Tavilla v. Blue Cross

CourtCourt of Appeals of Arizona
DecidedSeptember 11, 2014
Docket1 CA-CV 12-0843
StatusUnpublished

This text of Tavilla v. Blue Cross (Tavilla v. Blue Cross) is published on Counsel Stack Legal Research, covering Court of Appeals of Arizona primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Tavilla v. Blue Cross, (Ark. Ct. App. 2014).

Opinion

NOTICE: NOT FOR PUBLICATION. UNDER ARIZ. R. SUP. CT. 111(c), THIS DECISION DOES NOT CREATE LEGAL PRECEDENT AND MAY NOT BE CITED EXCEPT AS AUTHORIZED.

IN THE ARIZONA COURT OF APPEALS DIVISION ONE

NICOLAI TAVILLA and DONNA TAVILLA, husband and wife; and on behalf of their children, BRITNY NICOLE TAVILLA, KATHERINE MARIE TAVILLA and ALYSSA JOYCE TAVILLA, Plaintiffs/Appellants,

v.

BLUE CROSS AND BLUE SHIELD OF ARIZONA, INC., an Arizona corporation, Defendant/Appellee.

No. 1 CA-CV 12-0843 FILED 09-11-2014

Appeal from the Superior Court in Maricopa County No. CV2009-025256 The Honorable Lisa Daniel Flores, Judge

AFFIRMED

COUNSEL

Treon, Aguirre, Newman & Norris, P.C., Phoenix By Richard T. Treon Counsel for Plaintiffs/Appellants

Jones, Skelton & Hochuli, P.L.C., Phoenix By Donald L. Myles, Jr., Jefferson T. Collins, Lori L. Voepel, and Jennifer B. Anderson Counsel for Defendant/Appellee TAVILLA v. BLUE CROSS Decision of the Court

MEMORANDUM DECISION

Judge Lawrence F. Winthrop delivered the decision of the Court, in which Presiding Judge Patricia A. Orozco and Chief Judge Diane M. Johnsen joined.

W I N T H R O P, Judge:

¶1 Plaintiffs/Appellants, Nicolai and Donna Tavilla, individually and on behalf of their children (collectively, “the Tavillas”), appeal the superior court’s summary judgment in favor of defendant Blue Cross and Blue Shield of Arizona, Inc. (“Blue Cross”) on the Tavillas’ claims for breach of contract and breach of the implied covenant of good faith and fair dealing. For the following reasons, we affirm.

FACTUAL AND PROCEDURAL BACKGROUND1

¶2 The Tavillas entered a contract (“the Contract”) with Blue Cross for health insurance. At all relevant times, the Contract has provided benefits for eligible prescription medications and excluded benefits for dental services, except in limited circumstances.

¶3 Nicolai Tavilla has a history of chronic pain dating to the 1990s. In 2004, Nicolai’s pain management physician, Dr. Christopher P. Barnes, began prescribing Nicolai the medication ACTIQ, a solid form of the pain reliever fentanyl citrate that is placed on a plastic stick for absorption through the mouth. ACTIQ is a Schedule II controlled substance the Food and Drug Administration (“FDA”) has approved “only for the management of breakthrough cancer pain in patients with malignancies who are already receiving and who are tolerant to around-the-clock opioid

1 Blue Cross contends the Tavillas’ statement of facts in their opening brief does not comply with Arizona Rule of Civil Appellate Procedure (“ARCAP”) 13(a)(4), and asks us to disregard those factual assertions. The Tavillas argue the factual section of their opening brief satisfies ARCAP 13(a)(4). We rely on our review of the record for our recitation of the facts. See Sholes v. Fernando, 228 Ariz. 455, 457 n.2, ¶ 2, 268 P.3d 1112, 1114 n.2 (App. 2011); State Farm Mut. Auto. Ins. Co. v. Arrington, 192 Ariz. 255, 257 n.1, 963 P.2d 334, 336 n.1 (App. 1998).

2 TAVILLA v. BLUE CROSS Decision of the Court

therapy for their underlying persistent cancer pain.” Because Nicolai did not have cancer, Dr. Barnes’ prescription of ACTIQ was considered “off- label.”2 Although the Contract only provided coverage for prescription medications approved by the FDA for the diagnosis for which a medication was prescribed, Blue Cross nevertheless paid Nicolai’s pharmacy claims for ACTIQ through November 2008.

¶4 In June 2007, Nicolai’s dentist, Dr. Steven H. Poulos, informed Blue Cross that Nicolai had severe dental breakdown, with acute and chronic infection. Dr. Poulos stated the long-standing nature of the decay was “typical of that seen in individuals [who] use sugar containing lozenges,” and he requested that Blue Cross authorize dental repair or replacement of nearly all of Nicolai’s teeth. Blue Cross determined the dental services were not covered by the Contract and denied the request.3

¶5 The Tavillas filed this action against Blue Cross, alleging Blue Cross breached the Contract and the covenant of good faith and fair dealing implied therein by paying Nicolai’s pharmacy claims for ACTIQ and refusing to pay for Nicolai’s dental services.4 The superior court granted summary judgment for Blue Cross on all claims.

¶6 The Tavillas timely appealed. We have jurisdiction pursuant to Arizona Revised Statutes (“A.R.S.”) section 12-2101(A)(1) (West 2014).5

2 Off-label prescribing is “the prescription of a medication in a manner different from that approved by the FDA,” such as the use of drugs for unapproved clinical indications or in unapproved subpopulations. Randall S. Stafford, Regulating Off-Label Drug Use - Rethinking the Role of the FDA, 358 New Eng. J. Med. 1427, 1427 (2008).

3 Blue Cross later paid for a portion of Nicolai’s dental services that were purportedly related to a February 2007 fall.

4 In separate actions, the Tavillas sued Dr. Barnes and other health providers for alleged malpractice and the manufacturer of ACTIQ (Cephalon, Inc.) for alleged product liability.

5 We cite the current version of all statutes unless revisions material to our decision have occurred since the relevant dates.

3 TAVILLA v. BLUE CROSS Decision of the Court

ANALYSIS

¶7 The Tavillas allege the superior court erred by granting summary judgment for Blue Cross on their claims for breach of contract and breach of the implied covenant of good faith and fair dealing. We disagree.

¶8 We review de novo the entry of summary judgment, viewing the evidence and reasonable inferences therefrom in the light most favorable to the party opposing the motion. Andrews v. Blake, 205 Ariz. 236, 240, ¶ 12, 69 P.3d 7, 11 (2003). Summary judgment is appropriate only when “there is no genuine dispute as to any material fact and the moving party is entitled to judgment as a matter of law.” Ariz. R. Civ. P. 56(a); accord Orme Sch. v. Reeves, 166 Ariz. 301, 309, 802 P.2d 1000, 1008 (1990) (explaining that summary judgment is proper “if the facts produced in support of the claim . . . have so little probative value, given the quantum of evidence required, that reasonable people could not agree with the conclusion advanced by the proponent of the claim”).

¶9 Interpretation of an insurance contract is a question of law, which we review de novo. Messina v. Midway Chevrolet Co., 221 Ariz. 11, 14, ¶ 9, 209 P.3d 147, 150 (App. 2008). A court’s purpose in interpreting a contract is to ascertain and enforce the contracting parties’ intent. Elm Ret. Ctr., LP v. Callaway, 226 Ariz. 287, 290, ¶ 15, 246 P.3d 938, 941 (App. 2010). In our review, we construe provisions in insurance contracts according to their plain and ordinary meaning, Sparks v. Republic Nat’l Life Ins. Co., 132 Ariz. 529, 534, 647 P.2d 1127, 1132 (1982), and examine the language “from the viewpoint of one not trained in law or the insurance business.” Samsel v. Allstate Ins. Co., 204 Ariz. 1, 4, ¶ 8, 59 P.3d 281, 284 (2002). If contract language is clear and unambiguous, it will be given effect as written. Hadley v. Sw. Props., Inc., 116 Ariz. 503, 506, 570 P.2d 190, 193 (1977).

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Tavilla v. Blue Cross, Counsel Stack Legal Research, https://law.counselstack.com/opinion/tavilla-v-blue-cross-arizctapp-2014.