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Laws-info.com » Cases » Iowa » Supreme Court » 2006 » MARY EGGIMAN vs. SELF-INSURED SERVICES CO., and R.H. HUMMER, JR., INC.
MARY EGGIMAN vs. SELF-INSURED SERVICES CO., and R.H. HUMMER, JR., INC.
State: Iowa
Court: Supreme Court
Docket No: No. 70 / 05-0246
Case Date: 07/28/2006
Preview:IN THE SUPREME COURT OF IOWA
No. 70 / 05-0246 Filed July 28, 2006 MARY EGGIMAN, Appellant, vs. SELF-INSURED SERVICES CO., and R.H. HUMMER, JR., INC., Appellees. ________________________________________________________________________ On review from the Iowa Court of Appeals.

Appeal from the Iowa District Court for Johnson County, Douglas S. Russell, Judge.

Plaintiff seeks further review from court of appeals decision affirming district court order that granted defendants' summary judgment motion and dismissed plaintiff's claim for benefits under a medical insurance policy. DECISION OF COURT OF APPEALS

VACATED; DISTRICT COURT ORDER REVERSED IN PART AND REMANDED FOR FURTHER PROCEEDINGS.

Wallace L. Taylor, Cedar Rapids, for appellant.

Larry G. Gutz and Brian J. Fagan of Moyer & Bergman, P.L.C., Cedar Rapids, for appellees.

2 STREIT, Justice. A woman suffering from clinical obesity alleges the company processing claims on behalf of her health insurance plan made misrepresentations that led her to obtain treatment not covered by the plan. Mary Eggiman filed the present action against her husband's

employer, R.H. Hummer, Jr., Inc., and Self-Insured Services Company (SISCO), the claims processor for the health insurance plan. Hummer and SISCO filed a motion for summary judgment. This motion argued the denial of benefits was proper because Eggiman failed to obtain preauthorization for the surgery. The motion also argued the

misrepresentation claim against SISCO was improper because SISCO was not a fiduciary under the Employment Retirement Income and Security Act (ERISA). 29 U.S.C.
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