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On Monday, defendant-administrator Health Care Service Corp. (HCSC) secured the dismissal of a lawsuit brought by the beneficiary of an employer-sponsored health insurance plan. The Northern District of Illinois class-action was filed after HCSC denied coverage for residential treatment that the plaintiffâs daughter received for behavioral health conditions in 2018.
The court explained that pursuant to the plaintiffâs second amended complaint, HCSCâs denial was the consequence of âimproperly narrow residential treatment guidelines that HCSC continues to employ in making benefits determinations,â in violation of the Employment Retirement Income Security Act of 1974 (ERISA). The plaintiff seeks to certify a class consisting of âany member of a health plan governed by ERISA whose request for coverage of residential treatment services for a behavioral health disorder was denied by HCSC,â wholly or partly, and based on
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The five policy commitments from the Biden administration that we believe are of relevance to investors focused on environmental, social, and governance (ESG) issues are, in short: to recommit the US to a more proactive stance on tackling climate change, to adjust the rules on sustainable investing, to accelerate a range of energy transition rules, to strengthen sustainability-related priorities for corporate America and to set significant long-term and aspirational environment goals.
We expect these to broadly affect corporate issuers of bond and equity securities, governments and potentially even asset-backed securities.
Climate leadership is a genuine possibility under the new administration. In 2017, President Trump withdrew from the 2015 Paris Agreement, driven by concerns that the Paris Accord would undermine the US economy. President Biden orchestrated the original involvement of the US, and so it is hardly surprising that we have seen an early recommitment by the U
Health
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December 18, 2020 On Thursday, in the Eastern District of Michigan, Judge Stephen J. Murphy denied United Healthcare a motion to dismiss an action on grounds of preemption brought against the defendant by a group of hospitals providing emergency medical services who alleged the defendant paid less than market rate for the medical services rendered to customers of the insurance company.
The plaintiffs argued that the defendant had an implied contract with the hospitals to pay “reasonable market value” for the emergency medical services rendered. The hospitals sought damages equal to the “reasonable market value” of the services rendered minus the amount the defendant already paid for said services plus 12 percent interest under the Michigan Prompt Pay Act (MPPA). The defendant proffered that its plans were covered by the Employment Retirement Income Security Act (ERISA) and thus preempted the plaintiffs’ recovery under MPPA. Specifically, the de
Health
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December 16, 2020 On Tuesday, in the District of Minnesota, District Judge Paul A. Magnuson ruled that the Employment Retirement Income Security Act (ERISA), not state laws, dictated the standard of review for denial of benefits for self-funded plans offered by the Affordable Care Act.
The underlying litigation, as explained in the opinion, involved the mother of a child with depression and anxiety, seeking judicial review of insurer United Healthcare’s decision to deny her son coverage in a wilderness therapy program in Hawaii. As a result of the denial of coverage, the mother received a bill for $49,000.
The mother then sued the insurance company for benefit review and payout, alleging the denial of benefits violated ERISA. The plaintiff averred that the correct standard of review by the court was de novo, pointing to a Minnesota law that states “no health plan…may specify a standard of review upon which a court may review denial of a claim or a