John C. McConnell, M.D. v. Coventry Health Care National Network and First Health Group Corp. and Liberty Mutual Insurance Company

CourtCourt of Appeals of Texas
DecidedJuly 30, 2015
Docket05-13-01365-CV
StatusPublished

This text of John C. McConnell, M.D. v. Coventry Health Care National Network and First Health Group Corp. and Liberty Mutual Insurance Company (John C. McConnell, M.D. v. Coventry Health Care National Network and First Health Group Corp. and Liberty Mutual Insurance Company) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
John C. McConnell, M.D. v. Coventry Health Care National Network and First Health Group Corp. and Liberty Mutual Insurance Company, (Tex. Ct. App. 2015).

Opinion

Affirmed and Opinion Filed July 30, 2015.

In The Court of Appeals Fifth District of Texas at Dallas No. 05-13-01365-CV

JOHN C. MCCONNELL, M.D., Appellant V. COVENTRY HEALTH CARE NATIONAL NETWORK, FIRST HEALTH GROUP CORP., AND LIBERTY MUTUAL INSURANCE COMPANY, Appellees

On Appeal from the 298th Judicial District Court Dallas County, Texas Trial Court Cause No. 11-09509

MEMORANDUM OPINION Before Justices Bridges, Myers, and Stoddart Opinion by Justice Stoddart

John C. McConnell, M.D., appeals the trial court’s final summary judgment rejecting his

causes of action against Coventry Health Care National Network, First Health Group Corp., and

Liberty Mutual Insurance Company. In general, McConnell alleged he was wrongfully

terminated as a workers’ compensation network provider by Coventry,1 Coventry tortiously

interfered with McConnell’s business relationships with referring doctors, and Liberty tortiously

interfered with McConnell’s contract with Coventry. The trial court denied McConnell’s motion

for continuance of the Coventry summary judgment hearing and granted Coventry’s and

Liberty’s motions for summary judgment.

1 Coventry and First Health are related entities and we will refer to them collectively as Coventry unless it is necessary to distinguish between the parties. In two broad issues, McConnell argues the trial court erred by granting Coventry’s and

Liberty’s motions for summary judgment. He also complains that the trial court erred by

denying his motion for continuance of the hearing on Coventry’s motion. We affirm the trial

court’s judgment.

BACKGROUND

McConnell, an orthopedic surgeon, entered into a contract with Coventry to become a

provider in Coventry’s workers’ compensation health care network.2 McConnell agreed to

provide health care services to patients covered by insurance carriers, such as Liberty, who

contracted with Coventry. The Coventry contract with McConnell contains provisions relating

to termination, notice, rights to cure, and appeals of adverse decisions to a review board. Liberty

contracted with Coventry for Coventry to provide a list of providers to see patients covered by

Liberty’s workers’ compensation policies. McConnell was one of those providers.

This dispute arises out of comments made by McConnell in his medical records for three

patients covered by Liberty. These comments were critical of Liberty and accused it of delaying,

disputing, and denying valid claims. In one case, McConnell recommended surgery for a patient,

but Liberty initially denied the claim. McConnell stated in the medical record that he would

stand by his opinion that the patient was harmed by the delay in surgery and by Liberty’s

standard business practice of “delay/dispute/denied care.” In a second case, Liberty denied the

treatment recommended by McConnell and authorized non-surgical treatment after a review of

the patient by another doctor. McConnell noted in the medical records his belief that Liberty

was acting in bad faith by denying medically necessary surgery. McConnell wrote that the

patient’s “outcome will likely be worsened because of the carrier’s use of standard business

practice of dispute/deny/delay care, often supported by opinions of a network of physicians from

2 See TEX. INS. CODE ANN. § 1305.004(a)(16) (West Supp. 2014) (“Network” means an organization formed as a health care provider network to provide health care services to injured workers that is certified as required by the insurance code and operates under a contract with an insurance carrier).

–2– whom carriers can obtain whatever opinions they want.” In the third case, McConnell’s

recommendation of a joint stimulation device was rejected by Liberty. McConnell wrote in the

record that he informed the patient that “inappropriate (‘bad faith’) denials on the part of work

comp carriers in Texas are unfortunately endemic. Insurance carriers in Texas freely engage in a

standard ‘3-D’ (delay/denial/dispute of care) business strategy.”

Liberty’s contract with Coventry allowed Liberty to notify Coventry of any “clinical,

quality of care, customer service, billing issues or other provider related issues with a Provider.”

Liberty notified Coventry about McConnell’s comments in the patient medical records after each

of the three cases described above. Coventry contacted McConnell about each case as described

below.

In April 2009, Coventry notified McConnell by letter that Liberty was concerned about

his unprofessional comments in the patient’s medical record. Coventry advised McConnell that

the medical record “is intended to record the objective findings and the results of treatment. The

use of medical records to cast aspersions on the motives of the insurance carrier is not

acceptable.” In August 2009, after the second case, Coventry again notified McConnell of

Liberty’s complaint and warned, “Should you continue to narrate in your medical records your

feelings that the insurance company withholds and delays treatment, your participation in the

First Health network will be subject to non-renewal.” In October 2009, following the third case,

Coventry notified McConnell of Liberty’s complaint that “despite a Designated Doctor Exam

which contradicted your diagnosis and treatment recommendations, you proceeded with surgery

that was also not supported by her MRI results.” Coventry warned McConnell that as a member

of the network, he had agreed to cooperate with the carrier’s medical review program.

Coventry notified McConnell on December 30, 2010 of its intent to terminate

McConnell’s contract effective April 1, 2011 for material breach. Coventry found that

McConnell failed to correct the concerns regarding negative comments about Liberty in his

–3– medical records identified in Coventry’s letters following the first two cases, and that McConnell

made similar remarks in another patient’s records. Coventry gave McConnell the option to file a

corrective action plan to cure the breach within 60 days or to file an appeal before the network’s

advisory review panel within 30 days. McConnell chose to appeal the termination decision. The

review panel upheld the decision to remove McConnell as a network provider effective April 1,

2011.

McConnell filed this lawsuit on August 1, 2011. He sued for Coventry for breach of

contract and tortious interference with his business relationships, sued Liberty for tortious

interference with his contract with Coventry, and sued them both for conspiracy.

On May 9, 2012, Coventry filed a combined traditional and no-evidence motion for

summary judgment on the breach of contract and tortious interference with business relations

claims raised in McConnell’s first amended petition. McConnell responded by filing a second

amended petition, a motion for continuance of the summary judgment hearing, and a response to

the motion for summary judgment. McConnell’s second amended petition dropped the breach of

contract claim against Coventry. McConnell sought a continuance of the hearing to allow

additional discovery and served notices for several depositions with the motion for continuance.

In his response to the motion for summary judgment, McConnell stated that he “amended his

pleadings better to conform to the facts, the allegations, and the law [and] dropped his claims for

breach of contract. . . .” McConnell asserted, “Coventry argues that it acted within its rights to

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John C. McConnell, M.D. v. Coventry Health Care National Network and First Health Group Corp. and Liberty Mutual Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/john-c-mcconnell-md-v-coventry-health-care-national-network-and-first-texapp-2015.