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Tag Archives: medical benefits

Contract – Health Insurance – Maxed-Out Benefits – Preferred Providers’ Charges – Civil Practice – Standing – Class Action (access required)

Hamm v. Blue Cross & Blue Shield of North Carolina. According to the defendant-insurer's health insurance booklet, covered services remain covered services notwithstanding an exhausted benefit or lifetime maximum; as such, during claim processing, when the insurer labels a covered service as one that is not covered, this may lead to plan members being charged more than the allowed amount for covered services. Therefore, such labeling may constitute a breach of the insurer's contract with its members.

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Workers’ Compensation – Medical Benefits – Knee Injury – Future Replacement – Discovery Violations (access required)

Innes v. Kmart/Sears Holdings Corp. (Lawyers Weekly No. 10-08-0788, 6 pp.) (Laura Kranifeld Mavretic, Commissioner) Appealed from Opinion & Award of Deputy Commissioner George R. Hall III. I.C. 234063. Holding: Although plaintiff has managed her knee pain with a brace ...

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Workers’ Compensation – Medical Benefits – Knee Injury – Future Replacement – Discovery Violations (access required)

Innes v. Kmart/Sears Holdings Corp. Although plaintiff has managed her knee pain with a brace and Celebrex for longer than her doctor believed she would be able to, it is still likely that she will need a total replacement in the future because of her compensable knee injury.

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