Legal Roundup: Lack of Insurance for Accidental Amputation Lands in Court, Hospital Sued Over M&As and More

A look at recent court decisions and how their rulings have an impact on risk management and the insurance industry.
By: | September 17, 2019

Stunt Double Loses Arm, Sues Movie Producers

The Case: Olivia Jackson, a stunt double on the feature film Resident Evil: The Last Chapter has sued producers of the film after a stunt gone wrong left her with various medical problems. Jackson suffered an amputated arm and other injuries during an on-set motorcycle crash.

Advertisement




She claims the motorcycle stunt was a last-minute and highly complex replacement for a fight scene she’d been preparing for that day.

ABC News reports: “Jackson, also a former model, claims the producers ‘abandoned’ her and took out an insurance policy that only covered $33,000 of her medical expenses. After the accident, she said she was paid $990 in lost earnings despite the film’s blockbuster success and gross of more than $300 million.”

ABC News goes on to say: “She accused the producers of misleading her into believing that the insurance company would pay for her injuries, but she later learned there was no liability coverage for her claim.”

Scorecard: The case was filed in early September, we’ll see how it plays out.

Takeaway: Dangerous jobs require proper insurance coverages.

Report: Purdue Pharma Nearing $3B Deal to Settle Opioid Cases

The Case: Purdue Pharma is facing at least 2,300 lawsuits from a wide range of plaintiffs including 44 states for its alleged role in the opioid crisis.

The company manufactures oxycontin, a drug many say helped to fuel the epidemic.

Scorecard: Purdue Pharma and its owners, the Sackler family, have tentatively agreed to a $3 billion deal to settle almost all of the lawsuits.

The New York Times explains: “The deal is a landmark moment in the long-running effort to compel Purdue, the company whose signature opioid, OxyContin, is seen as an early driver of the epidemic, and its owners, the Sacklers, to face a reckoning for the deaths of hundreds of thousands of people from overdoses and the calamitous systemic costs.”

The New York Times goes on to report that Purdue would file for Chapter 11 bankruptcy, dissolve the company and sell OxyContin under a new name — with the profits going to plaintiffs.

“Purdue Pharma also would donate drugs for addiction treatment and overdose reversal, several of which are in development,” the newspaper reported. But it appears far from a done deal.

At least 20 attorneys general told NBC News they oppose the deal.

Takeaway: If accepted, the deal would effectively end most of the litigation against Purdue Pharma and bring resolution to one of the largest opioid cases in the country. If not, the fight could drag on far longer.

Does Veterans Affairs Have to Cover Emergency Room Visits at Non-Department Facilities?

The Case: If a veteran gets emergency medical care outside the Veterans Affairs health system, is the VA on the hook to reimburse the cost?

That was the issue facing a three-judge panel on the U.S. Court of Appeals for Veterans Claims. The case centered around the VA’s current reimbursement regulation.

“In August, the VA Inspector General found $716 million in improperly processed payments in cases involving veterans who sought medical care outside the department’s health system in 2017, including about $53 million that should have been refunded under existing rules,” according to the Military Times.

Scorecard: At a September 10 hearing, the judges ordered the VA to cover all expenses incurred from emergency services at non-department health systems.

That “could mean payouts of tens of thousands of dollars to patients facing financial distress because of their hospital bills,” the Military Times reported.

Takeaway: Advocates see the decision as a big win for veterans.

“The legal defeat is the second time in the last three years that the court has struck down VA’s emergency medical services payment policies, both times chastising the department for only partially covering veterans’ expenses,” according to the Military Times.

Plaintiffs Seek $900 Million Over Medical Prices From California Hospital Giant

The Case: A group of self-funded employers and union trusts have sued California’s Sutter Health for allegedly overcharging patients after driving out competition through mergers and acquisitions.

The plaintiffs are seeking $900 million, an award that can be tripled to $2.7 billion in accordance with California law.

Advertisement




California Healthline reports: “The hospital giant, with $13 billion in operating revenue in 2018, stands accused of violating California’s antitrust laws by leveraging its market power to drive out competition and overcharge patients. Health care costs in Northern California, where Sutter is dominant, are 20% to 30% higher than in Southern California, even after adjusting for cost of living.”

California Healthline reports that Sutter Health has “24 hospitals, 34 surgery centers and 5,000 physicians across the region.”

Scorecard: On September 23, the case will begin in San Francisco Superior Court.

Takeaway: The potential implications of the case are huge.

It could dramatically drop healthcare prices in Northern California and set a scary precedent for healthcare systems around the country that could be accused of driving up prices with similar tactics. &

Jared Shelly is a journalist based in Philadelphia. He can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

Risk Matrix: Presented by Liberty Mutual Insurance

11 Crucial Trends That Are Impacting the Construction Industry Today

Increased hurricanes, opioids, women workers and more are just some of the latest trends driving construction risk.
By: | November 1, 2019




The R&I Editorial Team can be reached at [email protected]