John Grisham's The Rain Maker

John Grisham's The Rain Maker

When Can Insurance Companies Deny Coverage

"This is how the uninsured die in a world full of doctors and state of the art medical equipment." (John Grishams The Rain Maker, 1996) Health insurance issues are prevalent in every day lives. When can an insured be denied health coverage their insurance company? In the movie The Rainmaker this is exactly what's being addressed. A young man is ill with Leukemia has been denied medical coverage by his insurance company for a bone marrow transplant.

Rudy Baylor, a young lawyer who has just passed the bar exam, and now has his first case, and it is going to be life a life altering trail. He is defending the Black Family who is suing Great Benefit Mutual health insurance, which is a Tennessee based health insurance company. The Black Family had purchased a health insurance policy from Great Benefit, and when their son Billy Ray fell ill, medical coverage was denied him for a bone marrow transplant. The insurance company argued that the bone marrow transplant is a new and experimental treatment and would not have any great medical benefit for Billy Ray. Therefore could not cover such an experimental treatment.

The underlying practice of Great Benefit was that they would sell health insurance door to door in poorer neighborhoods and then deny all claims within three days in accordance with the company claims manual. These people would pay there policy in cash every week. Because many of Great Benefit's clients were poor southern people, there claims were denied constantly, as was Billy Ray's who was denied on seven different occasions. The insurance company figured that these poor people, when denied coverage, would just accept the denial and not contact a lawyer.

In the process of the trial Billy Ray died. After a few savvy maneuvers by the prosecution, the case was won in favor of the Blacks. Several key issues were raised in this case, such as jury tampering, wire tapping, and the admissibility of stolen evidence.

The defense illegally tapped the phone lines of the plaintiff. The plaintiff, having found out of the egregious act done by the defense, did not reveal this to the court, but use it to there advantage intentionally relaying false information, pretending to have tampered with the jury. Outwitted by the plaintiff, the defense eliminated the tampered juror.

It was discovered that the evidence that proved that Great Benefits denied all claims with in 3 day had been stolen documents and hence deemed inadmissible. It was then found, as was set precedence by the law firm for which Rudy Bailer worked, that stolen evidence, as stipulated in the court rules of evidence, allow for its admittance only if the lawyer had no part in the theft of said evidence. Also what helped to win the case, as was later discovered by the plaintiff, that the medical committee of Great Benefit believed that bone marrow transplants were considered a standard procedure and should be invested in by the company. The Black Family was awarded 50 Million dollars in punitive damages (John Grisham's The Rain Maker, 1996).

The type of insurance practices seen in the movie The Rain Maker is known as bad faith insurance (Ray Bourhis, 2005). Bad faith is the term used when an insurance company, based on policy or procedure, decides not to make payment on a legitimated claim. A landmark decision was made in the Supreme Court case of Campbell v. State Farm (1984);