“Carve-back” Provision Does Not Render Policy Ambiguous
UNITEDHEALTH GROUP, INC. v. COLUMBIA CASUALTY COMPANY (D. Minn. Jan. 19, 2010)
UnitedHealth Group, Inc. brought suit against Columbia Casualty Company seeking coverage for some seventeen claims made by third parties against UnitedHealth. After a Special Master was appointed to help manage the litigation and make recommendations, UnitedHealth filed a motion for partial summary judgment with respect to two of the claims at issue. In its motion for partial summary judgment, UnitedHealth sought coverage under its excess policy for the Samuelson claim which arose when a doctor and professional association filed suit claiming that UnitedHealth had illegally changed the reimbursement formula it had used to calculate payments to medical providers. In addition, UnitedHealth sought coverage for the McRand and Murphy claims which alleged that UnitedHealth misrepresented and concealed the standards by which it made coverage determinations.