Attorneys Joseph K. Meusey and Mark C. Laughlin successfully argued an appeal before the Supreme Court of Nebraska on behalf of the firm's client, State Farm Mutual Automobile Insurance Company ("State Farm").
Suit was brought against State Farm in Douglas County District Court by Mary Lyn Lynch and Thomas Lynch. The plaintiffs sought class certification on behalf of similarly-situated policyholders for six causes of action. Mary Lynch was involved in an automobile accident on August 18, 1995. She submitted a claim to State Farm under the medical payments coverage for treatment she allegedly received as a result of the accident. State Farm denied a portion of Mary Lynch's claim citing the provisions of the policy which gives State Farm "the right to make or obtain a utilization review of the medical expenses and services to determine if they are reasonable and necessary for the bodily injury sustained." The Lynches filed suit on March 1, 1999. Their first cause of action was for breach of contract. The Lynches claimed that State Farm engaged in a scheme in which it sold them and other members of the class traditional indemnity coverage, but delivered a program of managed care coverage which was of lesser value. Among the various prayers for relief, the Lynches sought a partial refund of the premiums paid for medical payments coverage by the members of the class.
On August 26, 2002, the district court granted the Lynches leave to file a ninth amended petition which added John McGinn as an additional plaintiff and class representative. Purportedly, McGinn represented policyholders who had purchased medical payments coverage from State Farm but had never filed a claim under that coverage and, thus, had not had a claim denied. State Farm demurred, asserting that the allegations of the petition failed to state facts sufficient to constitute a cause of action. The district court sustained the demurrer, dismissed McGinn's claims, and struck McGinn as a plaintiff.
McGinn appealed to the Supreme Court of Nebraska. After briefing and oral argument, the Supreme Court affirmed the district court's decision. In its analysis, the Supreme Court noted that an insurance policy is a contract and that in assessing claims for damages in insurance contract actions, it is necessary to assert a breach. The Supreme Court ruled that since McGinn admitted that he had not filed a claim under his medical payments coverage and that he had not had a claim denied, he cannot assert that State Farm billed him for traditional indemnity medical payments coverage but delivered managed care coverage. The court found that it cannot be said that State Farm breached the contract of insurance or failed to do the things it agreed to do.