Justia Arbitration & Mediation Opinion Summaries

UEBT is a healthcare employee benefits trust governed by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001, and pays healthcare providers directly from its own funds for the services provided to enrollees in its health plans. UEBT contracted with a “network vendor,” Blue Shield, to obtain access to Blue Shield’s provider network at the rates Blue Shield had separately negotiated, and certain administrative services. One of Blue Shield’s preexisting provider contracts was with Sutter, a group of health care providers in Northern California. UEBT sued Sutter, on behalf of a putative class of all California self-funded payors, alleging that Sutter’s contracts with network vendors, such as Blue Shield, contain anticompetitive terms that insulate Sutter from competition and drive up the cost of healthcare. UEBT sought damages, restitution, and injunctive relief under the Cartwright Act (Bus. & Prof. Code 16720) and California’s unfair competition law (section 17200). Sutter moved to compel arbitration, relying on an arbitration clause in the provider contract signed by Sutter and Blue Shield. The trial court denied Sutter’s motion, concluding that UEBT was not bound to arbitrate its claims pursuant to an agreement it had not signed or even seen. The court of appeal affirmed. View "UFCW & Employers Benefit Trust v. Sutter Health" on Justia Law

In 2011, 74-year-old Garnell Wilcoxon lived alone. He suffered a stroke, awoke on the floor of his bedroom covered in sweat, feeling sore and with no memory of how he got there. Wilcoxon was admitted to the Troy Regional Medical Center for analysis and treatment for approximately one year before he died. Following Wilcoxon's death, Brenda McFarland, one of Wilcoxon's daughters, filed a complaint as the personal representative for Wilcoxon's estate, asserting claims for : (1) medical malpractice; (2) negligence; (3) breach of contract; (4) negligent hiring, training, supervision, and retention; and (5) loss of consortium. In its answer, Troy Health asserted, in part, that McFarland's claims were barred from being litigated in a court of law "by virtue of an arbitration agreement entered into between plaintiff and defendant." Troy Health then moved to compel arbitration, asserting that forms signed by one of Wilcoxon's other daughters, acting as his attorney-in-fact, contained a valid and enforceable arbitration clause. McFarland argued that "Wilcoxon did not have the mental capacity to enter into the contract with [Troy Health,] and he did not have the mental capacity to give legal authority to enter into contracts on his behalf with" relatives who initially helped admit him to Troy Health facilities when he first fell ill. According to McFarland, "[t]he medical records document that Wilcoxon was habitually and/or permanently incompetent." Therefore, McFarland argued, both a 2011 arbitration agreement and a 2012 arbitration agreement were invalid. The circuit court denied Troy Health's motion to compel arbitration. The Supreme Court reversed, finding that McFarland failed to prove that Wilcoxon was mentally incompetent when he executed a 2012 durable power of attorney naming his other daughter as his attorney-in-fact, and also failed to demonstrate that Wilcoxon was "permanently incompetent" before that date, and because there was no other issue concerning the validity of the 2012 arbitration agreement. View "Troy Health and Rehabilitation Center v. McFarland" on Justia Law

Leo Brown was admitted to the Hattiesburg Health and Rehab Center (HHRC) in February 2012. His wife, Emma, signed an admission agreement both in her individual capacity and on Leo's behalf. Specifically, Emma's signature appears on a line just above the line: "signature of responsible party in his/her individual capacity and on behalf of the resident in the following capacity," where Emma circled the "authorized agent and/or health care surrogate" option. Leo did not sign the agreement. Her husband died soon after his discharge, and she brought a wrongful-death suit against HHRC. HHRC moved to stay the proceedings and to compel arbitration. The trial judge held a hearing on HHRC's motion and denied it, stating: "I do not agree that [Emma] was authorized to sign on Mr. Brown's behalf, and I don't – I do not agree that it is binding on Mr. Brown." The trial judge later entered an order, finding again that the Admission Agreement was not binding on Leo. HHRC appealed, challenging the trial court judgment as to: (1) whether the arbitration provision contained within the Admission Agreement entered between Emma Brown, individually and on behalf of Leo Brown, and [HHRC] created a valid and enforceable agreement to arbitrate; and (2) whether the arbitration provision contained within the Admission Agreement entered between Emma Brown, individually and on behalf of Leo Brown, and [HHRC] was unconscionable. The Supreme Court agreed with the trial court that Leo is not bound by the arbitration provision. And because that issue was dispositive, the Court did not address HHRC's unconscionability argument. View "Hattiesburg Health & Rehab Center, LLC v. Brown" on Justia Law

Nilene Junker was admitted to the Nichols Center nursing facility after surgery. Junker's daughter, acting with power of attorney, signed an admission agreement on Junker's behalf. The admission agreement contained an arbitration clause. While she was being put in a room, Junker fell and sustained injuries. Junker sued the Nichols Center, and the nursing home filed a motion to compel arbitration. The circuit court denied the motion to compel arbitration. The court ruled from the bench without hearing arguments from the parties, holding that the arbitration agreement was not valid and that the "arbitration agreement must fail because it does not make provision for an arbitrator in the event the parties could not agree." The Nichols Center appealed the denial of its motion to compel arbitration. The Supreme Court reversed, concluding the circuit court erred by denying the motion to compel arbitration on the basis of forum unavailability. "The motion to compel asked the court to determine whether the arbitration agreement was valid and enforceable. The court was not asked to rewrite the terms of the agreement to provide for an arbitrator, but rather to compel Junker to comply with the procedures outlined in the agreement. There must be some attempt by the parties to select an arbitrator; then, if the parties cannot agree, the court may be called on to appoint an arbitrator." The case was remanded for a hearing on the motion to compel and a determination of the validity of the arbitration agreement. "If the arbitration agreement is valid, Junker cannot simply refuse to arbitrate." View "NC Leasing, LLC v. Junker" on Justia Law

The trial judge denied the appellants' motion to compel arbitration on the ground that there was no binding arbitration agreement. The trial judge ruled that Tamera Nelson did not have authority to sign an arbitration agreement on behalf of her grandmother, Arda Lee Churchill (who was a resident of the Grace Living Center-Chikasha until her death), so no valid arbitration agreement existed. The Supreme Court agreed with the trial court that no valid arbitration agreement existed because Tamera Nelson was not authorized to make health care decisions for her grandmother under the circumstances. The Health Care Power of Attorney required that Arda Lee Churchill's physician certify that she was not capable of making her own health care decisions and no such certification was made. View "Johnson v. Convalescent Center of Grady, LLC" on Justia Law

The Providers supply outpatient cardiac telemetry (OCT) services, used by doctors to monitor cardiac arrhythmias. The device differs from conventional technology in that it transmits electrocardiographic (EKG) data in real time to certified technicians, who forward the data to a physician. OCT is approved by the FDA, and has long been covered by Medicare and commercial insurers. CIGNA administers employer sponsored health benefit plans. CIGNA pays its in-network providers directly for the services rendered to patients. In 2007, the Providers joined CIGNA’s network by Agreements that set the reimbursement rate and define “Covered Services.” In 2012, CIGNA issued a statement that it would no longer cover OCT “for any indication because it is considered experimental, investigational or unproven.” The 2012 Policy acknowledged that this new position would be trumped by any conflicting language in the coverage policies themselves. In arriving at the new policy, CIGNA relied on the same medical literature it had previously relied upon in concluding that OCT should be covered. The Providers claim that CIGNA indicated that its motive was financial, but refused to reconsider the 2012 Policy. The district court found that the Providers’ claims fell within the arbitration clause of the Agreement. The Third Circuit vacated. The clause at issue is limited in scope to disputes “regarding the performance or interpretation of the Agreement” and the claims at issue do not relate to the performance or interpretation of the Agreement.View "Cardionet Inc v. Cigna Health Corp." on Justia Law

Decedent became a resident of Golden Living Center, a nursing home, in 2009. Later that year, Courtyard Gardens took over ownership and operation of the facility. Thereafter, Decedent's son, Ronald Quarles signed a new admission agreement and optional arbitration agreement. In 2011, Kenny Quarles, another of Decedent's sons acting as power of attorney, filed an amended complaint against Courtyard Gardens and other entities associated with it and the Center, seeking damages for negligence, medical malpractice, and violations of the Arkansas Long-Term Care Residents' Act. Courtyard Gardens filed a motion to dismiss and compel arbitration. The circuit court denied Courtyard Garden's motion to compel arbitration, concluding that questions of fact remained regarding Ronald's authority to bind Decedent to the arbitration agreement. The Supreme Court affirmed the denial of the motion to compel arbitration, holding that there was no valid arbitration agreement as a matter of law because Ronald had neither actual authority nor statutory authority to enter into the arbitration agreement on Decedent's behalf. View "Courtyard Gardens Health & Rehab., LLC v. Quarles" on Justia Law

A nursing home patient (Decedent) signed an agreement providing for arbitration of disputes arising out of treatment and care at the nursing home. Decedent subsequently died, allegedly through the nursing home's negligence. Through Decedent's personal representative, Decedent's survivors (Plaintiffs) subsequently brought a cause of action for deprivation of rights under the applicable nursing home statute and, alternatively, a wrongful death action. At issue on appeal was whether an arbitration agreement signed by the decedent requires his estate and heirs to arbitrate their wrongful death claims. The court of appeal concluded that the estate and heirs were bound by the arbitration agreement but certified a question to the Supreme Court. The Court approved of the court of appeal's decision and answered that the execution of a nursing home arbitration agreement by a patient with capacity to contract binds the patient's estate and statutory heirs in a subsequent wrongful death action arising from an alleged tort within the scope of the valid arbitration agreement. View "Laizure v. Avante at Leesburg, Inc." on Justia Law

Nancy Belcher was the designated health care surrogate of decedent Beulah Wyatt. Belcher signed an arbitration agreement that was presented to her when she sought to admit Wyatt to the McDowell Nursing and Rehabilitation Center (McDowell Nursing). Wyatt died after living ten months in the nursing home. Lelia Baker subsequently filed a wrongful death suit against McDowell Nursing alleging that its negligent care of Wyatt caused and/or contributed to her death. McDowell Nursing filed a motion to dismiss and to enforce the arbitration agreement. The circuit court denied the motion and concluded that the agreement was unenforceable because Belcher did not have the authority to waive Wyatt's right to a jury trial. The Supreme Court denied McDowell Nursing's subsequent request for a writ of prohibition to prevent the circuit court from enforcing its order, holding that Belcher, as a health care surrogate, did not have the authority to enter the arbitration agreement because it was not a health care decision and was not required for Wyatt's receipt of nursing home services from McDowell Nursing. View "State ex rel. AMFM, LLC v. Circuit Court (King)" on Justia Law

AdvancePCS is a prescription benefits manager for plans sponsored by employers, unions, and others and is retained to achieve savings by negotiating discounts from drug manufacturers, providing mail order service, contracting with retail pharmacies, and electronic processing and paying of claims. Plaintiffs are retail pharmacies that entered into agreements with AdvancePCS that include an agreed reimbursement rate and an arbitration clause. In 2003, plaintiffs filed suit, asserting that AdvancePCS engaged in an unlawful conspiracy with plan sponsors to restrain competition in violation of the Sherman Act, 15 U.S.C. 1; that AdvancePCS used the economic power of its sponsors to reduce the contractual amount it pays below levels prevailing in a competitive marketplace; and that the agreements impose other limitations. For almost a year, AdvancePCS litigated without mentioning arbitration. After denial of a motion to dismiss and reconsideration, AdvancePCS filed an answer with affirmative defenses, then sought to compel arbitration. The court granted the motion. Plaintiffs did not initiate arbitration, but sought dismiss pending appeal. A different judge vacated the order compelling arbitration. The Third Circuit remanded with directions to reinstate the order compelling arbitration. On remand, a third judge granted dismissal. The Third Circuit ruled in favor of plaintiffs, holding that AdvancePCS waived its right to arbitrate. View "In Re: Pharmacy Benefit Mgrs. Antitrust Litig." on Justia Law