Logan v. Empire Blue Cross and Blue Shield

Logan v. Empire Blue Cross and Blue Shield,
No. 1999-04253, 1999-04254 (N.Y. App. Div. October 10, 2000)

Empire Blue Cross and Blue
Shield had established a preauthorization process and set forth specific standards
to confirm the diagnosis of Lyme’s Disease. This policy also included treatment
protocols. The policy was then updated from time to time in response to the
latest research on the disease. Empire’s policy determined that there was no
medical/scientific basis for a course of antibiotic therapy for Lyme’s Disease
in excess of 30 days, except under certain specified circumstances. The plaintiffs
in this case had submitted medical bills to Empire during the course of treatment
for Lyme’s Disease. At one point or another, Empire paid those claims. However,
eventually, Empire, citing its policy on Lyme’s Disease, refused to provide
further coverage for the plaintiffs’ intravenous antibiotic treatment. The plaintiffs
then sued Empire, claiming that Empire’s denials were a breach of contract and
a bad faith denial of coverage. The plaintiffs also alleged that Empire’s denial
of coverage constituted a tort claim that was independent of its alleged breach
of contract. The New York Supreme Court, Appellate Division refused to permit
the plaintiffs to transform a breach of contract claim against Empire into an
independent tort claim. The Court then dismissed any claim not directly related
to the plaintiffs’ breach of contract claim.