Health Insurance: Victory for Regional Oil Company
Our client was sued by GHI, a health insurer, for a refund of all health claims paid on behalf of our client's employees under its GHI health plan. GHI improperly claimed that the health plan should never have been issued and it sought a declaration from the court that would retroactively cancel the policy. Such a result would also have the effect of relieving GHI from having to pay another outstanding group of medical bills, in sum of $400,000, for the care and treatment of the wife of one of the employees. GHI also claimed that the employee whose wife is ill should not have health coverage, alleging that he was not a full time employee.
Quadrino Schwartz fought the case in state court initially, but then got it transferred to federal court due to the applicability of the federal law known as ERISA. After hard fought discovery battles, depositions, and intense investigation, we uncovered a series of facts favorable to our client and marshalled a series of legal challenges to GHI's attack.
Summary judgment motions and cross motions were filed, with various issues under ERISA being raised by the parties. After extensive legal briefing and argument, the federal court in Manhattan ruled in our client's favor, finding that GHI cannot recover any sums from our client for previously paid medical bills.