Partner Jim Murphy and Counsel Rosa Feeney Receive Winning Decision

Lewis Johs partner, Jim Murphy and counsel, Rosa Feeney successfully represented a Plaintiff in a case filed under ERISA seeking the payment by Plaintiff’s insurance carrier of approximately $500,000.00 in charges for physicians’ surgical services provided to Plaintiff. Plaintiff, whose surgery was pre-approved by the insurance carrier, underwent surgery and incurred a nearly $500,000.00 charge, only to learn that the insurance plan changed, and the carrier denied coverage. The carrier took the position that the underlying policy was amended shortly before the pre-approval was issued to delete coverage for services rendered by “out of network” providers. Since the physicians that provided the surgical services to Plaintiff were allegedly out of network the carrier refused to pay for the surgery, notwithstanding the pre-approval that was issued.

After exhausting all administrative remedies, Lewis Johs filed suit under ERISA in the Eastern District of New York, seeking payment of the surgical charges, statutory penalties and costs and expenses, including attorney’s fees. The suit ultimately resulted in a negotiated settlement with the insurance carrier pursuant to which the carrier agreed to satisfy, in full, all surgical charges billed to Plaintiff at a negotiated rate with the surgeons. No payments were required from Plaintiff under the terms of the settlement and his potential liability for the surgical charges was discharged and released.  


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