A successful produce merchant in Los Angeles was able to pay for a liver transplant himself. That enabled him to have the life-saving surgery when his insurer–after initially approving coverage for the surgery–rejected his doctor’s recommendation to seek a transplant out-of-state, where the wait time was expected to be much shorter.

liver.jpgSo when he sued Anthem Blue Cross, it wasn’t about the money. He claims he pursued the lawsuit to protect the rights of others who can’t afford to do what he did. And he was successful, awarded not only reimbursement for the surgery–which he pledges to donate to liver research–but his legal fees by a Los Angeles jury two weeks ago. Now he plans to take the case a step further. He hopes to win a court order requiring the insurer to pay for California policyholders’ liver transplants nationwide, not just in-state.
In addition to determining that the insurer breached its medical insurance contract, the jury also found that it acted in bad faith, thus providing a basis for the attorney fee award. It could dwarf the cost of the transplant, which was a little over $200,000.
“While we disagree with the jury’s coverage determination, we are pleased that the jury did not award punitive damages and unanimously concluded that Anthem Blue Cross did not act with any malice toward Mr. Nehme,” says Anthem Blue Cross in a written statement, noting that the company’s insurance contract says liver transplants must be performed at in-state facilities.

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