5th Circ.: Medical Administrator Liable for Wrongful Denial

Law360, New York (January 4, 2013, 10:33 PM EST) -- The Fifth Circuit on Friday affirmed a lower court’s ruling that a third-party medical benefits administrator had wrongly construed certain employee health plans in denying claims by two patients for treatments they received at LifeCare Management Services LLC.

A three-judge panel found Insurance Management Administrators Inc. had not adequately applied the plans’ criteria and miscategorized LifeCare as a facility other than a hospital. The panel agreed with the lower court that such a miscategorization to deny the patients’ claims amounted to an abuse of discretion, according...
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