Roose v. Lincoln County Employee Group Health Plan

When Kent Roose was injured in an automobile crash his wife was an employee of Lincoln County, which provided health benefits via a group health plan (the Plan) that was part of Joint Powers Trust (JPT). Employee Benefit Management Services, Inc. (EBMS administered the Plan. The Plan contained an exclusion stating that medical benefits would not be paid when any automobile or third-party liability insurance was available to pay medical costs. EBMS denied Roose’s request for reimbursement for medical expenses he paid out of the liability insurance payment he received from the tortfeasors’ insurer. Roose subsequently brought suit against EBMS and JPT. The Supreme Court held that the exclusion violated Mont. Code Ann. 2- 18-902(4). Appellants subsequently reimbursed Roose the requested amount. In 2014, Roose filed a motion for partial summary judgment and class certification, arguing that Appellants violated section 2-18-902 through systematic practices that amounted to seeking subrogation against the tortfeasor’s liability carrier before Roose was made whole. Roose also sought class certification on behalf of every member of Appellants’ plans subject to Montana law that contained the coverage exclusion. The district court granted Roose’s motion. The Supreme Court affirmed, holding that the district court did not abuse its discretion in certifying the class or in defining the class. View "Roose v. Lincoln County Employee Group Health Plan" on Justia Law