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

Feb. 21, 2020, 4:48 PM

A federal district court in New York denied a union welfare fund’s motion to dismiss an employee’s ERISA action for unpaid benefits on behalf of his minor child. The child had a right frontal craniotomy for a cystic necrotic mass, an intradural frameless stereotactic procedure, a titanium cranioplasty, an intraoperative ultrasound, and an intraoperative CT scan, performed by the only qualified pediatric neurosurgeon with privileges at the hospital to which the child was admitted, after receiving authorization from the fund. The employee stated a plausible claim for denial of benefits based on his allegations that the fund’s decision to pay...

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