5th Circ. Opinion Is Right To Question ERISA Review Norms

By Mark DeBofsky (October 5, 2021, 11:21 AM EDT) -- A concurrence to a Sept. 22 opinion issued by the U.S. Court of Appeals for the Fifth Circuit[1] in a case involving a health insurance raises serious concerns about the manner in which courts review benefit claim denials under the Employee Retirement Income Security Act.

The case, Michael J. P. v. Blue Cross and Blue Shield of Texas, involved the medical necessity for inpatient psychiatric hospitalization of a minor who had made multiple suicide attempts.

Although the first days of hospitalization were covered, the insurer refused to reimburse charges for the balance of the hospitalization on the claimed ground that the patient...

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