Shaffer v. WINhealth Partners

Kelly Shaffer received breast reduction surgery for medical purposes, after which she was hospitalized for a methicillin-resistant stophylococcus aureaus (MRSA) infection. Shaffer's insurer, WINhealth Partners (WIN), refused to pay for the treatment Shaffer received for her MRSA infection on the basis that it arose from treatment to improve appearance. Shaffer subsequently sued WIN, alleging breach of contract and bad faith contract. The trial court granted summary judgment in favor of WIN, concluding that the insurance contract language clearly and unambiguously excluded coverage for Shaffer's breast reduction surgery as well as treatment of complications arising from non-covered services. The Supreme Court reversed, holding that the district court erred in granting summary judgment to WIN because, based on the evidence in the record, the language of the insurance contract unambiguously provided coverage to Shaffer's non-cosmetic breast reduction surgery. Remanded with directions for the district court to enter summary judgment in favor of Shaffer on her claims for treatment of her MRSA infection.