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Berry v. Time Insurance Co.

United States District Court for the District of South Dakota
798 F.Supp.2d 1015 (D.S.D. 2011)


Facts

Berry (plaintiff) purchased a nursing home insurance policy from Time Insurance Company (Time) (defendant). The policy is administered by Hancock (defendant). Under the policy, Time was required to pay for Berry’s alternate care if Berry, Berry’s doctor, and Time agreed upon an alternate healthcare plan. In September 2008, Berry had an accident and was thereafter in need of home healthcare assistance in order to remain in her home. Hancock informed Berry that her policy would only pay for alternate care if provided by a licensed home healthcare provider. Berry subsequently learned that her state did not license home healthcare providers. When Berry found an unlicensed home healthcare provider, her doctor contacted Hancock to request coverage. Hancock refused, although Berry’s policy itself did not require that Berry’s home healthcare provider be licensed. Berry brought a breach of contract claim against the defendants. The defendants brought a motion to dismiss Berry’s complaint, arguing that because a condition precedent had not been fulfilled, namely an agreement as to an alternate home healthcare plan, the contract was unenforceable.

Rule of Law

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Issue

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Holding and Reasoning (Schreier, J.)

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  • A “yes” or “no” answer to the question framed in the issue section;
  • A summary of the majority or plurality opinion, using the CREAC method; and
  • The procedural disposition (e.g. reversed and remanded, affirmed, etc.).

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