Class Action Suit Allowed Against Aetna Under ERISA

In my wife’s and my battle against Aetna, I had just about accepted ERISA as currently worded as being a “Get Out of Jail” card for administrators of employer-funded health plans. With a lack of punitive damages and no acceptance of bad faith as an argument against the TPA, there is no incentive for a health plan administrator to behave civilly towards plan members.

So, I was very surprised to see this article at TradingMarkets:

A class-action lawsuit over Aetna Inc.’s (AET) denial of coverage for people with eating disorders may proceed under the federal Employee Retirement Income Security Act of 1974, a New Jersey federal judge has ruled.[...]

Bruce Nagel, an attorney representing the plaintiffs, said the ruling is “significant because it is the first time in the country that a federal court has ruled that there was a bona fide claim and that the insurance company’s internal appeals procedure does not trump the claim.” Nagel said he will try the case to ensure coverage for hundreds of families with children suffering from eating disorders, such as anorexia and bulimia.

In favorable rulings for Aetna, however, Hochberg dismissed the plaintiffs’ claim under the New Jersey Mental Health Parity Law and their claims for punitive damages as pre-empted by ERISA. Attempts to get comment from Aetna were unsuccessful.

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