11th Circuit: Employee Wellness Program Does Not Violate Federal Disability Act

ATLANTA - A Florida county's employee wellness program does not violate the Americans with Disabilities Act (ADA) because it falls within the ADA's safe harbor provision for insurance plans, the 11th Circuit U.S. Court of Appeals ruled Aug. 20, affirming a trial court ( Bradley Seff v. Broward...

Pennsylvania Federal Judge Expands Class In Denial Of Autism Benefits Case

PHILADELPHIA - A Pennsylvania federal judge on Aug. 21 granted a plaintiffs' motion to expand the class definition by adding a subclass in a case accusing multiple health insurers of wrongfully denying benefits for the treatment of autism spectrum disorder (ASD) ( Kristopher Churchill v. CIGNA Corp...

Provider's Misrepresentation Claims Not ERISA Preempted, Calif. Federal Judge Says

SAN DIEGO - A health-care provider's claims against insurers alleging that the insurers misappropriated his name and made misrepresentations to his patients by holding him out as a contracted provider, which negatively impacted his ability to recover additional amounts owed under his contracts with...

High Court Won't Hear Successor Liability Case Over Retiree Welfare Benefits

WASHINGTON, D.C. - The U.S. Supreme Court on Oct. 9 denied review of a Sixth Circuit U.S. Court of Appeals ruling that a company is liable for retiree health care benefits and reimbursement for Medicare Part B premiums for retirees of the company's predecessors ( Newell Window Furnishings Inc., et...

Judge Rules On Summary Judgment, Class Certification Motions In Reimbursement Suit

CHICAGO - In separate opinions issued Oct. 12, an Illinois federal judge issued rulings on motions for summary judgment and for judgment on the pleadings and declined to grant class certification to 32 proposed classes in a wrongful reimbursement suit brought by chiropractors ( Pennsylvania Chiropractic...

Federal Judge Declines To Remand Breach Of Health Insurance Contract Case

OKLAHOMA CITY - An Oklahoma federal judge on Nov. 7 declined to remand a breach of contract health insurance dispute to state court, saying that the plaintiff's claims could have been brought under the Employee Retirement Income Security Act and, therefore, federal jurisdiction was warranted ( Elizabeth...

New Jersey Federal Judge Dismisses Reimbursement Suit For Failure To State A Claim

NEWARK, N.J. - A New Jersey federal judge on Nov. 9 dismissed for failure to state a claim a putative class action case brought by multiple chiropractors seeking to hold health insurers accountable for past abuses of allegedly illegally bundling claims for chiropractic services into one type of treatment...

Unsettled Case Law Leads 7th Circuit To Uphold Award In ERISA Dispute

CHICAGO - Citing the previously unsettled state of case law regarding the production of insurers' internal documents and a lack of bad faith in an insurer's handling requests for such documents, a Seventh Circuit U.S. Court of Appeals panel on Nov. 28 upheld a lower court's ruling that had...

Preliminary Approval Of Settlement In Out-Of-Network Reimbursement MDL Sought

NEWARK, N.J. - Parties involved in a multidistrict litigation case in which defendants are accused of manipulating the rates for which they reimburse out-of-network medical providers filed a joint motion on Dec. 7 asking a New Jersey federal judge to preliminarily approve a settlement valued up to $120...

New Jersey Federal Judge Declines Class Certification In Reimbursement Dispute

NEWARK, N.J. - A New Jersey federal judge on Jan. 16 declined to certify two classes in a reimbursement lawsuit filed against a health care insurer, a database company and the database's parent company (Darlery Franco v. Connecticut General Life Insurance Co., et al., No. 07-6039, D. N.J.; 2013 U...

ERISA Plan Participants Seek Judge's Recusal In Reimbursement Suit

NEWARK, N.J. - Health plan participants who are suing a health care insurer for using flawed data to calculate the reimbursement rate for out-of-network providers on Feb. 7 moved for the federal judge in New Jersey who is overseeing the action to recuse himself and vacate his decision denying class certification...

Medical Providers Appeal Federal Judge's Dismissal Of Denial Of Benefits Claims

WEST PALM BEACH, Fla. - Medical providers on Feb. 8 filed a notice of appeal of a Florida federal judge's order dismissing 996 purported derivative claims asserted on behalf of 500 patients related to providers' claims that health insurers violated the Employee Retirement Income Security Act...

6th Circuit: Health Insurer Properly Denied Benefits In Eating Disorder Suit

CINCINNATI - A panel of the Sixth Circuit U.S. Court of Appeals on March 4 affirmed that a health insurance company did not err in denying coverage for the treatment of eating disorders (Mark Brigolin, et al. v. Blue Cross Blue Shield of Michigan, No. 11-1525, 6th Cir.).

Plan Administrator Didn't Breach Fiduciary Duties In Mental Health Parity Case

SEATTLE - A health plan administrator did not breach its fiduciary duties under the Employee Retirement Income Security Act by failing to modify its coverage certificates to reflect a court order that it provide mental health treatment because the administrator informed its members of the changes to...

New York Federal Judge Dismisses Copay Dispute For Lack Of Standing

NEW YORK - A New York federal judge on April 19 dismissed a health care copayment dispute, finding that the plaintiff lacked standing to bring her claims (Marianne Gates v. United Healthcare Insurance Co., et al., No. 11-3487, S.D. N.Y.; 2013 U.S. Dist. LEXIS 56619).

Fla. Federal Judge Dismisses Suit Alleging Insurer Schemed To Avoid Paying Rebates

FORT LAUDERDALE, Fla. - A Florida federal judge on May 7 dismissed a putative class action case against a health insurer and a third-party administrator accused of inflating medical loss ratios to avoid paying rebates for excessive premiums to subscribers as mandated by the Patient Protection and Affordable...

Plan Administrator That Didn't Supervise TPAs Is Hit With $1.8M COBRA Penalty

INDIANAPOLIS - A class of 741 former Visteon Corp. employees is entitled to more than $1.8 million in penalties based on the company's failure to provide them with timely notices of their rights to continued health care coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA), a...

Antitrust, Some ERISA Claims Dismissed From Wellpoint Reimbursement MDL

LOS ANGELES - A federal judge in California on July 19 dismissed antitrust and other claims alleging that WellPoint Inc. and other companies conspired to use a flawed database to set the rates for which out-of-network medical services (ONS) are reimbursed (In re: WellPoint Inc. Out-Of-Network "UCR"...

7th Circuit Affirms Dismissal Of Lawsuit Challenging Copayments

CHICAGO - A panel of the Seventh Circuit U.S. Court of Appeals on July 26 affirmed the dismissal of a proposed class action lawsuit alleging that six health insurance companies violated Wisconsin state law by requiring copayments for chiropractic care, saying that although the insurance companies were...

1 Claim Remains In Breach Of Health Insurance Contract Dispute

OKLAHOMA CITY - An Oklahoma federal judge on July 29 partially granted summary judgment in favor of a health care provider in a breach of contract dispute, leaving only the plaintiff's claim that she is a third-party beneficiary seeking to enforce restrictions on permitted billing of members for...

Chiropractors Sufficiently Alleged Breach, Bad Faith Under ERISA, Judge Rules

NEWARK, N.J. - Three chiropractors pursuing class claims against a health insurer's "bundling" of purportedly distinct claims survived dismissal on July 31, with a New Jersey federal judge finding that they had satisfied standing and pleading requirements under the Employee Retirement Income...

Federal Judge Grants Health Insurers Summary Judgment In Reimbursement Dispute

NEWARK, N.J. - A New Jersey federal judge on Aug. 1 granted summary judgment in favor of health insurers in a reimbursement dispute and denied the plaintiffs' motion for class certification (Premier Health Center, et al. v. UnitedHealth Group, et al., No. 11-425, D. N.J.; 2013 U.S. Dist. LEXIS 108041...

3rd Circuit Reverses Dismissal Of Dispute Against Health Insurer; Analysis Wrong

PHILADELPHIA - A Third Circuit U.S. Court of Appeals panel on Aug. 16 reversed a putative class action reimbursement dispute against a health insurer, saying the lower court improperly relied on the defendant's competing account of events when dismissing the claim (TRi3 Enterprises v. Aetna Inc....

Class Certification Denied In ERISA Coordination-Of-Benefits Action

CAMDEN, N.J. - A federal judge in New Jersey on Sept. 26 denied class certification of claims that United Healthcare, as the claims administrator for thousands of health insurance plans, violated the Employee Retirement Income Security Act by using a method for estimating what Medicare would have paid...

Split Montana High Court Reverses Certification Of Class Question In Benefits Suit

HELENA, Mont. - A split Montana Supreme Court on Dec. 13 upheld a state court's order defining the class in a suit challenging the denial of a preauthorization request for a medical procedure but reversed and remanded with respect to the court's certification of the plaintiffs' claim as to...