In Killian v. Concert Health Plan, No. 11-1112 (7th Cir. 2013), Susan Killian died of cancer, despite an operation and other treatment. At the time of her diagnosis, Mrs. Killian was an employee of Royal Management Corporation (“Royal Management”) and participated in its group health insurance plan (the “Plan”), which was insured by Concert Health Plan Insurance Company (“Concert”). Mrs. Killian’s husband (“Killian”) submitted medical bills for the costs of the operation and treatments to Concert. However, Concert refused to pay most of the costs, on the grounds that the service provider was not in-network.
Killian brought suit against Concert and Royal Management, seeking-among other things- payment of the treatment costs and relief for breach of fiduciary duty. The district court granted summary judgment for Concert and Royal Management, and Killian appeals.
In analyzing the case, the Seventh Court of Appeals (the “Court”) affirmed the district court’s summary judgment on the issue of the payment of the treatment costs. However, the Court reversed the judgment on the breach of fiduciary duty. It found that certain instructions given in the documents for the Plan were faulty, and certain telephone calls by Killian may have lead to a failure by the defendants to disclose information as to whether the service provider was in -network. The Court remanded the case back to the district court to make a determination on the breach of fiduciary duty claim.