8 results for 'cat:"ERISA" AND cat:"Health Care" AND cat:"Insurance"'.
J. Mendoza finds that the district court improperly dismissed an ERISA action brought by a surgery center which sought reimbursement from Anthem Blue Cross, an insurer and claims administrator, for the costs of medical services provided to patients. Under longstanding precedent, a healthcare provider has derivative authority to enforce ERISA’s protections if it has received a valid assignment of rights. The patients effectuated a valid assignment under the surgery center's “Assignment of Benefits.” Reversed.
Court: 9th Circuit, Judge: Mendoza, Filed On: January 10, 2024, Case #: 22-55717, Categories: erisa, health Care, insurance
J. Reidinger grants a health benefits management firm’s motion to dismiss a claim brought by a mother when her child, a beneficiary, was treated at a residential mental health facility. The firm denied the claim citing an exclusion in the mother’s health care plan. The mother exhausted the appeals process with the firm, then filed the current action to recover the cost of the claim through ERISA. However, the firm is no longer the claims administrator for the mother’s plan and so cannot provide relief.
Court: USDC Western District of North Carolina, Judge: Reidinger, Filed On: December 6, 2023, Case #: 1:21cv265, NOS: Employee Retirement Income Security Act (ERISA) - Labor, Categories: erisa, health Care, insurance
J. Mueller grants a benefit plan’s motion to dismiss a hospital’s action accusing it of refusing to pay for a patient’s $500,000 chemotherapy treatment. The hospital's claims, as pleaded, are not plausible under the Affordable Care Act.
Court: USDC Eastern District of California, Judge: Mueller, Filed On: November 1, 2023, Case #: 2:23cv676, NOS: Employee Retirement Income Security Act (ERISA) - Labor, Categories: erisa, health Care, insurance
J. Aiken grants judgment in favor of the daughter for her complaint alleging that Legacy Health wrongfully denied her claim for mental health treatment even though her mother is a participant of the employee welfare benefits plan. The lack of pre-approval is not a stated basis to deny the daughter coverage because although there were available in-network options, her mother was told that retroactive authorization was an option and PacificSource denied the request despite not seeking authorization until after the daughter already received treatment.
Court: USDC Oregon, Judge: Aiken, Filed On: September 28, 2023, Case #: 6:20cv705, NOS: Employee Retirement Income Security Act (ERISA) - Labor, Categories: erisa, health Care, insurance
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J. Greer grants summary judgment to the New Hampshire Insurance Department as to the claims arising from its fertility treatment mandate in this action brought under the Employee Retirement Income Security Act. Also, there is a question of law relating to the state's unfair insurance practices law, and the parties are ordered to file a proposed briefing schedule as to that issue.
Court: USDC Eastern District of Tennessee , Judge: Greer, Filed On: September 18, 2023, Case #: 1:21cv271, NOS: Other Statutory Actions - Other Suits, Categories: erisa, health Care, insurance
J. Casper denies an applicant’s motion against an insurance company for denying her long-term disability benefits. The information in the applicant’s file, as well as independent reviews of her records, supported her need for short-term disability benefits, which she was approved for, but failed to support her need for long-term disability benefits.
Court: USDC Massachusetts, Judge: Casper, Filed On: July 18, 2023, Case #: 1:22cv10085, NOS: Employee Retirement Income Security Act (ERISA) - Labor, Categories: erisa, health Care, insurance
J. Gruender finds a lower court properly granted summary judgment in favor of a benefit plan administrator on an employee's claims for health insurance under ERISA. The employee argued that the benefit plan administrator wrongfully denied coverage for complications he suffered from bariatric surgery. However, the benefit plan administrator presented sufficient evidence in court that it was not obligated to cover losses based on a prior procedure, which was considered as a non- covered service that was not medically necessary. Affirmed.
Court: 8th Circuit, Judge: Gruender , Filed On: June 7, 2023, Case #: 22-2275, Categories: erisa, health Care, insurance