Justia Arbitration & Mediation Opinion Summaries

Plaintiffs-Appellees Wheeling Hospital and Belmont Hospital along with other medical providers, filed this putative class action in West Virginia state court against the Ohio Valley Health Services and Education Corporation, Ohio Valley Medical Center and East Ohio Regional Hospital, (collectively, the "OV Health System Parties"), and Appellant The Health Plan of the Upper Ohio Valley, Inc. The plaintiffs sued in order to collect amounts allegedly owed to them by employee benefit plans established by the OV Health System Parties, for which The Health Plan acted as administrator. After pretrial activity, The Health Plan moved to dismiss the claims brought against it by the hospital plaintiffs pursuant to an arbitration agreement between the parties. The district court denied this motion, holding that The Health Plan had defaulted on its right to arbitrate. The Health Plan appealed. Upon review, the Fourth Circuit concluded that the district court erred in its determination that The Health Plan defaulted on its right to arbitrate. The Court therefore reversed the district court’s denial of The Health Plan’s motion to dismiss. View "Wheeling Hospital, Inc. v. Health Plan of the Upper Ohio Valley, Inc. " on Justia Law

By their 1998 Primary Care Physician Agreement, the parties agreed that Dr. Sutter would provide primary care health services to members of Oxford's managed care network in exchange for predetermined reimbursement. They agreed to arbitrate any disputes. A dispute arose when Sutter accused Oxford of improperly denying, underpaying, and delaying reimbursement of physicians' claims. Sutter filed a complaint on behalf of himself and a class of health care providers, alleging breach of contract and other violations of New Jersey law. The state court granted Oxford’s motion to compel arbitration. The arbitrator determined that the agreement allowed for class arbitration. The arbitrator entered a Partial Final Class Determination Award. Oxford sought to vacate, arguing that the arbitrator disregarded the law by ordering class arbitration. The district court denied Oxford's motion and the Sixth Circuit affirmed. Arbitration proceeded on a classwide basis. Oxford later moved to vacated, based on the 2010 Supreme Court decision, Stolt-Nielsen S.A. v. AnimalFeeds International Corp. The district court denied the motion. The Third Circuit affirmed. The arbitrator endeavored to interpret the parties' agreement within the bounds of the law and his interpretation was not irrational. Nothing more is required under the Federal Arbitration Act. View "Sutter v. Oxford Health Plans, L.L.C." on Justia Law

The parties in this case signed an arbitration agreement providing that arbitration would occur in accordance with the National Arbitration Forum (NAF) Code of Procedure, but the NAF became unavailable to administer its Code and the arbitration. Defendants moved the circuit court to appoint a substitute arbitrator under Section 5 of the Federal Arbitration Act (FAA). The circuit court concluded that a substitute arbitrator could not be appointed under Section 5 because the NAF Code of Procedure was integral to the parties' agreement to arbitrate and the NAF was unavailable to administer its Code. The Supreme Court reversed after considering the language of the arbitration agreement, the language of the NAF Code, and the federal policy expressed in the FAA, holding that Section 5 applied, and that absent some other defense, Section 5 required the appointment of a substitute arbitrator. View "Wright v. GGNSC Holdings LLC " on Justia Law

Petitioner filed suit against respondent, alleging negligence, violation of resident's rights, and breach of fiduciary duty. Respondent moved to compel arbitration. Petitioner raised several issues on appeal. The court held that its decision was controlled in part by Shotts v. OP Winter Haven, Inc., another nursing home arbitration case. Pursuant to the court's reasoning in that case, the court held that the district court erred in the following respects: (i) in ruling that the limitation of liability provisions in this case, which placed a $250,000 cap on noneconomic damages and waived punitive damages, were severable; (ii) in failing to rule that the court, not the arbitrator, must decide whether the arbitration agreement violated public policy; and (iii) in failing to rule that the above limitation of liability provisions violated public policy. The court also held that the United States Supreme Court decision in Rent-A-Center, West. Inc. v. Jackson was inapplicable. View "Gessa, etc. v. Manor Care of Florida, Inc., et al." on Justia Law

Petitioner, as personal representative of her uncle's estate, filed a complaint against respondent alleging negligence and breach of fiduciary duties. Respondent moved to compel arbitration based on an agreement petitioner had signed on her uncle's admission. The court held that the district court erred in failing to rule that the court, not the arbitrator, must decide whether the arbitration agreement violated public policy. The court also held that the district court erred in failing to rule that the limitations of remedies provisions in this case violated public policy, for they undermined specific statutory remedies created by the Legislature. The court further held that the district court erred in ruling that the limitations of remedies provisions that called for imposition of the American Health Lawyer Association rules was severable. The court finally concluded that the United States Supreme Court's recent decision in Rent-A-Center, West, Inc. v. Jackson was inapplicable. View "Shotts, etc. v. OP Winter Haven, Inc., et al." on Justia Law

From 2007 to 2008, Dorothy Rogers received Medicare benefits through Pacificare's federally-approved Medicare Advantage Plan, Secure Horizons. Rogers and Pacificare entered into separate contracts each year providing the terms and conditions of coverage. After receiving treatment from the Endoscopy Center of Southern Nevada (ECSN), a facility approved by Pacificare for use by its Secure Horizons plan members, Rogers tested positive for hepatitis C. Rogers sued Pacificare, alleging that Pacificare should be held responsible for her injuries because it failed to adopt and implement an appropriate quality assurance program. Pacificare moved to dismiss her claims and compel arbitration based on a provision in the parties' 2007 contract. The district court determined that the 2007 contract governed, but held that the arbitration provision was unconscionable and, thus, unenforceable. The Supreme Court reversed, holding (1) because the parties in this case did not expressly rescind the arbitration provision at issue, the provision survived the 2007 contract's expiration and was properly invoked; and (2) as the Medicare Act expressly preempts any state laws or regulations with respect to the Medicare plan at issue in this case, Nevada's unconscionability doctrine was preempted to the extent that it would regulate federally-approved Medicare plans. View "Pacificare of Nevada v. Rogers" on Justia Law

In three cases consolidated for review, the facts were similar. A person was admitted to a nursing home, and a family member signed an admission agreement containing an arbitration clause. After the person died, a family member filed suit against the nursing home, alleging the nursing home negligently caused injuries leading to the person's death. The nursing home sought to dismiss the lawsuit and compel the family member to participate in binding arbitration. The family members asserted the arbitration clauses were unenforceable, alleging (1) the clauses violated the West Virginia Nursing Home Act, and (2) were unconscionable under the common law. After reviewing the relevant laws, the Supreme Court held that (1) the Nursing Home Act, which states any that waiver by a nursing home resident of his right to sue for injuries sustained in a nursing home shall be void as contrary to public policy, is preempted by the Federal Arbitration Act; and (2) in the context of pre-injury nursing home admission agreements, where a personal injury or wrongful death occurred after the signing of the contract, arbitration clauses are unenforceable to compel arbitration of a dispute concerning negligence that results in a personal injury or wrongful death.