Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Hart v. Pacificsource Health Plans

United States District Court, D. Montana, Butte Division

July 19, 2019

HUNTER HART, COY COHENOUR through his parents, MONTANA COHENOUR through his parents, DAVID COHENOUR, as parent and individually, and HEIDI HART, as parent and individually, Plaintiffs,
v.
PACIFICSOURCE HEALTH PLANS, a health insurance service corporation, and JOHN DOES I-V, Defendants.

          ORDER ADOPTING FINDINGS AND RECOMMENDATIONS

          Brian Morris United States District Court Judge

         This insurance bad-faith case comes before the Court on cross-motions for partial summary judgment by Plaintiff David Cohenour (“David”) and Defendant PacificSource Health Plans (“PacificSource”).

         United States Magistrate Judge Lynch entered Findings and Recommendations in this matter on June 18th, 2019. (Doc. 43). Judge Lynch recommended that David's motion for partial summary judgment should be denied. Id. Judge Lynch further recommended that PacificSource's motion for partial summary judgment be granted. Id. at 18.

         The Court reviews de novo Findings and Recommendations to which a party timely objected. 28 U.S.C. § 636(b)(1). The Court reviews for clear error the portions of the Findings and Recommendations to which a party did not specifically object. McDonnell Douglas Corp. v. Commodore Bus. Mach., Inc., 656 F.2d 1309, 1313 (9th Cir. 1981). Where a party's objections constitute perfunctory responses argued in an attempt to engage the district court in a rehashing of the same arguments set forth in the original response, however, the Court will review for clear error the applicable portions of the findings and recommendations. Rosling v. Kirkegard, 2014 WL 693315 *3 (D. Mont. Feb. 21, 2014) (internal citations omitted).

         David timely filed objections to Magistrate Judge Lynch's Findings and Recommendations. (Doc. 47). David objects specifically to two recommendations. Id. at 3. David first objects to Judge Lynch's finding that David does not qualify as a first-party insured under the law. Id. David next objects to Judge Lynch's conclusion that David does not qualify as a third-party claimant. Id.

         Background

         David and Heidi Hart are the biological parents of Hunter Hart, Coy Cohenour, and Montana Cohenour (“sons”). (Doc. 31 at ¶ 1). The sons suffer from severe hemophilia and require antihemophilic medication prescribed by their treating physician. (Doc. 31 at ¶ 3). The antihemophilic medication remains expensive and PacificSource considers the medication to be a high cost injectable medication. (Doc. 31 at ¶ 6).

         Heidi submitted an Individual and Family Policy Enrollment Form to PacificSource in December 2015. (Doc. 35 at ¶ 1). The PacificSource policy (“the Policy”) went into effect on January 1, 2016, and provided health insurance coverage for Heidi and the three sons. (Docs. 31 at ¶ 8; 35 at ¶ 2). David is not named as an insured on the Policy. (Doc. 26-3 at 1). David and Heidi timely paid the premiums throughout the term of the Policy from their joint bank account. (Doc. 31 at ¶ 9).

         PacificSource paid for the antihemophilic medication as prescribed by the boys' treating physician from approximately January through June 2016. (Doc. 31 at ¶ 14). PacificSource sent the prescription drug claims out for external review in June 2016. (Doc. 35 at ¶ 2). The external reviewer determined that “the requested dosing [was] not clearly medically necessary.” (Doc. 30-2 at 3). PacificSource effectively stated that it would no longer pay for the full dose and frequency of antihemophilic medication as prescribed by the sons' treating physician, in a letter dated July 11, 2016. (Doc. 17-1).

         Heidi appealed PacificSource's decision internally and filed a complaint with the Montana Insurance Commissioner's Office. (Docs. 31 at ¶ 17; 35 at ¶ 4). The Commissioner's Office conducted two additional external reviews between August and November 2016. (Doc. 31 at ¶ 18). PacificSource approved the antihemophilic medication dosages and frequencies as prescribed by the treating physician after receiving the results of the second external review. (Docs. 31 at ¶ 19; 35 at ¶ 6).

         David and Heidi commenced this action against PacificSource in the Montana Eighteenth Judicial District Court in July 2018. (Doc. 1-2). The Complaint alleges claims for breach of contract and violations of Montana's Unfair Trade Practices Act (“UTPA”), Mont. Code Ann. § 33-18-201 et seq. (Doc. 1-2 at 13-16). David seeks a declaratory judgment that he stands as a first-party insured or, alternatively, a third-party claimant/beneficiary under the Policy. (Doc. 1-2 at 16-17).

         PacificSource removed the case to this Court pursuant to 28 U.S.C. § 1441, based on diversity of citizenship in August 2018. (Doc. 1). The parties have filed cross-motions for summary judgment to adjudicate David's status under the Policy and to determine whether he qualifies as a first-party insured or a third-party claimant/beneficiary under the Policy, thereby entitling him to maintain a bad faith claim against PacificSource.

         A. First Party Insured

         David takes issue first with Judge Lynch's analysis of Omaha Property and Casualty Co. Crosby, 756 F.Supp. 1380 (D. Mont. 1990). The district court in Omaha determined that a mother could enforce an insurance contract as a person with an insurable interest. Id. at 1383. Judge Lynch reasoned that Omaha remained inapplicable because the mother in Omaha stood as a named insured on the insurance ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.