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Case: Health Care & Benefits/Benefits Denial (N.D. Ohio)

Dec. 5, 2022, 8:30 PM

A federal district court in Ohio denied Anthem’s motion for judgment on the administrative record regarding an employee’s claim to have his son’s doctor certified as an in-network provider under the Employee Retirement Income Security Act. Anthem’s decision to deny the doctor’s in-network status was the result of a deliberate and principled reasoning process, having been based on the consideration of a vast number of documents offered by the employee, the court said. The court noted, however, that Anthem’s decision wasn’t supported by substantial evidence and that there weren’t any in-network providers offering the specialized treatment needed for the son ...