Case: Health & Welfare Benefits/Knee Replacement (D. Mass.)

April 6, 2021, 11:20 PM

An action against Aetna, Inc., and Aetna Life Insurance Company predicated on a denial of coverage for customized knee replacements survived a motion to dismiss in the U.S. District Court for District of Massachusetts. John M. Schaub pleaded sufficient facts to state claims for breach of fiduciary duty and for equitable relief under ERISA, the court said. According to the complaint, Aetna at one time covered the Conformis iTotal Knee Replacement System but later classified it as “experimental” and “investigational.” Schaub says it stopped coverage to save money, not because it was best for its members. The court granted Aetna’s...

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