Gooch v. Life Investors Ins. Co., No. 10-5003 (6th Cir. 2012)
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Plaintiff filed a class-action lawsuit against the insurance company, claiming breach of contract because the company began interpreting the "actual charges" provision of his cancer-insurance policy to mean the charges that the medical provider accepts as full payment from the primary insurer and the insured. Plaintiff claims that the policy entitles him to be paid the higher "list prices" that appear on his hospital bills before the primary insurer negotiates a lower rate. The company made payments to the insured, not directly to hospitals. The district court certified the class and issued a preliminary injunction, requiring the company to pay plaintiff according to his interpretation. Meanwhile, an Arkansas state court certified a nearly identical class, and the Arkansas Supreme Court affirmed a settlement in that action. The Sixth Circuit vacated class certification, based on the intervening Arkansas case. The court dismissed appeal of the injunction for lack of jurisdiction because was not a decision on the merits.
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