Before Chief Justice Pickering and Justices Hardesty and Saitta. Opinion by Justice Hardesty.
In this case, the Court was called upon to interpret Nevada’s pre-2011 charitable health care statue, NRS 439B.260, which requires hospitals to offer at least a thirty percent discount to patients receiving inpatient care who meet certain criteria. Among the eligibility criteria is a requirement that the patient not have health insurance or “other contractual provision for the payment of the charge by a third party.” Appellant Bielar received treatment for injuries due to a car accident and obtained a $1.3 million settlement from the party responsible for her injuries. Washoe Medical, the health center that provided treatment, sought payment of the full amounts of treatment billed and Bielar challenged, arguing that the amounts billed were unreasonable and she was entitled to a thirty percent discount under NRS 439B.260. In the primary issue on appeal, the Court determined that the settlement agreement did not prevent Bielar from qualifying for the thirty-percent discount, holding that a “patient's eligibility for the 30-percent discount is determined at the time of the rendition of the hospital services and a later agreement with a third-party tortfeasor for claims arising out of such services” would not bar application of the discount. Additionally, the Court held that a settlement agreement is not an agreement for the payment of medical charges under the language of the statute even if a portion of the settlement agreement is designated for medical expenses. The Court noted that the 2011 revisions to NRS 439B.260 were consistent with its interpretation. Having agreed with Bielar on the legal issues, the Court reversed the grant of summary judgment on Bielar’s claims for the discount; however, the Court affirmed the district court’s grant of judgment as a matter of law on Bielar’s claims that the charges were unreasonable, concluding that Bielar failed to carry her burden of proof. Reversed in part and remanded. (Kerry S. Doyle, Associate in the Reno office of McDonald Carano Wilson.)
Showing posts with label Insurance. Show all posts
Showing posts with label Insurance. Show all posts
Thursday, July 11, 2013
Thursday, June 28, 2012
Physicians Insurance Co. v. Williams, 128 Nev. Adv. Op. 30 (June 28, 2012)
Before Justices Cherry, Gibbons, and Pickering. Opinion by Justice Pickering.
In this appeal, the Court interpreted the notice terms of a claims-made-and-reported medical malpractice insurance policy (the “Policy”) to determine whether the insurer, Physicians Insurance Company of Wisconsin, Inc. d.b.a PIC Wisconsin (“PIC”), had timely notice of a claim made against the insured, Dr. Hamid Ahmadi, D.D.S. (“Dr. Ahmadi”), during the policy period. The Policy had a retroactive date of April 13, 1998 and, through renewals, its coverage extended to April 14, 2004. PIC was sued by a patient of Dr. Ahmadi seeking coverage under the Policy after Dr. Ahmadi used cocaine to anesthetize the patient, who then sideswiped a residential gas meter with his work cement truck, failed a drug test, and was fired from his employment. The District Court determined that “constructive” notice of a claim had been provided to PIC based on information that had been provided to PIC “anecdotally,” including through news reports, investigations into claims made on another PIC policy by Dr. Ahmadi relating to an alleged burglary, and an order suspending Dr. Ahmadi’s license. The Court reversed the District Court’s decision holding that the terms of the Policy required that the claim be reported to PIC within the policy period, and that without “actual” notice of the claim pursuant to such provision, there is no coverage for the claim under the Policy. The Court also rejected the interpretation that the Policy’s definition of “Claim” allowed for “constructive” notice of a claim, but rather PIC must be given “specific information about a specific wrongful act and consequent injury to a patient . . . more in the way of formal contact between the insurer and the insured.” Reversed and remanded. (David J. Stoft, Associate in the Las Vegas office of McDonald Carano Wilson.)
In this appeal, the Court interpreted the notice terms of a claims-made-and-reported medical malpractice insurance policy (the “Policy”) to determine whether the insurer, Physicians Insurance Company of Wisconsin, Inc. d.b.a PIC Wisconsin (“PIC”), had timely notice of a claim made against the insured, Dr. Hamid Ahmadi, D.D.S. (“Dr. Ahmadi”), during the policy period. The Policy had a retroactive date of April 13, 1998 and, through renewals, its coverage extended to April 14, 2004. PIC was sued by a patient of Dr. Ahmadi seeking coverage under the Policy after Dr. Ahmadi used cocaine to anesthetize the patient, who then sideswiped a residential gas meter with his work cement truck, failed a drug test, and was fired from his employment. The District Court determined that “constructive” notice of a claim had been provided to PIC based on information that had been provided to PIC “anecdotally,” including through news reports, investigations into claims made on another PIC policy by Dr. Ahmadi relating to an alleged burglary, and an order suspending Dr. Ahmadi’s license. The Court reversed the District Court’s decision holding that the terms of the Policy required that the claim be reported to PIC within the policy period, and that without “actual” notice of the claim pursuant to such provision, there is no coverage for the claim under the Policy. The Court also rejected the interpretation that the Policy’s definition of “Claim” allowed for “constructive” notice of a claim, but rather PIC must be given “specific information about a specific wrongful act and consequent injury to a patient . . . more in the way of formal contact between the insurer and the insured.” Reversed and remanded. (David J. Stoft, Associate in the Las Vegas office of McDonald Carano Wilson.)
Thursday, December 29, 2011
Fourth St. Place v. Travelers Indem. Co., 127 Nev. Adv. Op. 86 (December 29, 2011)
Before Justices Douglas, Hardesty, and Parraguirre. Opinion by Justice Douglas.
In this appeal from an order granting summary judgment in an insurance coverage action, the Court interpreted coverage limitations and exclusions in an “all risks” policy. Appellant, the owner of a building in Las Vegas, had roof repairs done to the building. Before the repairs were completed, Las Vegas had an unexpected and substantial rainstorm that caused significant damage to the building. Respondent denied coverage because the policy limited coverage for damage caused by rain to circumstances where the roof first sustained damage by wind or hail and excluded damage caused by faulty workmanship. The Court defined “roof” as “sufficiently durable to meet its intended purpose: to cover and protect a building against weather-related risks that reasonably may be anticipated,” and held that tarps that were used as temporary protection of the roof only after the rain began did not fit within that definition. The Court further concluded that “faulty workmanship” was not ambiguous and included both faulty products and processes. Having rejected both arguments that the potential causes of damage were covered by the policy, the Court nonetheless considered and adopted the doctrine of efficient proximate cause, which allows for recovery under an insurance policy if a covered cause of loss is the predominant cause of the loss even if a non-covered cause contributed to the loss. Because none of the asserted causes of the damage were covered under the policy, the Court affirmed the district court’s order granting summary judgment to the insurance company. Affirmed. (Kerry S. Doyle, Associate in the Reno office of McDonald Carano Wilson.)
In this appeal from an order granting summary judgment in an insurance coverage action, the Court interpreted coverage limitations and exclusions in an “all risks” policy. Appellant, the owner of a building in Las Vegas, had roof repairs done to the building. Before the repairs were completed, Las Vegas had an unexpected and substantial rainstorm that caused significant damage to the building. Respondent denied coverage because the policy limited coverage for damage caused by rain to circumstances where the roof first sustained damage by wind or hail and excluded damage caused by faulty workmanship. The Court defined “roof” as “sufficiently durable to meet its intended purpose: to cover and protect a building against weather-related risks that reasonably may be anticipated,” and held that tarps that were used as temporary protection of the roof only after the rain began did not fit within that definition. The Court further concluded that “faulty workmanship” was not ambiguous and included both faulty products and processes. Having rejected both arguments that the potential causes of damage were covered by the policy, the Court nonetheless considered and adopted the doctrine of efficient proximate cause, which allows for recovery under an insurance policy if a covered cause of loss is the predominant cause of the loss even if a non-covered cause contributed to the loss. Because none of the asserted causes of the damage were covered under the policy, the Court affirmed the district court’s order granting summary judgment to the insurance company. Affirmed. (Kerry S. Doyle, Associate in the Reno office of McDonald Carano Wilson.)
Thursday, August 4, 2011
Gallegos v. Malco Enterprises of Nevada, 127 Nev. Adv. Op. 51 (August 4, 2011).
Before Saitta, Hardesty and Parraguirre. Opinion by Parraguirre.
In this appeal from a summary judgment decision in an insurance action, the Nevada Supreme Court clarifies that rights of action held by a judgment debtor are subject to execution toward satisfaction of a judgment under NRS 21.080, and may be judicially assigned pursuant to NRS 21.320. In making this determination, the Court first held that so long as a right of action is “property . . . not exempt from execution,” it may be judicially assigned in satisfaction of a judgment. See NRS 21.320. The Court then turned to NRS 21.080(1) to determine whether a right of action is “property . . . exempt from execution.” NRS 21.080(1) provides that “[a]ll goods, chattels, money and other property, real and personal, of the judgment debtor, or any interest therein of the judgment debtor not exempt by law, and all property and rights of property seized and held under attachment in the action are liable to execution.” The Court also considered NRS 10.045, which applies to the entire statutory title, including NRS 21.080, and defines personal property as including “money, goods, chattels, things in action and evidences of debt.” Accordingly, based upon the plain language of these statutes, the Court found that rights of action held by a judgment debtor are personal property subject to execution in satisfaction of a judgment. Reversed and remanded for further proceedings. (Amanda C. Yen, Associate in the Las Vegas office of McDonald Carano Wilson)
In this appeal from a summary judgment decision in an insurance action, the Nevada Supreme Court clarifies that rights of action held by a judgment debtor are subject to execution toward satisfaction of a judgment under NRS 21.080, and may be judicially assigned pursuant to NRS 21.320. In making this determination, the Court first held that so long as a right of action is “property . . . not exempt from execution,” it may be judicially assigned in satisfaction of a judgment. See NRS 21.320. The Court then turned to NRS 21.080(1) to determine whether a right of action is “property . . . exempt from execution.” NRS 21.080(1) provides that “[a]ll goods, chattels, money and other property, real and personal, of the judgment debtor, or any interest therein of the judgment debtor not exempt by law, and all property and rights of property seized and held under attachment in the action are liable to execution.” The Court also considered NRS 10.045, which applies to the entire statutory title, including NRS 21.080, and defines personal property as including “money, goods, chattels, things in action and evidences of debt.” Accordingly, based upon the plain language of these statutes, the Court found that rights of action held by a judgment debtor are personal property subject to execution in satisfaction of a judgment. Reversed and remanded for further proceedings. (Amanda C. Yen, Associate in the Las Vegas office of McDonald Carano Wilson)
LVMPD v. Coregis Insurance Co., 127 Nev. Adv. Op. 47 (August 4, 2011)
Before the court en banc. Opinion by Gibbons.
In these consolidated appeals regarding insurance coverage, the Court addressed whether an insurer must demonstrate that it was prejudiced by the delay before denying coverage based on untimely notice of a claim. The Court first determined that the district court improperly granted summary judgment because the facts regarding the timeliness of the notice were in dispute. Addressing the main substance of the case, the Court held that its decision rejecting a prejudice requirement, Insurance Co. v. Cassinelli, 67 Nev. 227, 216 P.2d 606 (1950), had been abrogated by a later enacted administrative regulation and that requiring the insurer to demonstrate prejudice is the better rule. As such, the Court held that an insurer may not deny coverage based on untimely notice of a claim without demonstrating (1) that the notice was late and (2) that the late notice prejudiced the insurer. Reversed and remanded for further proceedings. (Kerry S. Doyle, Associate in the Reno office of McDonald Carano Wilson)
In these consolidated appeals regarding insurance coverage, the Court addressed whether an insurer must demonstrate that it was prejudiced by the delay before denying coverage based on untimely notice of a claim. The Court first determined that the district court improperly granted summary judgment because the facts regarding the timeliness of the notice were in dispute. Addressing the main substance of the case, the Court held that its decision rejecting a prejudice requirement, Insurance Co. v. Cassinelli, 67 Nev. 227, 216 P.2d 606 (1950), had been abrogated by a later enacted administrative regulation and that requiring the insurer to demonstrate prejudice is the better rule. As such, the Court held that an insurer may not deny coverage based on untimely notice of a claim without demonstrating (1) that the notice was late and (2) that the late notice prejudiced the insurer. Reversed and remanded for further proceedings. (Kerry S. Doyle, Associate in the Reno office of McDonald Carano Wilson)
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