This week’s notable decision allows three cancer patients to proceed with their case challenging United Healthcare’s policy of denying proton beam therapy. In Weissman v. United Healthcare Ins. Co., 19-cv-10580, 2021 WL 858436 (D. Mass. Mar. 8, 2021) (Judge Allison D. Burroughs), three cancer patients brought a putative class action alleging that United Healthcare and their individual healthcare plans violated ERISA by wrongfully denying medically necessary proton beam therapy cancer treatment (“PBRT”). Lead class plaintiff Kate Weissman was able to come up with over $125,000 to privately pay for medically necessary proton therapy treatment to treat her cervical cancer diagnosis after UHC denied her coverage for the treatment in 2016. She, along with two other named plaintiffs – Zachary Rizzuto and Richard Cole – brought suit challenging UnitedHealthcare’s application of its own internal guidelines on proton therapy as flawed and out-of-date.
Continue Reading A Proton Beam Therapy Class Action Survives a Motion to Dismiss
Three Wins for Participants
There is an embarrassment of riches this week for plan participants, as three cases share the notable decision spotlight. Two are significant plaintiff wins with respect to mental health coverage under ERISA healthcare plans. The third is an important arbitration decision from the Second Circuit involving a pension plan, also a big win for plan participants.
Continue Reading Three Wins for Participants
Two Wins for LTD Plaintiffs
I am happy to report two notable decisions this week, both resounding wins for plan participants. The first is a favorable Ninth Circuit decision obtained by ERISA Watch subscriber Laurence Padway, telling Unum Life Insurance Company that it must live up to its 2005 promises to the California Department of Insurance (“CDOI”). Cox v. Allin Corp. Plan, __ Fed. Appx. __, No. 18-16975, 2021 WL 613799 (9th Cir. Feb. 17, 2021) (Bybee and R. Nelson, Circuit Judges, and Whaley, District Judge). In Cox, the Ninth Circuit overturned a district court decision in Unum’s favor with respect to plaintiff Elgin Cox’s claim for long-term disability benefits based on his diagnoses of vertigo and dizziness.
Unum was the plan administrator for an ERISA-governed disability plan sponsored by Allin Corporation, for which Mr. Cox worked prior to becoming disabled. Unum terminated Mr. Cox’s benefits after 24-months based on an exclusion in the governing policy for self-reported symptoms. Unum did so despite its 2005 California Settlement Agreement (“CSA”) with the CDOI which, among other things, prohibits such self-reported symptom limitations in “existing California Contracts.” The Ninth Circuit held that the CSA applied to the Allin Plan.
Continue Reading Two Wins for LTD Plaintiffs