BERRY V. TIME INSURANCE CO.
798 F.Supp.2d 1015 (2011)
NATURE OF THE CASE: Time's (D) motion to dismiss Berry's (P) breach of contract claim was
denied because P pleaded that D intentionally engaged in actions to prevent the condition
precedent from being fulfilled.
FACTS: P purchased a Nursing Home Insurance Policy (the policy) from D. P fell in
September of 2008. P has required home healthcare assistance to remain in her home. D
informed her that, with no exceptions, alternate care could only be covered by the policy if
it were provided by a licensed home healthcare provider. After this discussion, P discovered
South Dakota does not license home healthcare providers. P believed D would not provide
alternate care coverage and obtained independently funded home healthcare, services, and
equipment so she could remain in her home. Eighteen months later, P's son, Dr. Spencer
Berry, M.D., contacted D and, for the first time, P was informed of a list of steps that
were required before she could receive alternative care benefits. Dr. Berry called D to
request coverage of P's treatment plan, which had been in effect prior to the evaluation,
and he provided D with information on P's healthcare providers. D refused to cover this care
because the home healthcare provider did not meet minimum licensing criteria. The policy
does not state that a home health provider must be licensed or certified. D offered to pay
for some equipment and approved some home healthcare expenses. P rejected this offer because
she desires full coverage of the expenses associated with her chosen home healthcare
provider. The policy states that alternative care plans are to be negotiated between the
parties, but the parties were unable to reach a final agreement. P sued for breach of
contract.
ISSUE:
RULE OF LAW:
HOLDING AND DECISION:
LEGAL ANALYSIS:
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