Blue Shield of Va. v. McCready - 457 U.S. 465, 102 S. Ct. 2540 (1982)

Rule:

Section 4 of the Clayton Act provides a treble-damages remedy to any person who shall be injured in his business or property by reason of anything forbidden in the antitrust laws.

Facts:

Respondent employee was provided coverage under a prepaid group health plan purchased by her employer from petitioner Blue Shield of Virginia (Blue Shield). The plan provided reimbursement for part of the cost incurred by subscribers for outpatient treatment for mental and nervous disorders, including psychotherapy. However, Blue Shield's practice was to reimburse subscribers for services provided by psychiatrists but not by psychologists unless the treatment was supervised by and billed through a physician. Respondent was treated by a clinical psychologist and submitted claims to Blue Shield for the costs of the treatment. After the claims were routinely denied because they had not been billed through a physician, respondent brought a class action in Federal District Court, alleging that Blue Shield and petitioner Neuropsychiatric Society of Virginia, Inc., had engaged in an unlawful conspiracy in violation of § 1 of the Sherman Act to exclude psychologists from receiving compensation under Blue Shield's plans. She further alleged that Blue Shield's failure to reimburse was in furtherance of the conspiracy and had caused injury to her business or property for which she was entitled to treble damages under § 4 of the Clayton Act. The District Court granted petitioners' motion to dismiss, holding that respondent had no standing under § 4 to maintain her suit. The Court of Appeals reversed. Petitioner filed a motion for certiorari.

Issue:

Did the respondent have standing to maintain the action under § 4 of the Clayton Act? 

Answer:

Yes.

Conclusion:

The court held that respondent have standing to maintain the action under § 4 of the Clayton Act, noting that respondent's injury arose when petitioner refused to reimburse her for the costs of her psychologist's services. The group health plan in question covered the services of psychiatrist for psychotherapy, but not for the services of psychologists unless such services were supervised and billed through a physician. The harm to respondent was clearly foreseeable. It was a necessary step in effecting the ends of the alleged illegal conspiracy. Since the injury was an integral aspect of the conspiracy alleged, there was no question that the type of loss suffered by respondent was the type of loss sought to be prevented by antitrust laws.