Lubeznik v. HealthChicago, Inc. case brief

Lubeznik v. HealthChicago, Inc. case brief summary
644 N.E.2d 777 (1994)

CASE SYNOPSIS

Defendant insurance company challenged the order of the Circuit Court of Cook County (Illinois) granting a permanent injunction requiring the pre-certification of plaintiff cancer patient's treatment.

CASE FACTS
The patient enrolled in a bone marrow program, which contacted the insurance company to arrange pre-certification of insurance benefits as required by her policy. The pre-certification was denied because the treatment was viewed as experimental. The patient sought a mandatory injunction requiring the isurance company to pre-certify her.

DISCUSSION

• The court affirmed the trial court's order granting the injunction. 
• The trial court did not err in determining that the treatment was covered under the policy. 
• The exclusionary language in the contract was not clear and unambiguous. 
• This exclusionary language varied from the Illinois Health Maintenance Organization Act, Ill. Rev. Stat. ch. 111 1/2, para. 1408.5 (1991), that detailed which agencies determined if a treatment was experimental. 
• The bone marrow transplant treatment was neither an experimental therapy nor a transplant. 
• The insurance company's testimony about a third party's statement that the treatment was experimental was properly excluded as hearsay. 
• The patient was eligible for the treatment, had a high chance of recovery with the treatment, and would suffer irreparable harm without the treatment.

CONCLUSION
The court denied the insurance company's motion challenging a trial court order, which granted a permanent injunction requiring the insurance company to pre-certify bone marrow treatment for the patient.


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