October Term 2007 · Docket 06-923
Should courts weigh insurer profit motives when reviewing denied claims?
Parties dispute whether a court must consider an insurer's financial conflict when it denies a claim.
Verified source milestones
- — An official oral-argument transcript was verified.
The arguments, in order
This case may have been argued more than once. Each entry below uses that session's official transcript. Later arguments do not erase earlier ones.
Argument 1 ·
What happened at the argument
Ms. Posner argued the insurer's profit motive should not affect the review.
Mr. Rosenkranz argued the Court should keep its prior unanimous ruling.
Ms. Saharsky argued the Court must consider the conflict of interest.
Read the official transcript for this argument · Official argument details
Sources used for this argument breakdown
- Official Supreme Court Transcript — file page 27, lines 5-15 — Transcript, file page 27, lines 5-15
- Official Supreme Court Transcript — file page 3, lines 19-7 — Transcript, file page 3, lines 19-7
- Official Supreme Court Transcript — file page 3, lines 7-17 — Transcript, file page 3, lines 7-17
- Official Supreme Court Transcript — file page 4, lines 31-37 — Transcript, file page 4, lines 31-37
- Official Supreme Court Transcript — file page 4, lines 41-45 — Transcript, file page 4, lines 41-45
- Official Supreme Court Transcript — file page 4, lines 9-19 — Transcript, file page 4, lines 9-19
- Official Supreme Court Transcript — file page 44, lines 7-23 — Transcript, file page 44, lines 7-23
- Official Supreme Court Transcript — file page 5, lines 19-25 — Transcript, file page 5, lines 19-25
- Official Supreme Court Transcript — file page 5, lines 33-11 — Transcript, file page 5, lines 33-11
- Official Supreme Court Transcript — file page 5, lines 5-11 — Transcript, file page 5, lines 5-11
- Official Supreme Court Transcript — file page 6, lines 23-33 — Transcript, file page 6, lines 23-33
- Official Supreme Court Transcript — file page 6, lines 43-51 — Transcript, file page 6, lines 43-51
- Official Supreme Court Transcript — file page 7, lines 21-27 — Transcript, file page 7, lines 21-27
- Official Supreme Court Transcript — file page 7, lines 43-49 — Transcript, file page 7, lines 43-49
- Official Supreme Court Transcript — file page 7, lines 7-15 — Transcript, file page 7, lines 7-15
- Official Supreme Court Transcript — file page 8, lines 9-25 — Transcript, file page 8, lines 9-25
A citizen's guide to the whole case
What this case is about
The case tests how courts review insurer claim denials. One side argues profit motives must influence the review. The other side argues the conflict is irrelevant to the legal standard.
Official sources for this section
- Official Supreme Court Transcript — file page 27, lines 5-15 — Transcript, file page 27, lines 5-15
- Official Supreme Court Transcript — file page 3, lines 19-7 — Transcript, file page 3, lines 19-7
- Official Supreme Court Transcript — file page 44, lines 7-23 — Transcript, file page 44, lines 7-23
How the case got here
The Supreme Court heard oral argument in this case on April 23, 2008.
Official sources for this section
- Official Supreme Court Transcript — file page 3, lines 7-17 — Transcript, file page 3, lines 7-17
What each side wants
The insurer wants a neutral review standard that ignores its profit motive.
The claimant wants a stricter review standard that weighs the insurer's profit motive.
Official sources for this section
- Official Supreme Court Transcript — file page 27, lines 5-15 — Transcript, file page 27, lines 5-15
- Official Supreme Court Transcript — file page 3, lines 19-7 — Transcript, file page 3, lines 19-7
- Official Supreme Court Transcript — file page 44, lines 7-23 — Transcript, file page 44, lines 7-23
What each side says
The insurer argues the conflict of interest is legally irrelevant to the review.
The claimant argues the conflict of interest must be a factor in the review.
Official sources for this section
- Official Supreme Court Transcript — file page 27, lines 5-15 — Transcript, file page 27, lines 5-15
- Official Supreme Court Transcript — file page 3, lines 19-7 — Transcript, file page 3, lines 19-7
- Official Supreme Court Transcript — file page 44, lines 7-23 — Transcript, file page 44, lines 7-23
What the justices asked
Justice Kennedy asked if the insurer must prove it separated profit and claims staff.
Justice Scalia asked if a fiduciary with financial interests is inherently conflicted.
Official sources for this section
- Official Supreme Court Transcript — file page 4, lines 31-37 — Transcript, file page 4, lines 31-37
- Official Supreme Court Transcript — file page 4, lines 41-45 — Transcript, file page 4, lines 41-45
- Official Supreme Court Transcript — file page 4, lines 9-19 — Transcript, file page 4, lines 9-19
- Official Supreme Court Transcript — file page 5, lines 19-25 — Transcript, file page 5, lines 19-25
- Official Supreme Court Transcript — file page 5, lines 33-11 — Transcript, file page 5, lines 33-11
- Official Supreme Court Transcript — file page 5, lines 5-11 — Transcript, file page 5, lines 5-11
- Official Supreme Court Transcript — file page 6, lines 23-33 — Transcript, file page 6, lines 23-33
- Official Supreme Court Transcript — file page 6, lines 43-51 — Transcript, file page 6, lines 43-51
- Official Supreme Court Transcript — file page 7, lines 21-27 — Transcript, file page 7, lines 21-27
- Official Supreme Court Transcript — file page 7, lines 43-49 — Transcript, file page 7, lines 43-49
- Official Supreme Court Transcript — file page 7, lines 7-15 — Transcript, file page 7, lines 7-15
- Official Supreme Court Transcript — file page 8, lines 9-25 — Transcript, file page 8, lines 9-25
Why it matters
This case defines how courts treat insurer profit motives. It sets the standard for reviewing denied health claims. It affects the balance between insurer autonomy and claimant protection.
Official sources for this section
- Official Supreme Court Transcript — file page 27, lines 5-15 — Transcript, file page 27, lines 5-15
- Official Supreme Court Transcript — file page 3, lines 19-7 — Transcript, file page 3, lines 19-7
- Official Supreme Court Transcript — file page 44, lines 7-23 — Transcript, file page 44, lines 7-23
What happens next
This article currently covers the argument record. Use the official docket link for later case activity.
Official sources for this section
- Official Supreme Court Transcript — file page 3, lines 7-17 — Transcript, file page 3, lines 7-17
- Official Supreme Court Transcript — file page 4, lines 31-37 — Transcript, file page 4, lines 31-37
- Official Supreme Court Transcript — file page 4, lines 41-45 — Transcript, file page 4, lines 41-45
- Official Supreme Court Transcript — file page 4, lines 9-19 — Transcript, file page 4, lines 9-19
- Official Supreme Court Transcript — file page 5, lines 19-25 — Transcript, file page 5, lines 19-25
- Official Supreme Court Transcript — file page 5, lines 33-11 — Transcript, file page 5, lines 33-11
- Official Supreme Court Transcript — file page 5, lines 5-11 — Transcript, file page 5, lines 5-11
- Official Supreme Court Transcript — file page 6, lines 23-33 — Transcript, file page 6, lines 23-33
- Official Supreme Court Transcript — file page 6, lines 43-51 — Transcript, file page 6, lines 43-51
- Official Supreme Court Transcript — file page 7, lines 21-27 — Transcript, file page 7, lines 21-27
- Official Supreme Court Transcript — file page 7, lines 43-49 — Transcript, file page 7, lines 43-49
- Official Supreme Court Transcript — file page 7, lines 7-15 — Transcript, file page 7, lines 7-15
- Official Supreme Court Transcript — file page 8, lines 9-25 — Transcript, file page 8, lines 9-25
Official Court provenance
Official docket and case history · Official Supreme Court oral-argument detail page
Title and summary sources
- Official Supreme Court Transcript — file page 27, lines 5-15 — Transcript, file page 27, lines 5-15
- Official Supreme Court Transcript — file page 3, lines 19-7 — Transcript, file page 3, lines 19-7
- Official Supreme Court Transcript — file page 44, lines 7-23 — Transcript, file page 44, lines 7-23
- Official Supreme Court Transcript — file page 27, lines 5-15 — Transcript, file page 27, lines 5-15
- Official Supreme Court Transcript — file page 3, lines 19-7 — Transcript, file page 3, lines 19-7
- Official Supreme Court Transcript — file page 44, lines 7-23 — Transcript, file page 44, lines 7-23
Revision history
- Revision 1 · Official Transcript ·
Correction: Rewritten to the concise citizen-facing editorial standard.
- Revision 2 · Official Transcript ·
Correction: Migrated to the dated official Court activity contract without model use.