Justia Arbitration & Mediation Opinion Summaries

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

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