Feb 06, 2012

Case Results

DISCLAIMER: Please note that every case is different and these verdicts and settlements, while accurate, do not represent what we may obtain for you in your case.

Teen Help, Inc. v. Operating Engineers Health & Welfare Trust Fund

A critical piece of the litigation puzzle is knowing what basis the insurer is using to deny a claim. But insurers and self-funded plans have an advantage in keeping patients and their healthcare providers in the dark. Consequently, the Firm makes sure its clients have all the information necessary to evaluate a claim before and during litigation. The Firm brought suit to require a union medical trust fund to disclose the criteria it used to deny medical claims. In Teen Help, Inc., v. Operating Engineers Health and Welfare Trust Fund, 1999 U.S. Dist. LEXIS 21989 (N.D. Cal. 1999), the court ruled that trust fund should have produced the criteria used to evaluate medical necessity when requested patient and healthcare provider. The court also ruled that the trust fund should have disclosed the credentials of the trust fund's medical reviewers as well as their reasons for believing the care was not medically necessary.

Awarded: Medical Criteria Must Be Produced Upon Request