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Liberty Nat'l Life Ins. Co. v. Radiotherapy of Ga. PC

Plaintiff failed to show that it reasonably relied on defendants' alleged misrepresentations regarding the reasonable and customary charges for certain cancer treatments.

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Seeking injunctive and declaratory relief and damages for misrepresentation, Liberty National Life Insurance Company “Liberty National” sued Radiotherapy of Georgia, P.C. “Radiotherapy” and Atlanta Oncology Associates, P.C. d/b/a Cancer Center of Gwinnett, Middle Georgia Radiation Oncology, L.L.C., Hematology & Oncology of N.E. Georgia, P.C., and the Cherokee Cancer Center, P.C. collectively “Atlanta Oncology”. Liberty National’s complaint centered on allegations that these medical providers had improperly billed Liberty National’s policyholders. After the trial court awarded summary judgment to Radiotherapy and Atlanta Oncology, Liberty National then filed this appeal, primarily arguing that the trial court failed to consider whether the billed charges of these medical providers were negligently represented as being reasonable. After review, we find no error and affirm.

Liberty National issues cancer policies which provide insurance benefits for certain expenses incurred for cancer treatment. These policies do not require the coordination of benefits with Medicare or with other insurers. Under the terms of these cancer policies, Liberty National makes direct payments to its insureds unless those benefits have been assigned to a medical provider. Typically, Liberty National pays the insurance benefits based upon the amount billed by the provider, subject to that amount being reasonable and customary. The Liberty National policy at issue provides in pertinent part:

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