please the court house all my needs and united healthcare and i had a contract in march of two thousand and four we entered into a written contract according to which united was to provide health insurance coverage for my family in exchange for which i was to pay premiums i performed it's undisputed that i paid my premiums beginning in march two thousand and four and continuing through to june first two thousand and eight when i secured coverage with another carrier united health care did not perform on october first two thousand and seven united health care unilaterally without cause and without notice terminated my family's health insurance coverage not only did they decline coverage going forward they actually went backwards and demanded and received received refunds of money paid out on claims in two thousand and six and two thousand and seven united healthcare it meant they did not notify me that terminations was imminent indeed they did not notify me at all i learned we've been terminated five months after  covered the problem here was that united healthcare was denying benefits for certain services under the terms of an otherwise inforce policy the problem is the united honor but also a little more simple we provided benefits for employees and as the record reflects in my first year with the firm i actually was an employee of the firm and as an employee i was entitled to benefits including paid health insurance understood premiums from the shareholders which included our premiums by the way and of course as a shareholder i paid my proportionate share about the employee benefit as you said you were the policy i am the policy holder that's what  i'm trying to do all right and they were on their own what were here are those stats limitations question i have in this a probably more for the insurance company but i'm going to ask you did the you have a three year statute of limitations which probably under i was a reasonable limitation but when i read the policy in the second paragraph here about any that the company ever issued a final decision but i also don't see that you raised that issue well and the issue is is well statute has not even of begun to run begin to whatever  at united healthcare invoked federal question trailblazer and under iowa law ok when a risk is adopted i walk i will all you get the same type of situation you can you're come by contract you can limit the statute of limitations if it's reasonable and probably it's reasonable under or so the question is when the did start when did this when did it hasn't started running up your i think actually it has not started running and here's why i don't believe that strachey limitations applies to my claims at all because that policy by it's own terms that their contractual limitation period applies and to contact some pay number one where suit follows united health care is refusal to provide benefits for services obtained from out of network providers that was never an issue here or number two where united health care has denied benefits under the terms of a policy exclusion again not a pluggable here those are not my  so i don't believe whether the contraction limitations period is reasonable or unreasonable i just think has no bearing at all in my case in my case is about their unilateral determination of coverage in its entirety not the denial of benefits for certain services not covered under an otherwise enforced policy missteps and before we can measure of the statute of limitations we have to know do we whether you have a performance trauma nation liability remedies those are all matters of state law i'm not trying to recover or restore the benefits but to remedy the damage that was done to me and my family but i united health care is unilateral breach  supreme court has a whole bunch of cases of cases that involve more forms where you're the the firm pays the premiums even though it's yours that it's employee and i was entitle to paid employee benefits including paid health insurance by my firm and the second contract which is absolutely silent on that point and then the other evidence of record being of course that we did not provide benefits for ourselves and indeed your honor this plan was voluntary in the first couple years of my relationship with the firm i didn't participate in the plan i didn't participate at all use my late husband's health insurance i want to get to load let me follow up with them  recent dop state law the statue of limitations what difference does it make here you know for just a side the statue of limitations what difference does it make whether it's the res statue of limitation with the iowa law that says you can you apply a contractual statute of limitations if it's reasonable so you look you're right back to the same place you're looking at the contract that says three year statute of limitations assuming those that statute limitations applied to claims of the nature of those presented in this case your honor and it does not and that's united health care is language not mine it's as very clearly it applies to section five claims those permits by contract to shortland it does and so if you have a separate contract with them that shortens it how is that different than the rest adopting the honor i maintain that contraption limitation period doesn't apply to my claims i do and this isn't about out of network services this isn't about a policy exclusion it's about a blanket declamation of coverage of the a nation going forward and a reclaiming of benefits paid out historically to the inception of the policy period and bat as a matter of state law the subject matter of this contract doesn't matter what matters and from which the liability arises is the relationship of the parties and that relationship is a matter of contract i'm going to stop there at this point and reserve for the comments from a bottle a ma just to clarify something this suits and said this was not an individual policy this was a group policy entered into between united health care and the enrolling group and that is appendix pix thirty four she's she's arguing that the three year limitation in the policy only applies to certain things like denial because of exclusions and so forth and it's not a catch all for every claim under the policy that's number one in the i'd like to address and then number two is has just that has the limitation even begun to run begin to run because it's it's you talk about it being within three years after our final decision and i don't see in the file of any final decision was made maybe you can certainly correct me if i'm wrong there are two statute of limitation paragraph lawsuit then below that is the catch all provisions that you have an outside limit of three years from when we make our final decision final decision was made on april fourth two thousand and through tailored benefits the employee benefits company that represented law firm she appealed those claims on april fourth there's an email opinion from united health care service department saying what they would do to fix that problem the problem was not fixed right away and here's why the issues arose first missteps and when rolled as an employee of the law firm signed a document certifying to the truth of all the information in there but it had the wrong social security number down the road under the policy if if the united health care discovered that there was false information you have a right to terminate the typical of coverage of one of the participants under the group policy and recoup benefits that's what it did do i believe they handled it in the best possible way should they have notified or first in the world the best behavior yes but it did what it was entitle to do under the poles and then it went to correct that and that decision is in the april eighth e mail from united health care to tailored benefits which was then forwarded to miss united health care said it would do all of it what they did exactly what it would do to fix the situation unfortunately health care providers subsequently submitted claims under the old id number and they weren't paid so certified as being true that it was paid ninety percent of the premiums this is a law firm there are cases that law firms they made may pay the premiums they did arista clearly governs government the complain here is that since that she's not seeking any kind of damages for health care benefits the very  that united health care breached it this is page five and six of the appendix that she suffered damages in the form of health care related bills and expenses that said that is the claim under a group health insurance ok now we're here really because of this that shuttle the three year statue of limitation i'm not sure your supremacy for email rises to a final decision i'd like you could address that further  r it doesn't sound like a final decision but here's my question did the plane raise that issue that the statue of limitations had not begun  and it has never been raised so your say you do this is a result i view think that e mail is enough to be a final decision is out of it sounded to me like a still it was a negotiation of a of trying to resolve something that was a problem that everybody didn't do to have well what else could be done if it acknowledges the problem was made and it said here's what we're going to do fix everything that you've raised what more can the united health care do to make her husband who unfortunately passed away and i i'm sorry i don't have the amount right now of the top my head but there is there is some outstanding medical bills that have not been paid under the recent policy to my knowledge no and some of that maybe just on a death of her ex husband that was written off by medical providers but her bills in the children's bills were paid as far as i know in mississippi claims in her brief that there interest policy and that the three years begins to rise and at the expiration of the time period in which a request for reimbursement must be submitted that is that is that the light is that that the date that triggers the three years in can your view or is it three years from from a communication denying a claim for benefits it's three years from the day to requests for reimbursement must be submitted for out of network claims that are submitted it is three hears from the date of a final decision for all other types claims so some claims are in that work and the medical provider submit the claim and sell side i think counsel said a few minutes ago that out of network claims are not were not in dispute here and so here you have you seen her claim for the extent that they do exist paul and of the second part of any other reason if you filed legal action against us for any other reason that's granting summary judgment he says he talks about the quotes this language that if you want to bring a legal action against this you must do so within three years from the expiration of the time period in which your request for reimbursement must be submitted that's correct and have focused only as i read that that looks to be the the the language that that he focused upon rather than the date of the now that's correct that's absolutely correct i don't know that i was wrong loaders as for its right as to certain claims but to the extent she has other claims which i believe she's making here today that triggers the other that would rather read reason claim that w i'm sorry which is the first cause we won't know any other respect for claims for network providers if they existed would be the second clause but they don't exist any longer if there are valid like the state law can you cannot turn to the contractual limitation in that policy to limit her statute of limitation to three years i'm the only one who was terminated united health care remember said that we weren't parties to a contract at all that's what gives rise to my claims but now they want to bind me to a term and within that contract you ask did i ever bring up the substance of that suppose it did not go in april of two thousand and eight i most certainly did so in the last section of my brief here's what else happened and april of two thousand and eight that's when united health care finally told me why they had terminated us according to united health care i apply for coverage using an incorrect social security number now persons made no sense because for three and a half years my claims have been paid and they were submitted by my providers who had my correct social security number which clearly had to match what was being used internally at united health care but in october of two thousand and seven is that only you submitted an application under a false security number and then five years later in march of two thousand and thirteen united health or served their initial disclosure and then page two twenty seven of the appendix is to suppose that application of mine and indeed the social security number on that application is not mine the handwriting is not mine the last two digits of my social receipt in dealing with me they never gave me notice at all that they had terminated my contract and never they certainly didn't give the kind of notice that a restore requires plan participants to give but then when i see them all of a sudden my claim service or preempted here is the difference between a wholesale declination of coverage and a denial of benefits and how it impacted my family remember in the beginning i said i'm june first of two thousand and eight i secured coverage with another carrier that was wal mart blue cross blue shield of iowa that was in june of zero eight in september of zero eight my husband's cancer was back and when the bill started coming in to well mark they initially denied payment for chase cancer care under their preexisting condition exclusion which required us to have continuous coverage for chase cancer care in the twelve months preceding the start date of my policy with wal mart and according to the information united health care gave them we had not had  at all but but well mark but your whole lawsuit is premised upon can teach you that there was a contract while i insisted there was a contract i paid my ovaries or was ever in there with that with yours since you've taken that position required to be in writing in iowa but i say i'm going to give you ten thousand dollars a year in premium dollars which by the way was what i paid and in exchange for that i want you to cover my family and they say ok i mean that was the essence of our relationship now in those early years of course our claims were maybe one tenth of what i paid in premium but in those last years our claims went from hundreds of dollars to hundreds of thousands of dollars i'm sorry  time really hasn't started to run i did address that america and i i'm sorry that email from from april of two thousand and eight even if united health care had done what they promised to do in that e mail which they didn't that is not an arrest or any other thank you thank you very much i think we'll take about a five to ten minute recess