Goodman Receives Victory in CIGNA Insurance Case
Mark Goodman successfully represented a 12-year-old handicapped child in a dispute with a State Health Care Plan which had denied benefits for skilled nursing care in Atherton versus Quality Care Health Plan. After a two-day trial, Judge William Thursten, a Pulaski County, IL Circuit Judge, entered a declaratory judgment, which in essence deferred to the child’s treating pediatrician and nurses who testified about her needs.
The State of Illinois maintains a Health Care Plan for its employees, which is administered by CIGNA Healthcare. It was alleged that CIGNA and its medical directors wrongfully denied benefits under the Plan which were medically necessary. Repeated appeals using CIGNA’s internal procedures were unsuccessful, necessitating the lawsuit. This decision restored the level of nursing care to the amount of hours which were deemed necessary by the child’s physician.
Capes Sokol is a St. Louis-based law firm focusing on corporate and real estate matters; business, commercial, intellectual property, and product liability litigation; employment law; tax litigation and controversy; white collar criminal defense; trusts and estates; entertainment and media; and digital currency and blockchain technology.
The content on this post does not constitute legal advice, may be geographically or time sensitive, and is for informational purposes only. You should not act upon the information presented herein without seeking the advice of legal counsel.
The choice of a lawyer is an important decision and should not be based solely upon advertisements. Past results afford no guarantee of future results. Every case is different and must be judged on its own merits.