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The Wagner Law Group

The Wagner Law Group is a nationally recognized practice in the areas of ERISA and employee benefits, estate planning, employment, labor and human resources and investment management.

 

 

Established in 1996, The Wagner Law Group is dedicated to the highest standards of integrity, excellence and thought leadership and is considered to be amongst the nation's premier ERISA and employee benefits law firms. The firm has eight offices across the country, providing unparalleled legal advice to its clients, including large, small and nonprofit corporations as well as individuals and government entities worldwide. The Wagner Law Group's 35 attorneys, senior benefits consultant and seven paralegals combine many years of experience in their fields of practice with a variety of backgrounds. Nine of the attorneys are AV-rated by Martindale-Hubbell and six are Fellows of the American College of Employee Benefits Counsel, an invitation-only organization of nationally recognized employee benefits lawyers.  Five of the firm's attorneys have been named to the prestigious Super Lawyers list for 2018, which highlights outstanding lawyers based on a rigorous selection process. The Wagner Law Group is certified as a woman-owned and operated business by the Women's Business Enterprise National Council. 

 

 

 

Contact Info

The Wagner Law Group

 

  Integrity | Excellence

  

Boston 

Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110

 

Washington, D.C.

Tel: (202) 969-2800

 

Fax: (202) 969-2568

 800 Connecticut Avenue, N.W.

Suite 810

Washington, D.C. 20006

 

Chicago

Tel: (847) 990-9034

Fax: (847) 557-1312

190 South LaSalle Street

Suite 2100

Chicago, IL 60603

 

  

Palm Beach Gardens 

Tel: (561) 293-3590
Fax: (561) 293-3591
7108 Fairway Drive
Suite 125
Palm Beach Gardens, FL 33418

   

Tampa

Tel: (813) 603-2959

Fax: (813) 603-2961

101 East Kennedy Boulevard

Suite 2140
Tampa, FL  33602 

  

San Francisco

Tel: (415) 625-0002

Fax: (415) 358-8300

300 Montgomery Street

Suite 600

San Francisco, CA 94104

  

St. Louis

Tel: (314) 236-0065

Fax: (314) 236-5743
25 W. Moody Avenue
St. Louis, MO  63119 

 

Lincoln, MA

Tel: (617) 532-8080

Fax: (617) 532-9090

55 Old Bedford Road

Lincoln, MA 01773

 

 

www.wagnerlawgroup.com

 

 

 

  Agreement Required District Court to Consider Information from Post-Complaint Internal Review Process

 

September 20, 2018

 

 

 

The First Circuit Court of Appeals, in Doe v. Harvard Pilgrim Health Care ("HPHC"), has held that the district court erred in upholding a benefit claim denial because it neglected to enforce an agreement between the parties to supplement the record to include information generated during a post-complaint benefits review.

 

Background. The plaintiff, a college student who suffered from depression and anxiety, received inpatient treatment for several months during 2013 in a residential mental health facility. She was insured under the her father's employer-provided group health plan. The defendant, HPHC, subsequently reviewed the plaintiff's claim for benefits and agreed to cover most of the residential treatment except for a period of time that it determined was not medically necessary.

 

Following several unsuccessful internal administrative appeals over the denial of coverage, the plaintiff sued HPHC in federal district court. During the litigation process, the parties agreed that the plaintiff would be allowed to complete another internal administrative review of her claim, and that the information generated during that review would become part of the record before the district court.

 

The litigation resumed after HPHC upheld its benefit denial following the completion of the post-complaint internal administrative review process. The district court ultimately sided with HPHC and granted its motion for summary judgment. However, in reaching this decision, the district court did not consider the additional information provided by the plaintiff during the post-complaint internal administrative review process. In response, the plaintiff appealed to the First Circuit.

 

First Circuit. The First Circuit reversed the district court's decision, finding that "the administrative record upon which the district court based its findings should have been supplemented." The First Circuit noted that HPHC "explicitly agreed - twice in a two-page document" that information submitted or generated as part of the plaintiff's pending administrative review would be included in the record before the court. Accordingly, the First Circuit held that neither First Circuit precedent nor ERISA precluded the district court from enforcing the agreement.

 

 

 

 

 

 

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This Newsletter is provided for information purposes by The Wagner Law Group to clients and others who may be interested in the subject matter, and may not be relied upon as specific legal advice.  This material is not to be construed as legal advice or legal opinions on specific facts. Under the Rules of the Supreme Judicial Court of Massachusetts, this material may be considered advertising.