News & Events

Anderson & Kreiger Persuades First Circuit Judge that a Reasonable Reading of the Expert Reports Backed the Denial of Coverage for Inpatient Mental Health Costs

On September 9, 2020, the First Circuit upheld a Massachusetts Federal District Court judge’s summary judgment decision that Anderson & Kreiger client, Harvard Pilgrim Health Care, does not have to cover a woman’s inpatient mental health care costs under ERISA because they were not medically necessary after reviewing additional expert records submitted after the denial of the initial claim.

In addition to siding with Harvard Pilgrim for denial of coverage, the First Circuit also held that an award for attorney’s fees was not warranted for the woman’s earlier litigation victory.