Rula A.-S. v. Aurora Health Care

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Rula A.-S. v. Aurora Health Care (U.S. Dist. Ct. for the Eastern Dist. of Wisconsin, case no. 20-CV-1816-JPS , July 22, 2021). In response to Defendant’s motion to dismiss Plaintiff’s summary judgement motion under its ERISA Parity Claim, Judge Stadmueller ruled that Plaintiffs have sufficiently pleaded the Parity Claim for relief both facially and as applied.  The self-funded health plan denied coverage for care at a residential treatment center (RTC) because the facility identified itself as a “school.”  But the Judge noted that the RTC also was licensed as a residential treatment facility by the state of Utah — which means the denial of care could be a possible parity violation.  Judge Stadmueller also rejected the Defendant’s argument that Plaintiff’s Parity Claim is duplicative of its ERISA Recovery of Benefits Claim.  In making this decision, the Judge references prior case law that holds “Plaintiffs are entitled to plead alternative theories of recovery at this early state of the lawsuit.”   However, the Judge did dismiss a few of the Plaintiff’s claims related to “remedies of disgorgement, accounting, restitution, and equitable estoppel”.

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