Paul M. Sullivan, Jr.- Paul M. Sullivan, Jr.
$600,000 ERISA Air Ambulance Bill Awarded
". . . Defendants engaged in a concerted effort to find valid reasons to deny UAA's claim."
A 23-month old child with an extremely rare bowel disorder was rushed to the emergency room of Phoenix Children's Hospital. After treatment the parents were faced with a decision: admit their son for continued treatment of the emergent condition or depart for Boston Children's Hospital on a pre-arranged air ambulance flight to address the underlying condition which the hospital in Phoenix could not treat and under which their son had long-suffered. They chose the latter.
"This case is about who pays for that flight."
In a detailed order, the court concluded: "This case asks the question whether an ERISA plan administrator with a conflict of interest dutifully reviewed a provider claim for a child with complex, interrelated medical conditions -- some chronic, some emergent; some covered, some not."
"Defendants vacillate between interpreting the Plan reasonably and inexplicably."
Defendants offered five distinct justifications at different stages of the review process.
". . . the Court finds the litany of procedural irregularities erode Defendants credibility to sufficiently undermine the stated reasons for denying coverage. Thus, the Court holds Defendants abused their discretion in review of UAA's clam."