The Maul Firm, P.C.

Health Law and Policy

Anthony F. Maul is an attorney and public policy consultant with over a decade of experience in complex and class action litigation. With a practice focused on health care advocacy and reform, Mr. Maul provides expert legal and consulting services to patients, providers and professional associations.

Filtering by Tag: Mental health parity cases

Second Circuit Reverses Dismissal of Federal Mental Health Parity Claims

In a landmark decision, the Second Circuit Court of Appeals has partially reversed a lower court's dismissal of an action against UnitedHealthcare ("United") alleging violations of the Mental Health Parity & Addiction Equity Act of 2008 (the "Parity Act") and the Employee Retirement Income Security Act of 1974 ("ERISA"). The action, brought by the New York State Psychiatric Association ("NYSPA") and various mental health professionals and patients, alleges that United illegally applies more restrictive treatment limitations to care for mental health than for physical health care.

The Second Circuit's decision resolved three important legal questions in the plaintiffs' favor. First, in the District Court, United successfully argued that it could not be sued through ERISA's enforcement provisions because it was a "claims administrator," not the nominal ERISA "plan" or "plan administrator." In reversing the District Court's holding, the Second Circuit confirmed that a claims administrator that exercises control over the administration of benefits is indeed a proper defendant under the enforcement provisions set out in both ERISA Sections 502(a)(1)(B) and (a)(3).

Second, the Court rejected United's argument that plaintiffs could not sustain a claim under ERISA Section 502(a)(3) because it was duplicative of plaintiffs' claims under Section (a)(1)(B). The Court held that, although duplicative relief may not be awarded under both sub-sections, that is not itself grounds for dismissal at the pleading stage.

Finally, in reversing dismissal of NYSPA's claims, the Second Circuit held that, contrary to the District Court's holding, the Association had standing to bring claims on behalf of its members.

The case is entitled New York State Psychiatric Association, Inc. v. UnitedHealth Group (2d Cir. Aug. 20, 2015). In addition to serving as co-counsel for the plaintiffs in this action, the Maul Firm is plaintiff's counsel in a New York state court action against United alleging similar violations of New York's Mental Health Parity Law, also known as Timothy's Law.  

New York's Mental Health Parity Law to be Tested in Court

A class-action lawsuit filed on June 4, 2014 in the Supreme Court of the State of New York, County of Suffolk was recently served on UnitedHealthcare Insurance Company of New York, and United Behavioral Health (doing business as OptumHealth Behavioral Solutions). The Empire Plan is also named as a defendant. The complaint alleges that the defendants’ practices violate anti-discrimination laws protecting crucial access to mental health services, including outpatient psychotherapy, to artificially inflate corporate profits and limit costs.

“By attempting to ration outpatient psychotherapy for mentally ill patients, defendants have flagrantly jeopardized the health and well-being of their insured members,” said Meiram Bendat, mental health attorney and founder of Psych-Appeal Inc.

Through December 31, 2013, UHC administered the Empire Plan’s mental health and substance abuse program, which insures more than one million participating New York state employees and their dependents, including members of the state executive branch, judiciary, legislature, public school teachers, firefighters and police officers. The class-action suit alleges that during this time, UHC violated Timothy’s Law, which requires insurers to administer benefits for severe mental illnesses in parity with medical and surgical benefits. In the case of the lead plaintiff, the complaint alleges that the defendants’ rationing practices led to his college age son’s psychiatric hospitalization and academic withdrawal.

“Without a private right to enforce Timothy’s Law and class-wide relief, insurers like UHC will continue to pay lip service to mental health parity,” added co-counsel Anthony F. Maul of The Maul Firm, P.C.

The complaint also alleges that UHC failed to maintain an independent appeals process to review coverage denials.

Class Action Alleges Improper Denial of Mental Health Benefits by UnitedHealthCare

In collaboration with Psych-Appeal Inc. and Zuckerman Spaeder LLP, the Maul Firm has filed a nationwide class action alleging that UnitedHealthCare improperly denies benefits for mental health care in violation of ERISA and the Mental Health Parity and Addiction Equity Act. In particular, the lawsuit alleges that United's use of overly-restrictive coverage criteria for mental health services violates both the mental health parity laws and the terms of United members' insurance contracts.

Details of the class action, captioned Wit v. UnitedHealthCare Insurance Company, 3:14-cv-02346 (N.D. Cal.), are described in a press release issued by Psych-Appeal Inc. 

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