Katskee v. Blue Cross/Blue Shield of Nebraska, 515 N.W. 2d 265 (1984)

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Katskee v. Blue Cross/Blue Shield of Nebraska, 515 N.W. 2d 265 (1984) by Mind Map: Katskee v. Blue Cross/Blue Shield of Nebraska, 515 N.W. 2d 265 (1984)

1. Facts

1.1. Party

1.1.1. Katskee Vs Blue cross blue shield

1.2. What Happened:

1.2.1. Katskee (plaintiff) had surgery to treat her genetic condition called “Ovarian carcinoma syndrome. Her insurer blue cross blue shield did not cover the cost to the surgery claiming that her condition was not an illness and therefore was not covered in her insurance policy. Katskee sue blue cross blue shield for breach of contract.

2. Issue:

2.1. Should a genetic condition constitute an illness for an insurance policy

3. Rule of Law:

3.1. The legal principle and legal precedent the court used is contract law. The Court looked at the intention at the time the contract was signed. The court would not resort to rules of construct if a reasonable person would be able to understand the contract.

4. Analysis/application:

4.1. Defendant:

4.1.1. blue cross blue shield argued that the cost is not covered by the insurance policy. The company believes the policy provides coverage under 812 section for medically necessary. The surgery was for a genetic deviation evident from the family medical history.

4.2. Plaintiff:

4.2.1. Sindie Katskee’s brought a breach of contract case against blue cross blue shield. She argued the definition of what constitute an illness with in the 810 meaning of the health insurance policy. The fact the doctors recommended surgery and blue cross blue shield originally had agreed to cover the procedure is one of the main points of the plaintiff.

4.3. Court:

4.3.1. the case was brought forward in the district court that ruled in favor of the health insurance company blue cross blue shield. The supreme court reviewed the case and constitute that ovarian carcinoma syndrome was an “illness” within the meaning of health insurance policy.

5. Conclusion:

5.1. the court conclude that Katskee’s condition to be an illness within the policy. The court reverse the district court decision on the grounds that blue cross blue shield had not provided sufficient evidence that the origin of the plaintiff disease was due to a genetic makeup.

6. Importance:

6.1. the reason why health care professionals would care about the decision is because it could set a precedent for future case law.

7. Other Case Impact

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