Tuesday, November 12, 2013

Katskee v. Blue Cross/Blue Shield of Nebraska case brief

Katskee v. Blue Cross/Blue Shield of Nebraska case brief summary
515 N.W.2d 645 (1994)

Appellant sought review from a decision of the District Court for Douglas County (Nebraska), which granted summary judgment in favor of appellee health insurer in an action brought by appellant for breach of contract following appellee's refusal to cover the cost of appellant's surgery.


The court held that appellant suffered from a bodily disorder or disease and thus suffered from an illness as defined by insurance policy issued by appellee health insurer. Moreover, the court held that appellant's condition constituted illness within the meaning of the policy. Appellant was diagnosed with a genetic condition called breast-ovarian carcinoma syndrome, and two physicians recommended that appellant undergo surgery. In preparation for surgery, appellant filed a claim with appellee, her health insurer. Appellee notified appellant that it would not cover the cost of surgery, and appellant filed an action for breach of contract. Appellee argued that appellant did not suffer from an illness because she did not have cancer. 


  • The instant court held that appellee had not proffered any evidence disputing the premise that the origin of appellant's condition was in the genetic makeup of the individual, and that in its natural development it was likely to produce devastating results. 
  • In light of the plain and ordinary meaning of the terms "illness," "bodily disorder," and "disease," the court found that appellant's condition constituted an illness within the meaning of the policy.

The court reversed and remanded the decision of the lower court awarding summary judgment to appellee health insurer, on the ground that appellant's genetic condition constituted an "illness" within the meaning of the insurance policy issued by appellee.

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