Appealed from the 19th Judicial District Court In
and for the Parish of East Baton Rouge State of Louisiana
Docket No. C628132 The Honorable Judge Wilson E. Fields
Lindsey J. Leavoy Baton Rouge, Louisiana Counsel for
Plaintiff/Appellant Lynette Bayham
Marjorie G. O' Connor Tameika Richard Paul Holmes Baton
Rouge, LA Counsel for Defendant/Appellee State of Louisiana,
through the Office of Group Benefits
BEFORE: WHIPPLE, C.J., WELCH, AND LANIER, JJ
instant appeal, the plaintiff/appellant, Lynette Bayham,
challenges the judgment of the Nineteenth Judicial District
Court in favor of the defendant/appellee, the State of
Louisiana through the Office of Group Benefits OGB), which
awarded OGB $ 32, 252.74, with judicial interest and costs.
For the following reasons, we affirm.
AND PROCEDURAL HISTORY
13, 2012, Lynette Bayham and her adult son Adam were involved
in an automobile accident on La. Hwy. 44 in Ascension Parish.
Adam was operating his vehicle with Mrs. Bayham as his
passenger, when they were rear-ended by another vehicle. Mrs.
Bayham and her son were both injured in the accident.
result of the accident, on December 6, 2012, Mrs. Bayham
underwent a primary anterior interbody fusion from C5 to C7
with discectomy at C5-C6 and C6-C7. Treatment for her
accident-related injuries was completed by December 31, 2013.
Mrs. Bayham's past medical expenses totaled $105, 432.61.
From the time of the accident until December 31, 2013, Mrs.
Bayham had health coverage through OGB under its HMO plan.
OGB issued medical benefits to Mrs. Bayham in the amount of
$32, 252.74 for treatment of her accident-related injuries.
HMO plan under which Mrs. Bayham was covered contained a
"Subrogation and Reimbursement" section, which read
Subrogation and Reimbursement
Upon payment of any eligible Benefits covered under this
Plan, the Office of Group Benefits shall succeed and be
subrogated to all rights of recovery of the covered Employee,
his Dependents or other Covered Persons, or their heirs or
assigns, for whose benefit payment is made, and they shall
execute and deliver instruments and papers and do whatever is
necessary to secure such rights, and shall do nothing after
loss to prejudice such rights.
The Office of Group Benefits has an automatic lien against
and shall be entitled, to the extent of any payment made to a
covered Employee, his Dependents or other Covered Persons, to
100% of the proceeds of any settlement or judgment that may
result from the exercise of any rights of recovery of a
covered Employee, his Dependents or other Covered Persons,
against any person or entity legally responsible for the
disease, illness, accident or injury for which said payment
To this end, covered Employees, their Dependents, or other
Covered Persons agree to immediately notify the Office of
Group Benefits of any action taken to attempt to collect any
sums against any person or entity responsible for the
disease, illness, accident, or injury.
These subrogation and reimbursement rights also apply when a
Covered Person recovers under, but not limited to, an
uninsured or underinsured motorist plan, homeowner's
plan, renter's plan, medical malpractice plan,
worker's compensation plan or any general liability plan.
Under these subrogation and reimbursement rights, the Office
of Group Benefits has a right to first recovery to the extent
of any judgment, settlement, or any payment made to the
covered Employee, his Dependents or other Covered Persons.
These rights apply regardless of whether such recovery is
designated as payment for, but not limited to, pain and
suffering, medical benefits, or other specified damages, even
if he is not made whole (i.e., fully compensated for his
Bayham received a total of $155, 000.00 in insurance proceeds
as a result of the accident. The insurance proceeds were
comprised of the following: $5, 000.00 medical payments
coverage limits from Progressive Insurance Company
(Progressive), Mrs. Bayham's insurer; $50, 000.00 bodily
injury coverage limits from State Farm Insurance Company
(State Farm), the insurer of the at-fault driver; and $100,
000.00 underinsured bodily injury coverage limits from
Progressive. Upon receiving these payments, Mrs. Bayham and
her son released the at-fault driver, State Farm, and
Progressive from all liability related to the accident.
several occasions, OGB issued notices to Mrs. Bayham and her
son of its reimbursement/subrogation rights in relation to
the medical expense payments. In response, Mrs. Bayham and
her son sent letters to OGB, in which they informed OGB that
their case had been settled, but that OGB was not entitled to
any of the settlement funds pursuant to the "Make
Whole" doctrine. Nevertheless, Mrs. Bayham and her son
stated that the proceeds were being kept in a trust account
in case it was later determined that OGB was entitled to any
of the proceeds. Mrs. Bayham also requested from OGB any
statutory or legal authority that established OGB's
entitlement to the funds. Mrs. Bayham and her son alleged
that OGB never responded to their letters.
Bayham and her son filed a petition for declaratory judgment
on February 6, 2014, requesting the district court to rule
that, given their contention that the settlement funds had
not fully remedied their injuries from the accident, and
pursuant to the "make whole" doctrine, OGB was
barred from recovering any of the settlement funds. OGB filed
a reconventional demand on March 7, 2014, claiming that OGB
was entitled to recover all of the medical benefits it had
issued to Mrs. Bayham and her son.
hearing on April 10, 2018, the district court signed a
judgment on May 29, 2018 in favor of OGB in the amount of
$32, 252.74, plus judicial interest and costs. Mrs. Bayham
has appealed this judgment.
Bayham alleges the following assignments of error:
1. The district court abused its discretion in
"essentially" ruling Mrs. Bayham's damages were