Federal Court Agrees with Zuckerman Spaeder that UnitedHealth Group Subsidiary Illegally Denied Mental Health and Substance Use Coverage to Tens of Thousands of Patients – Including Thousands of Children
The decision comes after an
Zuckerman Spaeder partner
Zuckerman Spaeder, along with co-counsel Meiram Bendat of Psych-Appeal, successfully argued that UBH violated its fiduciary obligations under the Employee Retirement Income Security Act (ERISA) by systematically denying coverage for behavioral health treatment based on the use of "medical necessity" criteria that overemphasize acute mental health and substance use disorder symptoms, while disregarding chronic or complex conditions. In doing so, the court determined that the company effectively ignored the terms of the written insurance plan documents it was supposed to interpret, instead making coverage decisions based on flawed, internally-developed guidelines.
The Court's decision highlights many ways in which UBH's guidelines were inconsistent with generally accepted standards of care, including with regard to coverage for children and adolescents. As the Court found, "one of the most troubling aspects of UBH's Guidelines is their failure to address in any meaningful way the different standards that apply to children and adolescents with respect to the treatment of mental health and substance use disorders."
Zuckerman Spaeder partner
Under the direction of
The mental health effort is part of Zuckerman Spaeder's national practice representing patients and health care providers in disputes with health insurance companies. The practice's groundbreaking application of ERISA and other related federal and state laws has resulted in numerous precedent-setting wins, including two of the largest recoveries ever obtained in health insurance class actions. The firm's cases have received high-level support from former
With more than four decades of experience managing complex, high-stakes legal disputes and investigations,
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