Judge Allows Thousands of Plaintiffs Injured By Bad Faith Insurance to Sue as a Class
Posted June 14, 2018On Monday, September 19th a federal judge in California made a ruling that could affect thousands of people around the country and their right, as healthcare beneficiaries, to sue insurers as a class over mental health coverage issues. The case involved approximately 3,000 health plans, all challenging United Behavioral Health’s guidelines for coverage and whether they violated both state and federal law. In his ruling, the judge found that not only was the harm (defective guidelines) common to all the class members, but the requested remedy (the adoption of new guidelines) was as well.
United Behavioral Health is the largest managed behavioral healthcare organization in America, with more than 60 million members covered on its plans. In this case, the company was accused of breaching its fiduciary duty and improperly denying benefits and equitable relief under federal law.
Federal Legal Requirements
This case was brought in 2014 over treatments whose coverage was denied between 2011 and 2015 under the Employee Retirement Income Security Act (ERISA), a federal law which sets minimum standards for pension and health plans in private industry. Those with health care plans covered under the law claimed that United Behavioral Health effectively came up with impossible guidelines (aka “coverage determination guidelines”) in an effort to deny care based on medical necessity evaluations (aka “adjudicating benefits claims”).
The guidelines were created in reaction to a federal mental health parity law that had been passed previously, requiring that insurance companies offer mental health coverage which is comparable to coverage for physical issues. Plaintiffs contended that United was obligated to promulgate criteria which faithfully ensured that a particular level of care is covered by members’ plans and consistent with generally accepted standards of care, and the company failed to do so. Yet, the complaint goes into detail beyond members simply being denied health coverage; in fact, it describes several individuals who, after being wrongfully denied coverage for certain disorders, ultimately died as a result of said disorders.
The ruling is a significant one for patients on a national level, as few have the financial resources to individually sue the health care companies each time their benefits are denied. By allowing them to bring lawsuits as a class, challenging any health care insurer for denying insurance coverage for mental health treatment is simply more practical (as well as efficient for the judicial system).
Getting Legal Help
An insurance company’s failure to provide coverage can have devastating repercussions on a policyholder’s life. In some circumstances, these actions constitute bad faith.
If you were denied coverage in bad faith, it is important to contact an experienced attorney who can help. The Bennett Law Firm focus their practice on challenging bad faith insurance companies. Contact one of our experienced attorneys today at 405-272-0303 to schedule a free consultation.
On Monday, September 19th a federal judge in California made a ruling that could affect thousands of people around the country and their right, as healthcare beneficiaries, to sue insurers as a class over mental health coverage issues. The case involved approximately 3,000 health plans, all challenging United Behavioral Health’s guidelines for coverage and whether they violated both state and federal law. In his ruling, the judge found that not only was the harm (defective guidelines) common to all the class members, but the requested remedy (the adoption of new guidelines) was as well.
United Behavioral Health is the largest managed behavioral healthcare organization in America, with more than 60 million members covered on its plans. In this case, the company was accused of breaching its fiduciary duty and improperly denying benefits and equitable relief under federal law.
Federal Legal Requirements
This case was brought in 2014 over treatments whose coverage was denied between 2011 and 2015 under the Employee Retirement Income Security Act (ERISA), a federal law which sets minimum standards for pension and health plans in private industry. Those with health care plans covered under the law claimed that United Behavioral Health effectively came up with impossible guidelines (aka “coverage determination guidelines”) in an effort to deny care based on medical necessity evaluations (aka “adjudicating benefits claims”).
The guidelines were created in reaction to a federal mental health parity law that had been passed previously, requiring that insurance companies offer mental health coverage which is comparable to coverage for physical issues. Plaintiffs contended that United was obligated to promulgate criteria which faithfully ensured that a particular level of care is covered by members’ plans and consistent with generally accepted standards of care, and the company failed to do so. Yet, the complaint goes into detail beyond members simply being denied health coverage; in fact, it describes several individuals who, after being wrongfully denied coverage for certain disorders, ultimately died as a result of said disorders.
The ruling is a significant one for patients on a national level, as few have the financial resources to individually sue the health care companies each time their benefits are denied. By allowing them to bring lawsuits as a class, challenging any health care insurer for denying insurance coverage for mental health treatment is simply more practical (as well as efficient for the judicial system).
Getting Legal Help
An insurance company’s failure to provide coverage can have devastating repercussions on a policyholder’s life. In some circumstances, these actions constitute bad faith.
If you were denied coverage in bad faith, it is important to contact an experienced attorney who can help. The Bennett Law Firm focus their practice on challenging bad faith insurance companies. Contact one of our experienced attorneys today at 405-272-0303 to schedule a free consultation.