9 results for 'cat:"Health Care" AND cat:"Insurance" AND cat:"Contract"'.
J. Walker grants a health insurance company’s motion to dismiss a lawsuit brought against it by a hospital trying to have the insurance company cover healthcare services it provided to one of its insured. The hospital did not exhaust the administrative process in trying to get the insurance company to cover the cost of services it provided.
Court: USDC Maine, Judge: Walker, Filed On: April 23, 2024, Case #: 2:23cv258, NOS: Other Contract - Contract, Categories: health Care, insurance, contract
J. Quattlebaum finds the lower court properly granted summary judgment to the insurance company. Patients sued a pediatric clinic after discovering the clinic’s in-house psychologists had lied about her credentials. The clinic's insurance company proved they could rescind its policy because the owner misrepresented that she had thoroughly checked her employees' credentials. Affirmed.
Court: 4th Circuit, Judge: Quattlebaum, Filed On: February 16, 2024, Case #: 22-1994, Categories: health Care, insurance, contract
J. Eisnaugle finds the trial court properly found for the medical group in its dispute with the insurance company over coverage of medical bills stemming from a car accident. The insurance company incorrectly interprets the relevant Florida law, which only requires an itemized billing statement to list "each exact amount" in a claim, so its argument that the medical group's notice of intent to litigate provided deficient billing information fails. The trial court's order is upheld, and a conflict with two previous appellate court decisions is certified. Affirmed.
Court: Florida Courts Of Appeal, Judge: Eisnaugle, Filed On: October 27, 2023, Case #: 22-0603, Categories: health Care, insurance, contract
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J. Sullivan denies, in part, an insurer's motion to dismiss a nurse's claims related to the work she provided in South Africa to injured contractors. She has sufficiently alleged her claim for breach of contract.
Court: USDC District of Columbia, Judge: Sullivan, Filed On: September 11, 2023, Case #: 1:11cv1733, NOS: Amer w/Disabilities - Other - Civil Rights, Categories: health Care, insurance, contract
J. Kobes finds a lower court properly ruled in favor of a religious group on a hospital's contract claims. The hospital argued that it was entitled to seek additional insurance coverage on behalf of a patient with outstanding medical bills. However, it was not entitled to relief from third party insurers after accepting payment from Medicaid. Affirmed.
Court: 8th Circuit, Judge: Kobes, Filed On: August 30, 2023, Case #: 22-3121, Categories: health Care, insurance, contract
J. Do finds that the trial court properly found in favor of the insurance company in this dispute brought by the healthcare provider over payments. The provider could not demonstrate the existence of mutual assent or consideration. The insurance company had not agreed to reimburse amounts the provider billed for treatment. The insurance company's obligation was dependent on the terms of the operative benefit plans and was determined only after claims were submitted. Affirmed.
Court: California Courts Of Appeal, Judge: Do , Filed On: July 27, 2023, Case #: D080122, Categories: health Care, insurance, contract
J. Pirtle finds the trial court improperly granted summary judgment to the insurance company in this dispute over coverage for breast cancer treatment, payment for which was sent to the collector. The patient, pursuant to a previous mammogram, was told that the density of her breasts reduces instrument sensitivity and that a negative report can be inconclusive. She had reason to be concerned the lump could be cancerous despite the negative result. There are genuine issues of material fact regarding the applicability of the policy’s preexisting condition clause. Reversed and remanded.
Court: Nebraska Court Of Appeals, Judge: Pirtle, Filed On: June 6, 2023, Case #: A-22-406, Categories: health Care, insurance, contract