Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caDC-00-05185/USCOURTS-caDC-00-05185-0/pdf.json

Parties Involved:
Northeast Florida Credit Bureau
Appellee
Gordon E. Price
Appellant
United States of America
Appellee

Document Text:

<<The pagination in this PDF may not match the actual pagination in the printed slip opinion>>

United States Court of Appeals

FOR THE DISTRICT OF COLUMBIA CIRCUIT

Decided September 26, 2000

No. 00-5185

Gordon E. Price,

Appellant

v.

United States of America, et al.,

Appellees

Appeal from the United States District Court

for the District of Columbia

(No. 99cv0306)

Gordon E. Price, pro se.

Wilma A. Lewis, United States Attorney, and R. Craig

Lawrence and Edward D. Alkalay, Assistant United States

Attorneys, were on motion for the appellees.

Before: Ginsburg, Sentelle and Henderson, Circuit

Judges.

Opinion for the court filed Per Curiam.

USCA Case #00-5185 Document #546469 Filed: 09/26/2000 Page 1 of 5
<<The pagination in this PDF may not match the actual pagination in the printed slip opinion>>

Per Curiam: Gordon Price, appearing pro se, filed a complaint in the district court alleging the United States Department of Veteran Affairs (VA) wrongfully failed to reimburse

him for certain medical expenses he incurred in October 1994

while hospitalized for an emergency colon cancer operation at

a non-VA medical facility. Price also alleged Northeast Florida Credit Bureau (Northeast) caused him harm when it

persistently sought to collect on the unpaid medical bills on

behalf of the medical service providers. As relief, Price

sought $5 million in damages from the government alone,

apparently for his medical expenses and emotional distress.

The district court vacated an entry of default against Northeast and dismissed the complaint for failure to state a claim.

Price appealed and both he and the government filed crossmotions for summary disposition. Because the district court

lacked jurisdiction to consider an indirect challenge to the

government's veterans' benefits determination, we grant the

government's motion and deny Price's motion.

As amended by the Veterans Judicial Review Act, Pub. L.

No. 100-687, 102 Stat. 4105 (1988) (VJRA), the Veterans'

Benefits Act of 1957, Pub. L. No. 85-56, 71 Stat. 83, precludes

judicial review in Article III courts of VA decisions affecting

the provision of veterans' benefits, including medical expense

reimbursement. 38 U.S.C. s 511(a); see Larrabee v. Derwinski, 968 F.2d 1497, 1499-1501 (2d Cir. 1992) (detailing history

of veterans' benefits legislation); see also Zimick v. West, 11

Vet. App. 45, 48 (Vet. App. 1998) (term "benefit" encompasses

medical expenses veteran incurred at non-VA facility) (citing

38 C.F.R. s 20.3(e)). The exclusive avenue for redress of

veterans' benefits determinations is appeal to the Court of

Veterans Appeals and from there to the United States Court

of Appeals for the Federal Circuit. See 38 U.S.C. ss 511,

7252, 7292; In re Russell, 155 F.3d 1012 (8th Cir. 1998) (per

curiam); Beamon v. Brown, 125 F.3d 965, 967-71 (6th Cir.

1997); Larrabee, 968 F.2d at 1501.

The district court lacked jurisdiction to consider Price's

federal claim because underlying the claim is an allegation

that the VA unjustifiably denied him a veterans' benefit.

Price alleged the VA's failure to pay his medical bills was

USCA Case #00-5185 Document #546469 Filed: 09/26/2000 Page 2 of 5
<<The pagination in this PDF may not match the actual pagination in the printed slip opinion>>

wrongful because the agency was under a legal obligation to

make payment on account of Price's veteran status. He

attached to his amended complaint a September 1996 letter

from the VA's Gainesville, Florida office advising Price the

office had received his request for reimbursement but could

not process his claim because Price failed to provide the

personal information necessary to verify his veteran status

and ascertain the nature of the claim. In the letter, the VA

explained the eligibility criteria for reimbursement for medical services at a non-VA facility and directed Price's attention

to an enclosed claim form. See 38 U.S.C. s 1728 (setting

forth scheme for VA reimbursement of certain medical expenses incurred by veterans). Price referred to the 1996

letter in the amended complaint, asserting that he met the

eligibility criteria.

The record does not reflect whether Price pursued a formal

reimbursement claim with the VA. Nevertheless, because

Price is challenging the VA's action or inaction with respect

to a veterans' benefits matter, the district court lacked subject matter jurisdiction over the complaint. See 38 U.S.C.

s 511(a); Weaver v. United States, 98 F.3d 518, 519-20 (10th

Cir. 1996) (the substance of veteran's claims, not the labels

plaintiff assigns them, governs jurisdictional determination);

cf. Kidwell v. Department of the Army, Bd. for Correction of

Military Records, 56 F.3d 279, 284 (D.C. Cir. 1995) (plain

language of complaint does not settle question of Tucker Act

jurisdiction--court looks to the complaint's substance, not

merely its form).

Perhaps to avert a headlong collision with 38 U.S.C.

s 511(a), the district court liberally construed Price's complaint as asserting a federal tort claim for intentional or

negligent failure to pay medical bills. Under the Federal

Tort Claims Act, 28 U.S.C. ss 1346(b), 2671 et seq., a tort

claim is actionable if it arises "under circumstances where the

United States, if a private person, would be liable to the

claimant in accordance with the law of the place where the act

or omission occurred." Federal Deposit Ins. Corp. v. Meyer,

510 U.S. 471, 477 (1994) (quoting 28 U.S.C. s 1346(b)). Because the alleged wrong committed by the VA took place in

USCA Case #00-5185 Document #546469 Filed: 09/26/2000 Page 3 of 5
<<The pagination in this PDF may not match the actual pagination in the printed slip opinion>>

Florida, liability for negligent or intentional failure to pay a

medical bill must be determined in accordance with Florida

law. See Tarpeh-Doe v. United States, 28 F.3d 120, 123

(D.C. Cir. 1994).

Florida does recognize a cause of action analogous to that

which Price appears to be asserting. By Florida statute a

person may sue an insurer when the person is damaged by an

insurer's "bad faith" failure to settle his or her claim. Fla.

Stat. ch. 624.155(1)(b)(1); see Time Ins. Co. v. Burger, 712 So.

2d 389, 391 (Fla. 1998). The Florida Supreme Court has

construed the statute as encompassing claims that the insurer

unjustifiably refused to pay an insured's medical or hospital

bills, resulting in the insured's inability to obtain additional

health care. Burger, 712 So. 2d at 392. The insured may

also recover damages for emotional distress. Id.

Nevertheless, assuming Price's damages claim is cognizable

under Florida Statute 624.155(1)(b)(1), a necessary predicate

of such a claim is a determination that the insurer acted in

bad faith. See id. Here, the propriety of the VA's purported

refusal to reimburse Price has not yet been established.

Because a determination whether the VA acted in bad faith or

with negligence would require the district court to determine

first whether the VA acted properly in handling Price's

request for reimbursement, judicial review is foreclosed by 38

U.S.C. s 511(a). The courts have consistently held that a

federal district court may not entertain constitutional or

statutory claims whose resolution would require the court to

intrude upon the VA's exclusive jurisdiction. See, e.g., Beamon, 125 F.3d at 972-74 (due process challenge to VA procedures); Weaver, 98 F.3d at 520 (claims of fraud and misrepresentation in handling of benefits claim); Hicks v. Small, 69

F.3d 967, 970 (9th Cir. 1995) (tort claims of outrage and

intentional infliction of emotional distress based on VA's

reduction of benefits); Sugrue v. Derwinski, 26 F.3d 8, 11 (2d

Cir. 1994) (due process, Privacy Act and FOIA challenges to

VA's failure to raise disability rating); Rosen v. Walters, 719

F.2d 1422, 1425 (9th Cir. 1983) (Privacy Act claim based on

destruction of medical records pertinent to claim for veterans'

USCA Case #00-5185 Document #546469 Filed: 09/26/2000 Page 4 of 5
<<The pagination in this PDF may not match the actual pagination in the printed slip opinion>>

disability benefits) (construing predecessor statute, 38 U.S.C.

s 211(a)).

For the preceding reasons, we conclude the district court

lacked subject matter jurisdiction over Price's federal claim.

As a consequence, the court necessarily also lacked supplemental jurisdiction over Price's state law claim against Northeast. See 28 U.S.C. s 1367(a); Scarfo v. Ginsberg, 175 F.3d

957, 962 (11th Cir. 1999) (collecting authorities); Harris v.

Secretary, United States Dep't of Veterans Affairs, 126 F.3d

339, 346 (D.C. Cir. 1997). Accordingly, the judgment of the

district court is

Affirmed.

USCA Case #00-5185 Document #546469 Filed: 09/26/2000 Page 5 of 5