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M.A. v. Regence BlueCross

M.A. v. Regence BlueCross, 2020 UT App 177 (Orme, J.)

Contract Law (Insurance)

M.A. sued Regence, alleging among other things that the company had breach the implied covenant of good faith and fair dealing when it denied her pre-authorization request for insurance coverage for a course of treatment. The district court granted summary judgment to Regence. The Utah Court of Appeals affirmed, holding: 

  • An insurer has not breached the duty of good faith if the insurance claim is fairly debatable at the time it is denied. Here, M.A.’s claim was fairly debatable. Regence’s denial was founded on the opinion of four reviewing physicians, and the records submitted by M.A., including Specialist’s “blanket statement” that M.A. met the criteria for coverage (which did not specifically address the bases for Regence’s denial), failed to establish a legitimate factual issue concerning whether the denial was unreasonable.

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