If an HMO denies coverage to a participant in an ERISA qualified plan, the HMO may have violated ERISA. Denial of coverage claims, malpractice claims, and discrimination claims can be brought in the federal courts. Like other areas of our practice, we expect this will be an area where much new law will be made trying to address growing evidence of wrongdoing by the insurance industry.
Representative CasesWe file administrative claims and lawsuits on behalf of both patients and providers (doctors or hospitals). We have successfully resolved a number of administrative claims before litigation. Administrative claims, however, are not public record and we cannot disclose them here. The following is a list of our recent lawsuits against health insurance companies for failure to provide insurance coverage:
· Kramer v. Oxford, plaintiff sued Oxford Health Plans for health insurance coverage for rehabilitation. The parties settled out of court.
Nothing in this website is a promise or guarantee about the outcome of any case. We make no promises or guarantees. Cases are decided on their own facts and we cannot imply that our previous success will result in us winning your case.