Schedule a Consultation | Toll Free: 1-800-678-1307
Trial lawyers specializing in personal injury and civil litigation

Justice Taylor writes another opinion for the insurance industry: this time, he lets Engler's Insurance Commissioner overrule the expert physicians

In Ross v. Blue Care Network, Justice Taylor wrote for the majority, upholding the Insurance Commissioner's decision denying payment of health care costs incurred by a patient dying from multiple myeloma.  Under his health insurance contract, Ross was required to seek care "in-network" first.  When U of M couldn't treat him, he went to one of two facilities in the world that treat multiple melanoma (in Little Rock, Arkansas, surprisingly), where the doctors concluded that his life expectancy, without treatment, was on the order of 7 days.  Blue Care denied payment.  When the family appealed, the statutory Independent Review Organization--made up of health care professionals--recommended payment, but Governor Engler's Insurance Commissioner rejected the recommendation.  Justice Taylor endorsed the politically-appointed bureaucrat's decision.

Justice Taylor's opinion spent several hundred words parsing "recommendation" before rejecting the widow's right to coverage.  Even though her husband was told by U of M doctors that he had days to live and that they could not help him (and that he should go to LIttle Rock for treatment); even though he was looking at a survival period of seven days without treatment;  even though Blue Care had initially rejected the family's request for coverage of treatment in Little Rock because Little Rock hadn't provided a treatment plan (which the doctors there pointed out they could not prepare without seeing the patient); even though Blue Care rejected treatment because it would take 10-14 days to evaluate Little Rock's treatment plan (i.e., about one week longer than Ross' untreated life expectancy); and even though treatment in Little Rock extended Ross' life for several months, Taylor's majority allowed the Insurance Commissioner to reject the medical recommendations reached by the statutory IRO composed of medical professionals. 

The dissenters on the Supreme Court pointed out that the Insurance Commissioner's expertise lies in interpreting insurance language and risk--not medicine--[we might quibble with that conclusion and suggest that the political appointee's expertise is limited to back-scratching and contribution-bundling] and that her statutory power was limited to confirming that the IRO's recommendation did not violate the language of the insurance policy. 

We find it to be ironic that a political party which trashes universal health coverage--on the justification that it would make health professionals' opinions subject to the whims of bureaucrats--would turn around and interpret a statutory scheme in a manner that enables government bureaucrats to reject the recommendations of trained medical experts.  I guess the bottom line is that Justice Taylor and his political cronies will always favor the litigant with the deepest pockets.

Thompson O’Neil, P.C.
309 East Front Street
Traverse City, Michigan 49684
Toll Free: 1-800-678-1307
Fax: 231-929-7262