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SCHROEDER v. BLUE CROSS & BLUE SHIELD

No. 89-0150.

153 Wis.2d 165 (1989)

450 N.W.2d 470

Michael J. SCHROEDER, Sr., by Paul G. Swanson, his Guardian and Litem, and Michael J. Schroeder, Jr., as Special Administrator of the Estate of Helen E. Schroeder, Plaintiffs-Appellants, v. BLUE CROSS & BLUE SHIELD UNITED OF WISCONSIN, Defendant-Respondent.

Court of Appeals of Wisconsin.

Decided November 1, 1989.

Attorney(s) appearing for the Case

On behalf of the plaintiffs-appellants, there were briefs by Mary R. Curtis of Steinhilber, Nesbitt, Swanson & Mares and oral argument by George Curtis, of counsel.

On behalf of the defendant-respondent, there were briefs by Elizabeth Bartlett and Laurel Barnes and oral argument by David Hanson of Michael, Best & Friedrich, of counsel.

On behalf of the Center for Public Representation there was an amicus curiae brief and oral argument by Betsy J. Abramson, of counsel.

Before Brown, P.J., Scott, J., and Robert J. Paring, Reserve Judge.

BROWN, P.J.

In this insurance case, the trial court granted summary judgment to Blue Cross & Blue Shield (Blue Cross), holding that the Schroeders' expenses for home care treatment were not covered by their Medex-Plus Medicare supplement policies. We reverse, holding that the trial court improperly found that Blue Cross had reserved the right independently to determine the appropriateness of doctor-certified treatment.

Michael and Helen Schroeder were...

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