Georgia Appellate Court Favors Big Insurer Over Insured In Insurance Dispute

A divided Georgia Court of Appeals reversed a jury verdict in favor of an insured against her health insurance company for its failure to pay a hospital bill.   In the case of Blue Cross/Blue Shield of Georgia v. Shirley, #A10A0326, the majority ordered a new trial finding that the evidence did not support a judgment in favor of the insured.  The case centered around whether the treatment provided to Ms. Shirley was for inpatient or outpatient services.  Basically, Ms. Shirley went to an emergency room where she was kept overnight in a room that had a bed and bath.  She was also served two or three hospital meals during the approximate 23 hours she was in the hospital.  Based upon this information and other evidence, the jury found that Blue Cross/Blue Shield should have paid the bill.  The majority of the Court found, however, that since the hospital bill did not contain a specific charge for a hospital room, no layperson would reasonably conclude that Ms. Shirley was an inpatient.  As such, the majority of the Court determined the treatment rendered by the hospital should have been considered outpatient treatment and thus not covered by the insurance policy which provided limited catastrophic coverage.

            The minority of the Court felt that the insurance policy was ambiguous and that the case was rightfully submitted to a jury to consider all of the facts, including a pre-certification of inpatient status as to whether the services constituted included inpatient treatment or excluded outpatient treatment.

            In our opinion, the judges in the minority got it right in concluding that the dispute was properly submitted to a jury for resolution.   However, the majority view controls at least as to Ms. Shirley’s case and she now owes a significant amount of money to North Fulton Regional Hospital.  While the results of this case are troubling, do not hesitate to contact the attorneys at Chambers, Aholt & Rickard if you find yourself in an insurance coverage dispute.  As former insurance defense attorneys, we are willing to work for you to scrutinize your policy and evaluate the pertinent facts to determine if you are being treated fairly by your insurance company.

Comments

[Justin Bieber Supra]

A constant conversation I have with some, by no means all, of my European colleagues is to argue to them: don’t apply rules to the Government of Israel that you would never dream of applying to your own country. In any of our nations, if there were people firing rockets, committing acts of terrorism and living next door to us, our public opinion would go crazy. And any political leader who took the line that we shouldn’t get too excited about it, wouldn’t last long as a political leader. This is a democracy.

[belstaff]

What a wonderful blog you have created. I just stopped in to tell you I really appreciated the read and shall be dropping by from time to time now.

[cheap jerseys wholesale]

In this series, the Barrie Examiner looks at the evolution of jobs and joblessness.When Wolfgang Schroeter decided to expand into the furnace business, there was no question they would be manufactured in Barrie.After all, this is where he and his wife, Ingrid, built Wolf Steel and the Napoleon empire of fireplaces, barbecues and stoves.It was 1976, a time when only the bold dared to launch out on their own.Now their two grown sons, Stephen and Chris, are an integral part of a business that keeps growing.During a celebration marking their launch into the $5-billion North American furnace market earlier this fall, the Schroeters were all on hand.

[Aaron Rodgers Jersey]

A divided Georgia Court of Appeals reversed a jury verdict in favor of an insured against her health insurance company for its failure to pay a hospital bill.

[Charles Woodson Jersey]

The minority of the Court felt that the insurance policy was ambiguous and that the case was rightfully submitted to a jury to consider all of the facts,

[B.J. Raji Jersey]

including a pre-certification of inpatient status as to whether the services constituted included inpatient treatment or excluded outpatient treatment.

[Clay Matthews Jersey]

The case centered around whether the treatment provided to Ms. Shirley was for inpatient or outpatient services.

[Donald Driver Jersey]

In our opinion, the judges in the minority got it right in concluding that the dispute was properly submitted to a jury for resolution.

[Ralph Lauren Outlet]

Having read this post, I have learned for myself a lot of the new. Thanks