Blue Cross approved Ephram Nehme’s liver transplant in 2006 and he was on the wait list at UCLA Medical centre.
But Nehme was very ill and feared for his life, so he wanted to be on Indiana’s transplant list, where the wait was much shorter. Blue Cross refused to pay for an out-of-state liver transplant, but Nehme, a grocery merchant, had the money to pay for it himself and did so.
And then he sued the insurance company and won, the Los Angeles Times reported.
A jury awarded Nehme the cost of the transplant ($206,000), plus his yet-to-be-determined legal fees.The jury said both that Blue Cross breached the insurance contract and acted in bad faith by refusing the operation.
In a statement, Blue Cross acknowledged, the LAT said, “the jury’s determination that Mr. Nehme’s transplant should have been approved by Anthem Blue Cross despite the fact that Mr. Nehme’s Anthem Blue Cross contract states that transplants must be performed only at California centres of Excellence.”
We haven’t seen the insurance contract (and it usually is not as simple as one clause, plus if it were that clear a judge should have kicked it on summary judgment), but, no matter what the contract said, it would be tough to find someone who wouldn’t think that it feels “right” that Nehme got his pay day.
Basically that’s the problem with litigating insurance contracts — saying a man’s liver transplant must be later rather than sooner because of a million-page form never plays well to a jury.
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