When a chiropractor’s claims all started to get denied from one health insurance plan, he knew he had a significant problem. Not only was he getting the classic “run around”, his patient pool of referrals were almost all covered under that same plan. After engaging in a paper war with the health insurer, he hired an attorney and sued the health insurer.
The health insurer and the self-insured employer made a motion to dismiss the case and mounted various arguments under ERISA alleging that the chiropractor could not recover any money and that he allegedly blew various deadlines under the ERISA regulations. The prior attorney recommended that the client accept a very small, nuisance value, amount in full settlement of the case. The chiropractor interviewed and then hired our firm and discharged prior counsel.
We determined that it was the health insurer — and not the chiropractor — who was in violation of the ERISA regulations. We sought and obtained a court order allowing the Complaint to be amended and filed a brand new lawsuit, making new and different legal arguments and pointing out various aspects of the health insurer’s unlawful conduct.
We obtained agreement that the prior motion to dismiss be withdrawn and he engaged in vigorous and comprehensive settlement negotiations with the health insurer. Agreement was reached whereby the chiropractor received a very substantial settlement from the insurer and there was also a resolution as to the ongoing business relationship between the chiropractor and the health insurance company.
For more information on the ways we are making a difference in the health insurance arena, please call us at 800 745 1755.
Evan S. Schwartz
Founder of Schwartz, Conroy & Hack
800-745-1755
ESS@schwartzlawpc.com