Court Reviews an Insurance Policy to Determine Whether it is Liable for Unpaid Medical Expenses Related to Patient’s Pre-Existing Condition

WELLMONT HEALTH SYSTEM v. JOHN QUINTON QUALLS, ET AL. (Tenn. Ct. App. August 20, 2010)

Plaintiff hospital filed a lawsuit against defendant patient for unpaid medical expenses. Defendant patient filed a third party complaint against defendant insurance company alleging that the insurance company was responsible for the unpaid medical expenses pursuant to a health insurance policy. After a bench trial, the trial court concluded that the insurance contract was ambiguous and construed it against the defendant insurance company. Defendant insurance company appeals.

After reviewing the record and the health insurance policy, we conclude that the policy was not ambiguous and the insurance contract specifically excluded coverage of patient's pre-existing condition. Accordingly, we reverse.

Opinion may be found at:
http://www.tba2.org/tba_files/TCA/2010/wellmont_082010.pdf