The Maul Firm Wins Trial Victory Against Independence Blue Cross
On March 28, 2014, the Honorable Matthew F. Kennelly of the U.S. District Court for the Northern District of Illinois issued a trial decision in favor of the Pennsylvania Chiropractic Association ("PCA") in a case against Philadelphia-based insurance company Independence Blue Cross ("IBC"). The Maul Firm's principal attorney, Anthony F. Maul, represented the PCA as co-lead counsel in a bench trial held in December 2013.
In Pennsylvania Chiropractic Association v. Blue Cross Blue Shield Association, Mr. Maul and his co-counsel brought suit on behalf of various health care providers and professional associations. The lawsuit challenged the practice by IBC and other Blue Cross Blue Shield entities of issuing repayment demands to in-network providers without providing them the notice and appeal rights required by the Employee Retirement Income Security Act ("ERISA") and the U.S. Department of Labor regulations promulgated thereunder.
Judge Kennelly's decision is a complete victory for the PCA, ruling in its favor on every legal and factual issue contested in the trial. In particular, Judge Kennelly held that IBC's practices "come nowhere near substantial compliance with ERISA's notice and appeal requirements," and that the PCA was entitled to permanent injunction enjoining those unlawful practice.
The ruling establishes several ground-breaking precedents that strengthen the rights of providers facing repayment demands: it is the first trial decision holding that repayment demands constitute "adverse benefit determinations" under ERISA; it is the first time a court has held that in-network providers who receive direct payment from insurance companies are ERISA "beneficiaries"; and it is the first case in which a provider association has prevailed at trial on ERISA claims.
The Maul Firm is counsel in similar litigation against United Healthcare, Aetna and other insurers.