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Tucker v. Gorman3/6/1997
Plaintiff, Janice K. Tucker, appeals from the district court's judgment that dismissed her "Medicaid assignment" claim. We reverse and remand for entry of judgment in favor of plaintiff.
Plaintiff was struck by a motor vehicle driven by defendant, Yolanda Gorman. She sustained serious personal injuries and required medical treatment. As a result of her injuries, the Colorado Department of Health Care Policy and Financing made payments on her behalf under the Medicaid program in the amount of $69,222.82. The parties stipulated that such Medicaid payments were necessary, reasonable, and causally related to the accident.
Plaintiff later filed a complaint against defendant asserting claims for negligence, negligence per se, and based upon a "Medicaid assignment." The Medicaid assignment claim averred that the State of Colorado had assigned all of its rights and claims for damages it had against defendant under the Colorado Medical Assistance Act (CMAA), § 26-4-101, et seq., C.R.S. (1996 Cum. Supp.), to plaintiff and had authorized her to proceed against defendant to recover all amounts expended to pay for her medical expenses. Defendant does not dispute the validity of such assignment. Cf. Kiladhl v. Tagge, 1996 Colo. App. LEXIS 373, ___ P.2d ___ (Colo. App. 1996).
Prior to trial, plaintiff dismissed all of her personal injury claims without prejudice to the prosecution of the assigned Medicaid claim. Thereafter, in a pre-trial order, the trial court determined that, pursuant to the comparative negligence statute, § 13-21-111, C.R.S. (1987 Repl. Vol. 6A), any party asserting a claim under the CMAA may recover only to the extent that the defendant would be liable to the recipient of the Medicaid payments under that statute. It held that the General Assembly did not intend to allow the government to recover for payments made to a recipient if that recipient could not recover for his or her medical expenses.
As a result of this pre-trial ruling, the parties proceeded to trial on the assigned claim under the parties' stipulation as to all essential elements of the claim, except the relative fault of the parties. A verdict was returned, finding that both plaintiff and defendant had been negligent, that the negligence of each was a cause of plaintiff's injuries, and that defendant was 30% negligent, while plaintiff was 70% negligent.
Pursuant to its pre-trial determination, because of the finding that plaintiff's negligence had been greater than defendant's, the court entered judgment for defendant. Plaintiff appeals from this adverse judgment, asserting that the trial court erred in its interpretation of the CMAA. We agree.
The CMAA was enacted to provide medical care to the people of Colorado in conjunction with the federally-funded Medicaid program. See § 26-4-102, C.R.S. (1996 Cum. Supp.). To qualify to receive federal funds under that program, a state plan must provide that the administering agency will take reasonable measures to ascertain the legal liability of third parties and to seek reimbursement from such third parties for any medical assistance paid to recipients. 42 U.S.C. § 1396a(25) (1994).
The Colorado General Assembly has implemented this requirement by the adoption of § 26-4-403, C.R.S. (1996 Cum. Supp.). One provision of that statute, § 26-4-403(3), C.R.S. (1996 Cum. Supp.) provides, in part, as follows:
If medical assistance is furnished to or on behalf of a recipient pursuant to the provisions of this article for which a third party is liable, the state department has an enforceable right against such party for the amount of such medical assistance . . . .
The contributory negligenc
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