Tuesday, May 15, 2012

Motion to Amend to Add Counterclaim Denied in Lackawanna County Insurance Case

In his recent May 2, 2012 decision in the case of  Rader v. Hospital Service Assoc. of NEPA (Blue Cross), No. 10 CV 3423 (C.P. Lacka. May 2, 2012 Nealon, J.), Judge Terrence R. Nealon of the Lackawanna County Court of Common Pleas addressed the right of a defendant to amend its Answer and New Matter to state a Counterclaim in an insurance contract dispute.

By way of background, the Plaintiffs originally filed suit against the carriers for only paying a portion of the medical expenses charged by medical providers who were out-of-network.  The Plaintiffs asserted that the defendants breached the contract for not paying the full amounts and for allegedly leading the Plaintiffs to believe that the entire amounts would be paid.

After filing its Answer and New Matter, the defendants came to court seeking to amend the Answer and New Matter to assert a Counterclaim asserting that it was the Plaintiff who breached the contract for failing to pay the excess medical expenses over and above the insurance coverage as required by the policy provisions.

The Plaintiffs opposed the motion arguing, in part, that the defendants lacked standing to make such a claim given that the defendants were not the entity being harmed by the Plaintiff's non-payment. 

After reviewing the law of amendments of pleadings, the Court ruled that the requested amendment should not be allowed.  Simply put, the Court noted that, if the defendant's payment was appropriate under the policy terms, the carrier had no right of recovery against the Plaintiff to support the defendant's breach of contract claim.  Conversely, if it was determined that the defendants were required to pay more under the facts of this case, then it would be the defendants who would be required to make additional payments, not the Plaintiff.

Believing that the proposed Counterclaim did not state a valid  breach of contract claim against the Plaintiff, the court denied the Motion to Amend.

Anyone desiring a copy of this decision in the case of Rader v. Hospital Service, may contact me at dancummins@comcast.net.

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