WASHINGTON, Nov. 3, 2020 /PRNewswire/ -- Following a
ruling last year that United Behavioral Health (UBH), a subsidiary
of UnitedHealth Group (NYSE: UNH), illegally denied tens of
thousands of mental health and substance use disorder coverage
claims, a federal court has provided plaintiffs with the full
extent of relief available under the law. UBH must now reprocess
the claims in question, reform its handling of behavioral health
claims, and improve employee training. The court also says it will
appoint a Special Master to oversee the reprocessing and
reforms.
Zuckerman Spaeder partner
Caroline Reynolds, who led the case
through trial and the remedy phase, said, "Today's ruling imposes
as strong a remedy against UBH as the law allows and delivers
everything the plaintiffs asked for. The class members will get the
relief they deserve and United has been forced to change its
dangerous and self-serving behavioral health practices."
D. Brian Hufford, who heads up
Zuckerman's health insurance practice and has overseen the case
from its inception along with partner Jason
Cowart, commented, "The nation's largest insurer has been
exposed for deliberately limiting coverage, knowing thousands of
people would be left with inadequate or incredibly expensive care,
or no care at all. But the real shock of this case is that it's
actually not much of a shock at all. For-profit insurers have been
blatantly discriminating against mental health patients for years,
while facing virtually no government scrutiny."
Chief Magistrate Judge Joseph
Spero of the U.S. District Court for the Northern District
of California, who also presided
over last year's trial, explains in today's ruling that the case
"arises out of pervasive and long-standing violations of ERISA" in
which "UBH denied mental health and substance use disorder
treatment coverage…using internal guidelines that were inconsistent
with the terms of the class members' health insurance plans. UBH
engaged in this course of conduct deliberately, to protect its
bottom line. To conceal its misconduct, UBH lied to state
regulators and UBH executives…deliberately attempted to mislead the
Court at trial..."
In his order, Judge Spero says he will appoint a Special Master
to oversee all ordered reforms and requirements, and that UBH must
"proceed diligently with reprocessing" plaintiffs' claims and
complete the process within one year. The company must also reform
its claims processing so that coverage decisions are based on
generally accepted standards of care and, with the oversight of the
Special Master, implement a training program for all personnel with
input into clinical coverage determinations.
"This relief can't undo the pain United inflicted on thousands
of adolescents and adults, but it will give them meaningful help
and offer new hope for all who suffer from mental illness or
addiction," Ms. Reynolds continued. "This case should serve as a
strong warning to all insurers that the courts are recognizing
their discriminatory schemes and it's time to clean up their
act."
Under ERISA, plaintiffs have the right to recover benefits owed
to them and to force administrators like UBH to correct their
illegal behaviors. The statute does not provide plaintiffs with the
ability to collect punitive monetary awards.
During last year's trial, the court considered two consolidated
lawsuits—Wit, et. al. v. UnitedHealthcare et. al. and
Alexander, et al. v. United Behavioral Health—brought
by Zuckerman Spaeder and co-counsel
Meiram Bendat of Psych-Appeal, Inc. The lawsuits argued that tens
of thousands of UBH's behavioral health coverage decisions were
being made based on intentionally flawed internal guidelines. The
March 5th, 2019 ruling
against UBH was a landmark mental health decision and a resounding
win for the more than 50,000 plaintiffs.
Wit/Alexander is at the vanguard of the firm's nationwide
effort on behalf of clients to force insurer compliance with their
fiduciary duties under federal law. This work is led by
Messrs. Hufford and Cowart, and their trial team included
Carl Kravitz, Aitan Goelman, and Adam
Abelson, along with Ms. Reynolds.
"Last year's breakthrough win has fueled our ongoing efforts to
force health insurer accountability, but private legal action alone
can't deliver systemic change," Mr. Hufford said. "The spotlight is
now squarely on political leaders and regulators. Only with the
weight of government can we hope to make certain insurance
companies finally and fully live up to their legal and moral
responsibility."
Under the direction of Mr. Hufford, Mr. Cowart, and Ms.
Reynolds, Zuckerman Spaeder has
achieved several other class certifications, delivered multiple
settlements, and is pursuing additional mental health-related
lawsuits against insurers. The mental health effort is part of a
national practice representing patients and health care providers
in disputes with health insurance companies. The firm's cases have
received high-level support from former U.S. Representative
Patrick Kennedy and the U.S.
Department of Labor, which has filed four amicus briefs supporting
Zuckerman Spaeder cases in the
Second, Third, Fifth and Eighth Circuit Courts of Appeals, with the
firm obtaining successful decisions each time.
View original
content:http://www.prnewswire.com/news-releases/after-delivering-landmark-win-for-mental-health-patients-judge-orders-unitedhealth-to-reprocess-over-50-000-claims-and-reform-claims-handling-301166061.html
SOURCE Zuckerman Spaeder LLP