Insurer’s exclusion for outdoor mental health programs rejected

Workplace Issues

By Mark D. DeBofsky

Mark D. DeBofsky is a name partner of DeBofsky, Sherman & Casciari P.C. He handles civil and appellate litigation involving employee benefits, disability insurance and other insurance claims and coverage, and Social Security law. He can be reached at mdebofsky@debofsky.com.

Posted February 27, 2019 3:27 PM

One of the hottest current topics in Employee Retirement Income Security Act litigation concerns medical insurance coverage for residential treatment of behavioral health disorders.A recent Utah federal court ruling, Michael D. and Madeline D. v. Anthem Health Plans of Kentucky Inc., 2019 WL 586673 (D. Utah, Feb. 13, 2019), is a prime example. The lead plaintiff, “Mike,” filed suit seeking reimbursement for wilderness therapy and other residential treatment provided to Mike’s daughter Maddie, who suffered …

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Lawyer erred on personal representative after learning defendant was dead

Answering a question certified for immediate appeal in a case where the plaintiff didn’t know the defendant was dead when the lawsuit was filed, the Illinois Appellate Court concluded that the maneuver used by plaintiff’s attorney to rectify the problem — having his secretary appointed as “personal representative” of the decedent’s estate under Sec. 13-209(c) of the Code of Civil Procedure and then naming her as defendant in an amended complaint — was the wrong move.
By Steven P. Garmisa
High court says judge erred in trying to ‘rehabilitate’ juror

Guided by the principle that the purpose of voir dire is “investigation, not persuasion” — and bolstered by scholarly commentary that included a 2023 Chicago-Kent Law Review article — the Oregon Supreme Court critiqued a judge’s efforts to “rehabilitate” a prospective juror.
By Steven P. Garmisa
Current proposal isn’t enough to stem mushrooming MDLs

Assigned a multidistrict litigation (MDL) that grew from a couple of dozen cases to nearly a thousand, and observing cases that were not properly investigated or attended to by counsel, a judge in the Middle District with Georgia expressed a famous frustration with a process that has only gotten worse in the eight years since.
By Patrick Eckler
Manufacturer claims immunity for rubber bullet injury

Claiming immunity under the Protection of Lawful Commerce in Arms Act when Eduardo Santos sued for severe injuries allegedly caused by a police officer who shot him in the face with a rubber bullet, Defense Technology — the company that manufactured the “kinetic impact projectile” and KIP launcher — argued the statute’s product-liability exception didn’t apply.
By Steven P. Garmisa
A judge’s ethical imperative: Follow the law or face the JIB

“The law that applies to this case is stated in these instructions, and it is your duty to follow all of them.” So states Illinois Pattern Jury Instruction 1.01(2), which the judge reads to the jurors in every criminal case before the jury begins its deliberations. If we expect jurors to follow the law, we surely must expect judges to lead by example and do the same thing.
By David P. Sterba
Defendant challenges ‘judicial legislation’ in suit over insider trading

Accused of insider trading, Michael Shvartsman argued this offense is “criminal law made by judges” that violates Article I of the U.S. Constitution and the non-delegation doctrine.
By Steven P. Garmisa
Court assesses offsets against employee’s underinsured claim

The 7th U.S. Circuit Court of Appeals, construing Illinois law, recently held that an employee injured in an automobile accident was entitled to recover underinsured coverage from his employer’s automobile liability policy, subject to certain reductions.
By Don R. Sampen
Iowa Supreme Court blocks testimony about business records

In a case where prosecutors relied on the hearsay rule’s business-records exception to justify testimony about documents that weren’t admitted into evidence, the Iowa Supreme Court, citing decisions from across the country, reversed because “the rules of evidence create a ‘business records exception’ to the rule against hearsay and not a ‘testimony about business records exception.’”
By Steven P. Garmisa