The world’s largest health insurer has been charged with discrimination against medical insurance customers who were denied mental health services. Plaintiff Jane Doe is the mother of a 13 year old boy diagnosed with autism spectrum disorder. Her son John was denied applied behavioral analysis, the leading treatment for autism. The complaint states:
ABA (applied behavior analysis) is generally accepted as an effective form of treatment for minors with ASD…Plaintiff sought coverage under John’s father’s health benefits plan for John to begin ABA treatment, but Defendants denied coverage, relying upon a plan term that purports to exclude coverage for Intensive Behavioral Therapies (“IBT”) for mental health conditions like ABA for autism. The IBT Exclusion, however, violates the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (“Federal Parity Act”), codified at 29 U.S.C. § 1185a. As a result, the exclusion is unenforceable as a matter of federal law and Defendants’ application of it to deny coverage to Plaintiff’s son breached their fiduciary duties under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq.
Health insurance company practices often make it difficult or impossible for disabled people to receive the care they need. Plaintiff’s counsel argues that while the federal Parity Act does not require that behavioral health be covered by a plan, when it is, it must be covered consistent with parity.
Discrimination takes many forms. Whether age, sex, gender, or disability discrimination is alleged, hiring a top notch discrimination expert witness is crucial. Contact ForensisGroup to select a highly qualified expert for your case.