Dominic W. v. N. Trust Co. Emp. Welfare Benefit Plan et al.

DeBofsky Sherman Casciari Reynolds P.C., recently prevailed in a healthcare case, Dominic W. v. N. Trust Co. Emp. Welfare Benefit Plan et al., No. 18 C 327, 2019 WL 2576558, 2019 U.S. Dist. LEXIS 104747 (N.D. Ill. June 24, 2019), brought against the Northern Trust Company group healthcare plan and its administrator, Health Care Services Corporation d/b/a Blue Cross Blue Shield of Illinois (“BCBS IL”). The case was brought by a father on behalf of his minor daughter who suffered from multiple severe mental health conditions accompanied by self-harming and violent behavior. The daughter was admitted to a residential treatment facility after years of failed outpatient treatment and an attempt to take her own mother’s life at the age of only 12. Although BCBS IL covered approximately the first month of treatment, and against the recommendation of the treating providers, BCBS IL terminated coverage after that, claiming that the treatment was no longer medically. After the parties filed cross-motions for summary judgment under the arbitrary and capricious standard of review, the U.S. District Court for the Northern District of Illinois granted the plaintiff’s motion and denied the defendants’ motion. The court explained that it “can find no basis on which Blue Cross could reasonably refuse to reinstate coverage,” and declined to remand the claim because the “case is so clear cut.”