In Skelcy v. United Health Group, Inc., the insured had sought to continue medication and a program of therapy which his doctors had successfully used and continued to recommend. The insurer had agreed to the original use, but denied the later claim to use the drug at issue. There was an appeal, and the insurer assigned the appeal to a provider of peer review assessments, which assigned it to a doctor. That doctor concluded that the treatment requested was not the standard of care. The insurer declined to approve the treatment based on this analysis. The treating physicians pleaded with the insurer in light of the insured’s dire condition, and repeated that the treatment had previously been successful. The insurer changed its position a little over a month later, but the insured died within 36 hours of the reversal.
The appellate court affirmed the trial court’s holding that the peer review entity and the physician carrying out the peer review did not owe a duty to the deceased. In so holding, the Court stated in a footnote: “Our holding is strictly limited to the claims contained in [the] complaint. We do not opine whether entities and physicians could be liable as aiders and abettors in a scheme designed to deny insurance claims in bad faith.”
Date of Decision: September 22, 2015
Skelcy v. UnitedHealth Group, Inc., No. 15-1012, 2015 U.S. App. LEXIS 16772 (3d Cir., September 18, 2015) (Chagares, Fisher and Jordan, JJ.)