Case Title: Ex parte Blue Cross & Blue Shield of Alabama.

Citation: 

Docket Number: 1190232

State: alabama

Court: Alabama Supreme Court

Date: 2020-09-04T00:00:00Z

Document:
Rel: September 4, 2020
Notice: This opinion is subject to formal revision before publication in the advance
sheets of Southern Reporter.  Readers are requested to notify the Reporter of Decisions,
Alabama Appellate Courts, 300 Dexter Avenue, Montgomery, Alabama 36104-3741 ((334) 229-
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the opinion is printed in Southern Reporter.
SUPREME COURT OF ALABAMA
SPECIAL TERM, 2020
____________________
1190232
____________________
Ex parte Blue Cross and Blue Shield of Alabama
PETITION FOR WRIT OF MANDAMUS
(In re: Marilyn Player
v.
Blue Cross and Blue Shield of Alabama)
(Macon Circuit Court, CV-19-900104)
STEWART, Justice.
After her claim for coverage under the Public Education
Employees' Health Insurance Plan ("PEEHIP") was denied,
1190232
Marilyn Player sued Blue Cross and Blue Shield of Alabama
("BCBS") in the Macon Circuit Court ("the trial court")
asserting claims of breach of contract and bad faith. BCBS
seeks a  writ of mandamus directing the trial court to
transfer Player's case to the Montgomery Circuit Court
pursuant to § 16-25A-7(e), Ala. Code 1975. For the reasons
stated below, we grant BCBS's petition and issue the writ.
I. Facts and Procedural History
Player, a resident of Macon County, is a retired teacher,
formerly employed in the Alabama public-school system. Player
receives health insurance under a policy issued to her
husband, also a retired teacher, through PEEHIP. PEEHIP is a
group health-benefits plan funded by the State, and BCBS
serves as a claim administrator for PEEHIP. Player, who
suffers from Type 1 Diabetes, has previously received
preapproval through PEEHIP for the purchase of insulin to
control her diabetes. Player, however, alleges that on
December 1, 2018, BCBS denied her preapproval for diabetes
medication and subsequently refused to reimburse Player for
her out-of-pocket purchase of insulin.1 As a result, on July
1BCBS disputes Player's allegation that it was the claim
administrator that made the decision to deny the preapproval
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17, 2019, Player sued BCBS alleging breach of contract
pursuant to PEEHIP's coverages and bad faith on the part of
BCBS in failing to preapprove the purchase of insulin.
On August 16, 2019, BCBS filed a motion to dismiss or, in
the alternative, for a change of venue, in which it asserted
that Montgomery County is the exclusive statutory venue
authorized by § 16-25A-7(e) for the claims raised in Player's
complaint. BCBS asserted that Player's complaint invoked a
dispute over the denial of benefits and that Player was
seeking review of a claim administrator's decision, which, it
argued, falls within the purview of § 16-25A-7(e). BCBS
attached to its motion the PEEHIP Member Handbook and BCBS's
PEEHIP plan, which, among other things, provides details
pertaining to coverage. 
On October 16, 2019, Player filed a response in
opposition to BCBS's motion, asserting that BCBS misconstrued
the nature of her breach-of-contract and bad-faith claims and
that, therefore, § 16-25A-7(e) was not applicable to Player's
claims. Player argued that under § 6-3-7(a), Ala. Code 1975,
the general-venue statute, Macon County is the proper venue
and reimbursement because, it contends, it does not 
administer
pharmacy benefits under PEEHIP.
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1190232
for the action because Player is a resident of Macon County
and she received the denial letters from BCBS in Macon County.
Additionally, Player contended that BCBS does business in
Macon County by selling insurance  to and administering the
claims of Macon County residents.
The trial court held a hearing on BCBS's motion.
Subsequently, the trial court entered an order denying BCBS's
motion, concluding that venue was proper in Macon County. BCBS
petitioned this Court for the writ of mandamus.
II. Standard of Review
"'A 
writ of 
mandamus is 
an 
extraordinary remedy,
and it will be "issued only when there is: 1) a
clear legal right in the petitioner to the order
sought; 2) an imperative duty upon the respondent to
perform, accompanied by a refusal to do so; 3) the
lack of another adequate remedy; and 4) properly
invoked jurisdiction of the court."'"
Ex parte Flexible Prods. Co., 915 So. 2d 34, 39 (Ala.
2005)(quoting Ex parte Empire Fire & Marine Ins. Co., 720 So.
2d 893, 894 (Ala. 1998), quoting in turn Ex parte United Serv.
Stations, Inc., 628 So. 2d 501, 503 (Ala. 1993)). "'"The
proper method for obtaining review of a denial of a motion for
a change of venue in a civil action is to petition for the
writ of mandamus."'" Ex parte WMS, LLC, 170 So. 3d 645, 649
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1190232
(Ala. 2014)(quoting Ex parte Pike Fabrication, Inc., 859 So.
2d 1089, 1091 (Ala. 2002), quoting in turn Ex parte Alabama
Great Southern R.R., 788 So. 2d 886, 888 (Ala. 2000)). This
Court has explained that, "[w]hen we consider a mandamus
petition relating to a venue ruling, our scope of review is to
determine if the trial court [exceeded] its discretion, i.e.,
whether it exercised its discretion in an arbitrary and
capricious manner." Ex parte Integon Corp., 672 So. 2d 497,
499 (Ala. 1995). A trial court that refuses to transfer a case
when such a transfer is proper has routinely been held to be
exceeding its discretion. See Ex parte WMS, LLC, supra.
III. Analysis
BCBS argues that § 16-25A-7(e), rather than § 6-3-7(a),
is the venue statute applicable to Player's complaint because
Player's suit, it contends, seeks review of a final decision
by a PEEHIP claims administrator. Under § 16-25A-7(e), proper
venue for PEEHIP disputes is exclusively in 
Montgomery County,
and, therefore, BCBS asserts, the trial court erred in
refusing to transfer the case to the Montgomery Circuit Court.
BCBS contends that the trial court exceeded its discretion in
denying its motion for a change of venue and petitions this
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Court to issue the writ of mandamus compelling the trial court
to transfer the case.
In § 16-25A-1 et seq., Ala. Code 1975, a general act of
statewide 
application 
governing 
PEEHIP, 
the 
Alabama
Legislature implemented a procedure for judicial review of a
PEEHIP administrator's final decision and determined that
venue for such an action would be Montgomery County. Section
16-25A-7(e), 
concerning 
denial 
of 
claims, 
provides: 
"Review 
of
a final decision by the claims administrator shall be by the
Circuit Court of Montgomery County as provided for the review
of contested cases under the Alabama Administrative Procedure
Act, Section 41-22-20." (Emphasis added.) By using the words
"shall," the legislature affirmatively determined that proper
venue 
for 
all 
cases 
concerning 
review 
of 
a 
claims
administrator's final decision is Montgomery County. Ex parte
Prudential Ins. Co. of Am., 721 So. 2d 1135, 1138 (Ala.
1998)("The word 'shall' is clear and unambiguous and is
imperative and mandatory.").
This Court has recognized that
"in a series of cases addressing special venue
provisions incorporated by the Legislature in
general statutes of statewide application, this
Court has concluded that the respective enactments
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1190232
evidenced a clear intent by the Legislature to
exercise the authority accorded it by § 6.11 of
Amendment No. 328 [now § 150, Ala. Const 1901 (Off.
Recomp.)], pursuant to which any rules promulgated
by this Court governing the administration of
courts, and the practice and procedure in all
courts, 'may be changed by a general act of
statewide application.'"
Ex parte Fontaine Trailer Co., 854 So. 2d 71, 81 (Ala. 2003).
Additionally, 
well 
settled 
caselaw 
requires 
that 
courts 
follow
the mandate of a specific-venue provision when that provision
conflicts with general-venue statutes. Id.; see also Ex parte
Alabama Power Co., 640 So. 2d 921, 924 (Ala. 1994) (holding
that § 6–3–11, Ala. Code 1975, "effectively prevented the
application of the venue provision of Rule 82(c)[, Ala. R.
Civ. P.,] to claims against municipalities"); Ex parte
McDonald, 804 So. 2d 204 (Ala. 2001) (similar holding); Ex
parte Kennedy, 656 So. 2d 365 (Ala. 1995) (holding that the
provisions of § 6-5-546, Ala. Code 1975, setting venue for
medical-malpractice actions, were mandatory and that the
statute superseded Rule 82, Ala. R. Civ. P.); see also Ex
parte Alabama Bd. of Cosmetology & Barbering, 213 So. 3d 587,
590-91 (Ala. Civ. App. 2016) (issuing a writ of mandamus to
transfer case to Montgomery Circuit Court in accordance §
34-7B-11, Ala. Code 1975). 
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Because the PEEHIP statute identifies Montgomery County
as the exclusive venue for claim disputes arising from a
review of a final decision by the PEEHIP claims administrator,
§ 16-25A-7(e) overrides § 6-3-7(a), the general-venue statute
that Player argues is applicable to her complaint, an argument
we address later in this opinion. Further, this Court has
determined that, when a statute identifies a specific venue
for judicial review by a circuit court of a ruling resulting
from 
an 
administrative proceeding, 
only 
the 
designated circuit
court can hear the appeal, and if the appeal is filed in the
incorrect venue, the court in which it is filed "should
transfer the appeal to the circuit court designated by the
statute." Ex parte General Motors Corp., 800 So. 2d 159, 163
(Ala. 2000). Likewise, in accordance with § 16-25A-7(e), a
complaint seeking judicial review of a decision of a PEEHIP
claims administrator can be heard only by the Montgomery
Circuit Court. 
Player asserts that § 16-25A-7(e) does not apply to her
complaint because her claims, she contends, do not constitute
an action for a dispute over the denial of benefits and her
complaint cannot be characterized as an appeal of any
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1190232
administrative 
action. 
Rather, 
the 
breach-of-contract 
and 
bad-
faith claims, Player argues, are regular tort claims
recognized by the common law of Alabama and therefore do not
fall within the purview of § 16-25A-7(e). However, Player
cannot avoid the legislature's exclusive-venue provision by
recasting her claims using artful labels. Ex parte Bad Toys
Holdings, Inc., 958 So. 2d 852, 859 (Ala. 2006) (holding that
"'[s]trategic or artfully drawn pleadings ... will not work to
circumvent an otherwise applicable forum selection clause'"
(quoting Terra Int'l, Inc. v. Mississippi Chem. Corp., 119
F.3d 688, 695 (8th Cir. 1997))). In her complaint, Player
alleged:
"8. On or about December 1, 2018, the Defendant
BCBS, without a reasonable basis or justification,
denied 
[Player's] 
preapproval 
for 
diabetes
medication. As a consequence, [Player] had to
personally pay for the purchase of diabetes
medication so that she could survive. The Defendant
BCBS, upon submission of the personal payment by
[Player], refused to reimburse [Player] for the
insulin she was required to take to treat her
disease.
"9. As a proximate consequence of the Defendant
BCBS' 
intentional 
refusal 
to: 
(1) 
preapprove
[Player's] daily and weekly insulin medications;
and, (2) its failure to reimburse [Player] after she
personally incurred the cost of these medications,
constitutes an act of breach of contract pursuant to
the PEEHIP coverages insuring her for health
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1190232
insurance protection and was an act of bad faith
committed without a reasonable basis to deny
preapproval and/or reimbursement of the cost of said
medication."
Based on the stated facts, the underlying substance of
Player's complaint is that BCBS, as a PEEHIP claims
administrator, made a final decision denying Player's
insurance claim, and Player is contesting that decision.  The
legislature's mandate in § 16-25A-7(e), which requires review
of such a decision to be heard in Montgomery County, applies
to Player's complaint, regardless of any attempt to recast the
request for judicial review as claims sounding in tort.
Player's pleadings substantively address and refer to a denial
of benefits under PEEHIP, and, consequently, asserting the
complaint under a different title does not allow Player to
circumvent § 16-25A-7(e). This Court has often recognized the
importance of "treat[ing] pleadings according to their
substance, rather than merely their label." Century 21
Paramount Real Estate, Inc. v. Hometown Realty, LLC, 34 So. 3d
658, 662 (Ala. 2009); see also Ex parte McWilliams, 812 So. 2d
318 (Ala. 2001) (interpreting nature of petition based on
substantive contents rather than on style). According to the
substance of Player's complaint, the action falls within the
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category of disputes governed by § 16-25A-7(e); therefore,
venue is proper exclusively in Montgomery County. 
The trial court exceeded its discretion in denying BCBS's
motion for a change of venue from Macon County to Montgomery
County. Despite Player's attempt to cast the issues in her
complaint as regular tort claims, Player's breach-of-contract
and bad-faith claims are, in essence, disputes over a final
decision allegedly made by BCBS regarding Player's insulin
medication. Section 16-25A-7(e) controls in this action;
therefore, venue is proper in Montgomery County.
IV. Conclusion
For the reasons expressed above, we grant the petition,
issue the writ, and order the trial court to transfer the
action to the Montgomery Circuit Court.
PETITION GRANTED; WRIT ISSUED.  
Parker, C.J., and Bolin, Shaw, Wise, Bryan, Sellers, and
Mendheim, JJ., concur.  
Mitchell, J., recuses himself.
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