GEORGE E. MILLER ET AL.
TRH HEALTH INSURANCE COMPANY ET AL.
Session January 15, 2019
from the Chancery Court for Sevier County No. 16-11-368
Telford E. Forgety, Jr., Chancellor
insured sued his health insurance provider, seeking damages
for breach of contract and bad faith refusal to pay valid
insurance claims after coverage was denied for medical
expenses related to the removal of a kidney stone. The
defendants moved for summary judgment based on a benefit
exclusion rider to the insurance contract that excluded
coverage for treatment, surgery, or expenses related to
kidney stones. The trial court rejected the insured's
argument that the exclusion rider did not apply and granted
summary judgment to the defendants. Because the defendants
were entitled to a judgment of dismissal as a matter of law
based on the undisputed facts, we affirm.
R. App. P. 3 Appeal as of Right; Judgment of the Chancery
Douglas E. Taylor, Seymour, Tennessee, for the appellants,
George E. Miller and Donna Miller.
L. Kilday, Greeneville, Tennessee, for the appellees, TRH
Health Insurance Company and BlueCross BlueShield of
Neal McBrayer, J., delivered the opinion of the court, in
which Charles D. Susano, Jr. and Thomas R. Frierson II, JJ.,
NEAL MCBRAYER, JUDGE
October 2012, George Miller developed a fever with severe
abdominal pain. His primary care physician, Dr. Steven
Johnson, initially treated him with IV fluids for
dehydration. Tests later revealed Mr. Miller was suffering
from both a staph infection and a 2.5 centimeter kidney
stone. So Dr. Johnson referred Mr. Miller to Dr. Paul
Hatcher, a urologist, for treatment.
Hatcher diagnosed Mr. Miller with a recurrent right renal
stone. He recommended lithotripsy to remove the kidney stone
and blood work. Before the kidney stone was removed, Dr.
Hatcher prescribed antibiotics and ordered the insertion of a
drainage tube. Dr. Hatcher then removed the kidney stone
using percutaneous ultrasonic lithotripsy. Mr. Miller
tolerated the procedure well and was released from Dr.
Hatcher's care by the beginning of November.
Miller had health insurance through the Tennessee Rural
Health Improvement Association ("TRH"). The health
insurance contract included a benefit exclusion rider
specific to Mr. Miller. Based on his previous history, the
rider excluded coverage for "any treatment, surgery or
expenses relating to kidney stone, gravel or colic of the
urinary system" for seven years.
Mr. Miller's treatment, his health care providers
submitted claims for payment of medical expenses. Citing the
benefit exclusion rider, TRH refused to pay any claims for
medical expenses associated with treatment ...