In the summer of 2003, Gary Shephard learned that he needed to have surgery on his left knee. In accordance with the requirements of his insurance plan, Mr. Shephard obtained prior approval for the surgery from Blue Cross/Blue Shield and made plans to have the surgery on or about August 5, 2003. On August 1, 2003, a few days before his scheduled surgery, Mr. Shephard was laid off due to lack of work. (Shephard v. O'Quinn Case No. 3:05-CV-79, 2013) Defendant John O'Quinn, Gary Shephard’s boss, told him that the layoff would be temporary and that his insurance coverage was paid for one month after his layoff. Therefore, Mr. O'Quinn assured Mr. Shephard that his health insurance would still be effective the following week when he had knee surgery. …show more content…
Shephard was previously employed by defendant O'Quinn Enterprises, Inc., beginning in November 2002. One of the benefits offered to employees of O'Quinn Enterprises was participation in the company's group health insurance plan through Blue Cross/Blue Shield of Tennessee. The cost of the health insurance premiums were split between the employer and the employee. O'Quinn Enterprises deducted $59.83 per pay period from Mr. Shephard's paycheck for his portion of the health insurance premium. (Shephard v. O'Quinn Case No. 3:05-CV-79, 2013)
The Plaintiff, Gary Shephard later learned that for some period of time the deductions taken from his pay were not being applied to his health insurance premium and that his insurance coverage had lapsed. He also discovered that he did not have COBRA coverage as promised. Mr. Shephard testified that this lapse in coverage affected his ability to obtain new insurance coverage and he had to be placed on a list for knee transplants which delayed his ability to receive complete treatment for his
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Therefore, the Court finds that an award of statutory penalties of $110.00 per day for 826 days totaling $90,860.00 as requested is appropriate. The Court awarded $90,860 in statutory penalties at the $110 per day maximum for not providing an election notice. Attorney fees were another $16,909, and medical claims totaled $12,200. Interestingly, rates of $225 per hour for attorney time and $95 per hour for paralegal time were deemed to be reasonable by the Court. (Case Law Summaries,
...e terms and conditions the job entailed. I believe that Wal-Mart did accommodate Pam Huber’s disability needs by suggesting to her a different position to work in due to her downfall. If the company caused for her accident then they should accommodate for her disability and keep Pam Huber in her position but due to the fact that the accident happened on her own terms I do not think the company should be reliable for her disability and therefore Pam Huber should either accept and make the most out of her situation or leave the company. Based on all these factors I am defiantly in agreement with Wal-Mart and the district courts decision on ruling summery judgment in favor of Pam Huber.
In the plaintiff’s suit, he alleged the surgery did not go well because the hospital had hired a surgeon, who was not competent or qualified enough to perform the surgery therefore; the hospital was just as negligent as the doctor was. Before the trial date, Dr. Salinsky and his insurance company, Employers Mutual Liability Insurance Company of Wisconsin, settled with plantiff out of court on the basis they will be released from the suit upon payment of $140,000 (Johnson v. Misericordia Community Hospital). Although, Salinsky settled with plaintiff prior to trial, there was still “question of whether he was negligent in the manner in which he performed the operation on July 11, 1975, remained an issue at trial, as it was incumbent upon the plaintiff to prove that Salinsky was negligent in this respect to establish a
...who violated Randy’s rights. With such little evidence from the Plaintiff, and the fact that Caruso is not a medical professional, she was not involved in the making of policies and procedures relating to medical matters. Therefore, Caruso did not act with deliberate indifference and was entitled summary judgment, because Plaintiff Parsons failed to provide sufficient evidence on Caruso.
Steiner, John E. (2013). Problems in health care law: challenges for the 21st century (10th ed.). Burlington, MA: Jones & Bartlett Learning.
Medical error occurs more than most people realize and when a doctor is found negligent the patient has the right to sue for compensation of their losses. Debates and issues arise when malpractice lawsuits are claimed. If a patient is filing for a medical malpractice case, the l...
One of the biggest contributors to health care costs that I have seen during my time in the healthcare industry is insurance fraud. One example of such fraud came about two months ago. I was taking a phone call from a provider that was upset that one of their claims had denied even though all of their previous claims had been paid. In researching with a partner plan it was determined that the claim denied because this medical provid...
Jacobson, P. (1999, July/August). Legal challenges to managed care cost containment programs: an intital assessment. Courts & Managed Care, 69-85.
Another downfall to HMO coverage is selective-contracting. This is a process where hospitals deny treatment to patients because their...
“HHS:HMO’s Ignore Medical Incompotence.” International Council fpr Health & Human Services 5.21 (2001): 1-2 par. 17.
The steady rise of healthcare costs and the ever increasing cost of health insurance premiums are making it harder and harder for employers to pay healthcare premiums for their employees. In the past, it was almost a given that employers picked up the tab for health insurance coverage. The health coverage was usually exceptional with little or no money paid out of pocket by the individual for the insurance premiums. Those appear to be the “good old days”, with fewer and fewer employers shelling out money for health insurance premiums and demanding a larger percentage to be paid by the employee. Other employers are simply unable to financially provide healthcare coverage for their employees and have stopped all together.
"U.S. Judge Rules Health Care Reform Act Unconstitutional | Business Insurance." Business Insurance News, Analysis & Articles. Web. 20 Mar. 2011. .
Then came the question, should the employer be the one responsible for providing health insurance. While everyone on the panel could agree that our health care system in 2008 was broken, most seemed opposed to the alternative solution of universal healthcare. There is an incentive to the company to offer health insurance to a human being that may receive the opportunity to receive health insurance from another company. However, taking health insurance responsibility away from the employer and making it the government’s responsibility would increase availability and possibly eliminate freedom of
On September 14th, 2016 I had a wisdom tooth removed at Triad Oral Surgery by Dr. Stefan Simoncic. Before my appointment I was informed by my insurance company (Cigna) that although there were waiting periods and they would not cover the cost of the procedure I still would receive a discounted rate for going to an oral surgeon that was in the network. This is why I chose Triad Oral Surgery. At the time of service I was told I would need to pay the amount of $1332.0, which I paid with a debit card. I was also informed that this was the discounted rate. It wasn't until later that I reviewed my recent claims and learned the discounted rate I should have been charged was actually $730.00. I notified Triad Oral Surgery that I had been overcharged
...s not insured and I saw him struggle with not being insured and how he had wished he had made it a priority to stay insured throughout the years.
The nerves are raging, mainly in his stomach as the butterflies flutter till no end. "Is everything ok? Will everything go as planned?" He couldn't stop thinking about what might happen. Images were racing wild as he thought about his teammates going to battle without him. He couldn't comprehend why he had to let them handle it on their own. He has played with them since they were in eighth grade, and when they need him the most, all he can do is sit and cheer. He hates this feeling of helplessness, but at the same time he knows he has to do what little he can do, well.