A major group health insurer denied all of the health insurance claims of the employees in a large group. The employees were covered under a group health insurance policy. The reason for the claim denials, according to the health insurer, was that the group insurance policy had lapsed for non-payment of premium. After a few rounds of argument with their prior lawyers, the employer turned to our firm for help.
We determined that the group plan was governed by ERISA. We designed an approach that was vastly different from the efforts of the prior counsel. Using ERISA’s tools that allow us to investigate a health insurer without filing a lawsuit, we were able to obtain a quick victory.
The investigation we conducted demonstrated that the insurer was incorrect in its position and it agreed to deem the group policy in force for the disputed time period. All of the employees’ claims will now be re-processed for payment.
For any questions as to how we can use ERISA to help you, please call us at 800 745 1755.
Evan S. Schwartz
Founder of Schwartz, Conroy & Hack
800-745-1755
ESS@schwartzlawpc.com