Plaintiff v. Insurance Company

Summary Judgment
May 2017

Sedgwick obtained summary judgment in a New Jersey case involving a healthcare coverage insurance dispute between a New Jersey automobile insurance provider and healthcare insurer related to the primary responsibility for medical coverage related to treatment for catastrophic injuries sustained by a minor child in a single vehicle accident where multiple policies were implicated. Medical bills exceeded $450K and the automobile insurer sought reimbursement for $250K it paid per terms of its policy. The court held that absent statutory or regulatory obligation to reimburse the automobile insurance provider, the healthcare insurance provider was entitled to rely on the terms of its insurance plan, which required the automobile insurance provider to provide benefits first. Therefore the automobile insurer was not entitled to reimbursement — and the suit was dismissed with prejudice.