Manning v. Utilities Mut. Ins. Co.

The full case caption appears at the end of this opinion.

KATZMANN, Circuit Judge:

I. INTRODUCTION

Plaintiff-Appellant Robert Manning (“Manning” or “plaintiff”) appeals from a judgment of the District Court for the Southern District of New York (Casey, J.), dated August 31, 2000, denying plaintiff’s motion for reconsideration of the court’s September 30, 1999 memorandum and order dismissing the plaintiff’s fraud claim and granting defendant’s motion for reconsideration, dismissing plaintiff’s claim under the Medicaid Secondary Payer Act (“MSP”). For the reasons stated below, we affirm the decision to dismiss plaintiff’s fraud claim, but reverse the decision to dismiss plaintiff’s claim under the MSP. We hold that the six-year statute of limitations applicable to private rights of action under the False Claims Act should be applied to private rights of action under the MSP, and therefore plaintiff’s MSP claim is not time barred. We further hold that plaintiff should be permitted an opportunity to amend his complaint to allege more sufficiently a claim for bad faith refusal to pay insurance benefits. Therefore, we vacate the judgment and remand the case for further proceedings consistent with this opinion.

II. FACTS & PROCEDURAL HISTORY[FOOTNOTE 1]

On February 27, 1962, Manning, a 25-year-old father of two, was rendered a quadriplegic when he fell from a utility pole in upstate New York while working for Defendant Niagara Mohawk Power Co. (“NMP”). NMP used as its workers’ compensation carrier the Utilities Mutual Insurance Co. (“UMI”) (collectively “defendants”). From 1962 until 1968, UMI paid plaintiff workers’ compensation benefits, which included a weekly stipend and plaintiff’s medical expenses and the costs of around-the-clock nursing care. In 1968, plaintiff obtained a judgment against New York Telephone Company, from whose utility pole he had fallen, and recovered a net sum of approximately $388,000. As allowed by New York State Workers’ Compensation Law (“WCL”), UMI both received a lien for the workers’ compensation benefits already provided and stopped paying benefits while plaintiff’s expenses were covered by the recovery from New York Telephone Company.