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ARTICLE ID 190166

$________ Insurance Malpractice – Doctor sues after being denied entrance into network – Violation of fair procedure.

Los Angeles Superior Court

In this matter, the largest for-profit health insurer in California denied inclusion of a medical doctor. The doctor accused the insurer of denying him inclusion for his views on patient rights.

The plaintiff, Dr. N., is the medical director of Porter Ranch Quality Care in California, which serves patients in the San Fernando Valley. In March ________, Anthem Blue Cross denied Dr. N’s application to join its Provider Network contending that it had "no need" for another General Practitioner in its Network.

The plaintiff filed suit in the Los Angeles Superior Court, accusing the defendant Anthem Blue Cross of violating his right to Fair Procedure. The plaintiff further asserted that the defendant excluded him from its Provider Network because he was an advocate for his patients. The defendant denied these allegations. At trial, plaintiff accused Anthem Blue Cross of putting profits before patients by unlawfully excluding qualified doctors from its Provider Network. Because of a shortage of primary care doctors, the plaintiff asserted that Anthem Blue Cross was not acting in the best interests of its members, as the exclusion of primary care doctors restricts access to healthcare.After 15 days of trial, the jury deliberated for two days before returning a finding for the plaintiff, awarding Dr. N. nearly $4.5 million in damages for lost salary and profits from his practice, but found him 15% percent responsible for his losses, resulting in a net award of $3.8 million. The jury also found that Anthem Blue Cross acted with malice, oppression and fraud. The case was settled for a confidential amount before the punitive damages phase commenced.

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