Potvin v. Metropolitan Life Insurance Company case
brief summary
997 P.2d 1153 (2000)
CASE FACTS
After removal from respondent insurance company's preferred provider lists, appellant physician sued respondent. Citing the common law right to fair procedure, appellant alleged he should have been given reasonable notice and an opportunity to be heard before his removal. Trial court granted respondent's motion for summary judgment, but appellate court reversed, disagreeing with trial court that appellant's complaint failed to allege a claim for violation of the common law right to fair procedure.
DISCUSSION
CONCLUSION
Judgment affirmed; "without cause" termination clause in agreement between respondent and appellant for appellant's inclusion on respondent's preferred provider lists was unenforceable to the extent it purported to limit an otherwise existing right to fair procedure under the common law.
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997 P.2d 1153 (2000)
CASE SYNOPSIS
In action brought by
appellant physician against respondent insurer after appellant was
removed from respondent's preferred provider lists, respondent
petitioned for review of judgment of the Court of Appeal, Second
Appellate District, Division One (California), which reversed trial
court's decision that appellant's complaint failed to allege claim
for violation of the common law right to fair procedure.CASE FACTS
After removal from respondent insurance company's preferred provider lists, appellant physician sued respondent. Citing the common law right to fair procedure, appellant alleged he should have been given reasonable notice and an opportunity to be heard before his removal. Trial court granted respondent's motion for summary judgment, but appellate court reversed, disagreeing with trial court that appellant's complaint failed to allege a claim for violation of the common law right to fair procedure.
DISCUSSION
- The supreme court affirmed appellate court's decision, concluding that appellant alleged that among the adverse effects of removal from respondent's preferred provider lists were rejection by physician groups which were dependent upon credentialing by respondent and devastation of appellant's practice.
- Proof of appellant's allegations could establish that, in terminating a physician's preferred provider status, respondent wielded power so substantial as to significantly impair an ordinary, competent physician's ability to practice medicine or a medical specialty in a particular geographic area, thereby affecting an important, substantial economic interest.
CONCLUSION
Judgment affirmed; "without cause" termination clause in agreement between respondent and appellant for appellant's inclusion on respondent's preferred provider lists was unenforceable to the extent it purported to limit an otherwise existing right to fair procedure under the common law.
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