Healthcare & Pension Plans

For the past decade, CGL has been involved in prosecuting actions on behalf of subscribers and providers against insurance companies for inadequate reimbursements for "out of plan" charges for medical care.

United Health Care

In 2008, CGL was counsel in a case in which United Healthcare paid $350 million to a settlement class of subscribers and providers for inadequate healthcare reimbursements and agreed to change its calculation techniques. In 2011, after extensive hearings, the United States District Court for the Southern District of New York approved that settlement, which CGL and its clients had supported from the outset.

Morris v. Directors Guild of America – Producer Health Plan

Jonathan Cuneo and Matthew Miller recently represented documentary filmmaker Len Morris (director of Stolen Childhoods, an award winning documentary about child labor) in an ERISA action concerning eligibility for pension and health benefits with the pension and health plans associated with the Directors’ Guild of America.  Morris v. Directors Guild of America – Producer Health Plan (D. Mass. 2014).  The case raised questions of plan interpretation particularly relevant to directors engaged in nonprofit and public interest film making.  The matter was resolved with a confidential settlement.

Blue Cross & Blue Shield

Mr. Cynkar, while at another firm, was part of a team representing the Blue Cross & Blue Shield Association challenging Medicare regulations promulgated under a federal statute that makes Medicare a payer secondary to private insurers in certain circumstances, and requires reimbursement of Medicare when it has improperly made a primary payment.

Mr. Cynkar successfully argued Health Insurance Association of America v. Shalala in the U.S. Court of Appeals for the DC Circuit that regulations that purported to allow Medicare to secure reimbursement from the third party administrators of insurance plans, and to ignore the claims filing deadlines in insurance contracts, was unlawful.

New York Life Insurance

Mr. Cynkar, while at another firm, was lead counsel representing New York Life in New York Life Insurance Co. v. United States, a case against the federal government to recover medical expenses of New York Life’s older agents that should have been paid by Medicare.

New York Life had erroneously paid for the medical expenses of its older agents and sought reimbursement from Medicare. The Court of Appeals for the Federal Circuit held that these agents were not “employees” under the Medicare statute, so that New York Life was entitled to reimbursement. The case settled with a significant payment by the federal government to New York Life.

ERISA Settlement

The firm was co-lead counsel in this class involving all 21,000 salaried retirees of McDonnell Douglas Corporation in seeking to reinstate their rights to health and welfare benefits after termination by the corporation. The firm succeeded in obtaining a settlement in the approximate amount of $450 million on behalf of the retirees.

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