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HINES v. BLUE CROSS BLUE SHIELD OF VIRGINIA

No. 85-1875.

788 F.2d 1016 (1986)

John Henry HINES, Jr., Appellee, v. BLUE CROSS BLUE SHIELD OF VIRGINIA, Appellant, Blue Cross and Blue Shield of Southwestern Virginia, Amicus Curiae, Group Hospitalization and Medical Services of the District of Columbia, Inc., Amicus Curiae.

United States Court of Appeals, Fourth Circuit.

Decided April 21, 1986.

Attorney(s) appearing for the Case

Thomas E. Spahn (Gilbert E. Schill, Jr., Barbara Ann Williams, McGuire, Woods & Battle, on brief), for appellant.

W. Carrington Thompson (Clement & Wheatley, on brief), for appellee.

Heman A. Marshall, III, H. Allen Glover, Jr., T. Daniel Frith, III; Woods, Rogers and Hazelgrove, on brief, for amicus curiae Blue Cross and Blue Shield of Southwestern Virginia.

Charles J. Steele, Thomas F. Fitzgerald, Pierson, Ball & Dowd, on brief, for amicus curiae Group Hospitalization and Medical Services, Inc.

Before HALL and WILKINSON, Circuit Judges, and SENTELLE, United States District Judge for the Western District of North Carolina, sitting by designation.

WILKINSON, Circuit Judge:

This case concerns the validity of a provision in a Blue Cross and Blue Shield contract which excludes payment for services already covered by workers' compensation. Virginia law prohibits provisions in policies that deny recovery for services for which the insured has been reimbursed by "a third party responsible for such personal injuries." Va. Code § 38.1-342.2 (1980). The district court decided that a "workers' compensation carrier...

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