What Do You Mean It's Not Covered: You Have to Have Access to the Master Policy

Ohio law likewise mandated that group employers permit individuals covered by a group policy to examine the group policy as follows: Each such policy together with any application in connection therewith shall be available for inspection during regular business hours at the office of the policyholder where such policy is on file, by any beneficiary thereunder or by an authorized representative of such beneficiary. The duties of entities which are not insurers or group employers, such as Enterprise acting as a medical insurance administrator, weren't specifically delineated by Ohio law. And Svec presented "absolutely no evidence that Enterprise as agent for the insurer had a duty and failed in its duty to deliver a certificate of insurance coverage," the appeals court wrote. "Svec's lack of notice concerning the policy exclusions does not preclude enforcement of the policy exclusions which resulted from her own failure to obtain relevant information." Her failure to produce any evidence that Enterprise had a duty to deliver an individual certificate of insurance or other explanatory material to her precluded recovery on her claims for breach of a fiduciary duty and intentional infliction of emotional distress. "Since coverage was properly denied under the medical insurance contract in the case, Svec's claim for intentional infliction of emotional distress was properly rejected as a matter of law," the appeals court concluded. regular or customary charge: The prevailing charge which would be made for the same type of or comparable care by most providers in the area in which the care is provided.