XIX€of€the€SocialÏSecurity€Act€[codified€in€42€U.S.C.€ðððð€1396€òòet€seq.óó(1992€&€Supp.€1996)]€and€theÏregulations€promulgated€pursuant€thereto.ðð€€T.C.A.€€ðð€71„5„102€(1995).€€Ìà àT.C.A.€€ðð€71„5„117€provides€in€part,€pertinent€to€the€issue€before€us:ÌÓÓà8 àà8 àò ò71„5„117.€€Recovery€of€benefits€„€Stateððs€right€ofÏsubrogation€„€Assignment€of€insurance€benefitÏrights€„€Commissioner€authorized€to€require€certainÏinformation€identifying€persons€covered€by€thirdÏparties€„€Stateððs€right€of€action.€„€ó ó(a)€MedicalÏassistance€paid€to,€or€on€behalf€of,€any€recipientÏcannot€be€recovered€from€a€beneficiary€unless€suchÏassistance€has€been€incorrectly€paid,€or,€unless€theÏrecipient€or€beneficiary€recovers€or€is€entitled€toÏrecover€from€a€third€party€reimbursement€for€all€orÏpart€of€the€costs€of€care€or€treatment€for€the€injury€orÏillness€for€which€the€medical€assistance€is€paid.€€ToÏthe€extent€of€payments€of€medical€assistance,€the€stateÏshall€be€subrogated€to€all€rights€of€recovery,€for€theÏcost€of€care€or€treatment€for€the€injury€or€illness€forÏwhich€medical€assistance€is€provided,€contractual€orÏotherwise,€of€the€recipients€against€any€person.€ÏMedicaid€payments€to€the€provider€of€the€medicalÏservices€shall€not€be€withdrawn€or€reduced€to€recoverÏfunds€obtained€by€the€recipient€from€third€parties€forÏmedical€services€rendered€by€the€provider€if€theseÏfunds€were€obtained€without€the€knowledge€or€directÏassistance€of€the€provider€of€medical€assistance.€ÏWhen€the€state€asserts€its€right€to€subrogation,€theÏstate€shall€notify€the€recipients€in€languageÏunderstandable€to€all€recipients,€of€recipientððs€rights€ofÍrecovery€against€third€parties€and€that€recipientÏshould€seek€the€advice€of€an€attorney€regarding€thoseÏrights€of€recovery€to€which€recipient€may€be€entitled.€.Ï.€.ÌÌà8 àà8 à(b)€Upon€accepting€medical€assistance,€the€recipientÏshall€be€deemed€to€have€made€an€assignment€to€theÏstate€of€the€right€of€third€party€insurance€benefits€toÏwhich€the€recipient€may€be€entitled.€€Failure€of€theÏrecipient€to€reimburse€the€state€for€medical€assistanceÏreceived€from€any€third€party€insurance€benefitsÏreceived€as€a€result€of€the€illness€or€injury€from€whichÏthe€medical€assistance€was€paid€may€be€grounds€forÏremoving€the€recipient€from€future€participation€inÏthe€benefits€available€under€this€part;€provided,€thatÏany€removal€from€participation€shall€be€afterÏappropriate€advance€notice€to€the€recipient€and€thatÏthe€provider€of€service€shall€not€be€prevented€fromÏreceiving€payment€from€the€state€for€medicalÏassistance€services€previously€furnished€the€recipient,Ïand€that€nothing€herein€shall€require€an€insurer€to€payÏbenefits€to€the€state€which€have€already€been€paid€toÏthe€recipient.ÌÌà à42€U.S.C.€€ðð€1396a€(Supp.€1998)€states€in€pertinent€part:ÌÌà8 àà8 àò ò1396a.€€State€plans€for€medical€assistanceó óÌÌà8 àà8 àò ò(a)€ContentsÌà8 àà8 àó ó€€€€€€A€State€plan€for€medical€assistance€must€„„ÌÌà àà àà àà àà à*à àà à*à àà à*Ìà8 àà8 àò ò(25)ó ó€provide€„„ÌÌà8 àà8 àò ò(A)€ó óthat€the€State€or€local€agency€administering€suchÏplan€will€take€all€reasonable€measures€to€ascertain€theÏlegal€liability€of€third€parties€(including€healthÏinsurers,€group€health€plans€(as€defined€in€sectionÏ607(1)€of€the€Employee€Retirement€Income€SecurityÏAct€of€1974€[29€U.S.C.A.€€ðð€1167(1)]),€service€benefitÍplans,€and€health€maintenance€organizations)€to€payÏfor€care€and€services€available€under€the€plan,Ïincluding„„€Ìà8 àà8 àà à(i)€the€collection€of€sufficient€information€(asÏspecified€by€the€Secretary€in€regulations)€to€enable€theÏState€to€pursue€claims€against€such€third€parties,€withÏsuch€information€being€collected€at€the€time€of€anyÏdetermination€or€redetermination€of€eligibility€forÏmedical€assistance,€and€Ìà8 àà8 àà à(ii)€the€submission€to€the€Secretary€of€a€planÏ(subject€to€the€approval€by€the€Secretary)€for€pursuingÏclaims€against€such€third€parties,€.€.€.€.ÌÌà8 àà8 àò ò(B)ó ó€that€in€any€case€where€such€a€legal€liability€isÏfound€to€exist€after€medical€assistance€has€been€madeÏavailable€on€behalf€of€the€individual€and€where€theÏamount€of€reimbursement€the€State€can€reasonablyÏexpect€to€recover€exceeds€the€costs€of€such€recovery,Ïthe€State€or€local€agency€will€seek€reimbursement€forÏsuch€assistance€to€the€extent€of€such€legal€liability;ÌÌÓÓà àRelying€primarily€upon€the€holding€in€ò òòòWimberly€v€Amer.€Cas.€Co.ó óóó,€584ÏS.W.2d€200€(Tenn.€1979),€the€Blankenships€assert€that€the€administrator€is€notÏentitled€to€its€subrogation€claim€until€they€have€been€made€whole.€€InÏò òòòWimberlyó óóó,€two€fire€insurance€companies€sought€to€enforce€their€subrogationÏrights€under€their€fire€insurance€policies€issued€to€the€plaintiff,€Wimberly.€ÏWimberlyððs€restaurant€was€destroyed€by€fire€that€was€started€after€anotherÏparty€had€driven€her€automobile€into€the€restaurant.€€The€automobile€driverððsÏinsurance€carrier€paid€Wimberly€its€policy€limits€of€$25,000.00,€but€it€wasÏundisputed€that€the€loss€caused€by€the€fire€was€$44,619.00.€€WimberlyððsÏinsurance€companies€paid€$15,000.00,€and€sought€to€recover€the€amountÍpursuant€to€the€subrogation€provision€of€their€policies€and€settlementÏinstruments.€The€œCourt›€noted€that€the€doctrine€of€subrogation€had€its€origin€inÏgeneral€principles€of€equity,€and€under€equitable€principles€an€insured€must€beÏmade€whole€before€subrogation€rights€arise€in€favor€of€the€insured.€€ò òòòIdó óóó.€at€203.€ÏThe€œCourt›€held€that€this€principle€is€applicable€to€contractual€subrogations.€€ò òòòIdó óóó.Ïat€204.€€In€the€instant€case,€the€trial€court€extended€the€principle€to€statutoryÏsubrogation€because€T.C.A.€ðð€71„5„117€contains€no€statutory€exception€to€theÏð ðmade€wholeðð€doctrine,€and€held€that€the€statutory€interest€of€theÏadministrator€would€be€subject€to€the€Blankenships€being€first€made€whole.Ìà àWe€must€respectfully€disagree.€€Statutes€are€to€be€interpreted€so€as€toÏgive€effect€to€the€ordinary€meaning€of€the€language€used€by€the€legislature.€Ïò òòòGanzevoort€v.€Russelló óóó,€949€S.W.2d€293,€296€(Tenn.€1997);€ò òòòChapman€v.ÏSullivanó óóó,€608€S.W.2d€580,€581„82€(Tenn.€1980);€ò òòòsee€alsoóóó ó€ò òòòHenry€v.€Whiteó óóó,€250ÏS.W.2d€70,€72€(Tenn.€1952)€(ð ðIf€the€words€of€a€statute€plainly€mean€one€thingÏthey€cannot€be€given€another€meaning€by€judicial€construction.ðð).€€In€ò òòòWimberlyó óóó,Ïthere€was€no€statute€mandating€subrogation.€€In€the€instant€case€the€statuteÏspecifically€provides€for€subrogation,€and€the€subrogation€provision€is€in€theÏstatute€because€of€the€mandate€by€the€federal€government.€€The€statute€states:Ïð ðTo€the€extent€of€payments€of€medical€assistance,€the€state€òòò òshall€be€subrogatedÏto€all€rights€of€recoveryó óóó,€for€the€cost€of€care€or€treatment€for€the€injury€or€illnessÍfor€which€medical€assistance€is€provided.€.€.ðð€T.C.A.€ðð€71„5„117€(a).€€(emphasisÏadded).€€The€language€employed€by€the€legislature€in€this€statute€is€clear€andÏunequivocal.€€€In€the€instant€case,€the€legislation€was€passed€to€provide€theÏmedical€assistance€in€conformance€with€the€requirements€of€the€Social€SecurityÏAct.€€The€act€mandates€that€the€state€take€the€necessary€steps€to€pursue€theÏlegal€liability€of€third€parties.€€The€legislature,€in€responding€to€thisÏrequirement,€mandated€that€ð ðthe€state€shall€be€subrogated€to€all€rights€ofÏrecovery.ðð€€T.C.A.€ðð€71„5„117€(a).€€There€is€nothing€in€the€statute€to€indicateÏthat€this€mandate€is€subject€to€the€recipient€of€the€medical€benefits€being€madeÏwhole.€€Ìà àIn€ò òòòCastleman€v.€Ross€Engineering,€Inc.ó óóó,€958€S.W.2d€720€(Tenn.€1997),€theÏSupreme€Court€considered€enforcement€of€a€subrogation€claim€for€benefits€paidÏto€an€employee€where€fault€was€attributed€to€the€employee€and€to€the€employer.€ÏThe€employee€acknowledged€that€the€employerððs€insurance€carrier€has€aÏstatutory€subrogation€claim€for€benefits€paid€under€the€workers€compensationÏlaw,€but€asserted€that€this€claim€is€subject€to€the€principles€of€equitableÏsubrogation€and€is€not€enforceable€unless€the€employee€was€made€whole.€€InÏanswer€to€this€assertion,€the€Supreme€Court€said:€ÌÓÓà8 àà8 àà àThe€statute€creating€the€subrogation€claim€doesÏnot€by€its€terms€condition€the€claim€upon€theÏemployee€obtaining€a€full€recovery€of€damagesÏsustained.€€The€subrogation€lien€attaches€to€ð ðthe€netÍrecovery€collectedðð€and€secures€the€amount€ð ðpaidðð€byÏthe€employer€or€the€amount€of€the€employerððs€ð ðfutureÏliability,€as€it€accrues.ðð€€It€appears€that,€under€theÏstatute,€the€subrogation€lien€attaches€to€any€recoveryÏfrom€the€tortfeasor€ð ðby€judgment,€settlement€orÏotherwise.ðð€€Consequently,€even€if€under€equitableÏprinciples€of€subrogation€the€employer€was€notÏentitled€to€assert€the€subrogation€lien,€the€statuteÏspecifically€creates€that€right.ÌÌò òòòId.ó óóó€at€724€(internal€citation€omitted).ÌÌÓÓà àThis€Court€has€previously€recognized€the€similarity€between€TennesseeððsÏworkersðð€compensation€statute€and€Tennesseeððs€Medicaid€statute.€€ò òòòSee€HughlettÏv.€Shelby€County€Health€Care€Corp.ó óóó,€940€S.W.2d€571€(Tenn.€App.€1996).€ÏInsofar€as€subrogation€is€concerned,€there€is€no€meaningful€distinction€betweenÏthe€statutes.€€ò òòòId.ó óóó€at€574„75.€€€Both€workersðð€compensation€subrogation€andÏTennCare€subrogation€are€mandated€by€statute.€€Neither€statute€makesÏreference€to€the€ð ðmade€wholeðð€doctrine,€€and€we€are€not€at€liberty€to€add€thisÏlanguage€to€the€legislative€enactments.€€Therefore,€we€must€reverse€the€trialÏcourtððs€judgment€which€refuses€to€recognize€the€subrogation€claim.Ìà àThe€trial€court€also€held€that€ð ðif€Blue€Cross€Blue€Shield€had€anÏenforceable€and€valid€subrogation€claim€regarding€the€settlement€proceeds,€theirÏclaims€would€be€subject€to€the€reasonable,€necessary,€and€ordinary€one„thirdÏcontingent€attorneyððs€fees€incurred€by€the€Blankenships€and€pro€rata€litigationÏexpenses€incurred€by€the€Blankenships€pursuant€to€T.C.A.€ðð€71„5„117€(c).ððÌà àAlthough€no€issue€is€presented€for€review€concerning€the€trial€courtððsÏholding€regarding€attorneyððs€fees,€we€will€consider€the€trial€courtððs€ruling€in€viewÏof€our€decision€concerning€the€issue€presented€for€review.€€Tennessee€CodeÏAnnotated€ðð€71„5„117€(c)€provides:ÌÓÓà8 àà8 àThe€right€of€subrogation€by€the€state€to€theÏrecipientsðð€right€to€recovery€shall€be€subject€toÏordinary€and€reasonable€attorney€fees;€provided,€thatÏfurther,€where€a€recipient€has€retained€an€attorney,Ïthe€attorney€shall€not€be€considered€liable€unless€theÏattorney€has€notice€from€the€state€of€the€stateððs€claimÏof€subrogation€prior€to€disbursement€of€the€funds€toÏthe€recipient.ÌÌÓÓà àThe€administrator€asserts€that€this€language€is€not€terminology€requiringÏpayment€of€attorneyððs€fees€out€of€the€subrogation€claim€but€provides€forÏpriority€of€payment.€€The€administrator€argues€that€the€provision€should€beÏconstrued€so€that€the€state€is€entitled€to€subrogation€claim€after€the€recipientððsÏcounsel€receives€the€ordinary€and€reasonable€fees€out€of€the€total€recovery.€€WeÏmust€respectfully€disagree.€€We€find€no€ambiguity€in€the€language€of€the€statuteÏwhich€explicitly€provides€that€the€òòstateððs€right€of€subrogationóó€is€subject€to€theÏordinary€and€reasonable€attorneyððs€fees.Ìà àAccordingly,€the€judgment€of€the€trial€court€declaring€that€theÏBlankenship€recovery€is€not€subject€to€the€administratorððs€subrogation€claim€isÏreversed.€€The€case€is€remanded€to€the€trial€court€for€a€determination€of€theÏamount€of€any€attorneyððs€fees€and€expenses€to€be€charged€to€the€subrogationÍclaim.€€Costs€of€the€appeal€are€assessed€to€the€appellees.ÌÓÓà àà àà àà àà àà àà à_________________________________Ìà àà àà àà àà àà àà àò òW.€FRANK€CRAWFORD,€Ìà àà àà àà àà àà àà àPRESIDING€JUDGE,€W.S.ó óÌÌò òCONCUR:ÌÌÌ____________________________________ÌALAN€E.€HIGHERS,€JUDGEó óÌÌò ò____________________________________ÌHOLLY€KIRBY€LILLARD,€JUDGEó óœ