News

Mark Goodman gets victory in insurance case, proving that CIGNA had wrongfully denied coverage

(St. Louis, MO) – Mark Goodman of Capes, Sokol, Goodman & Sarachan, P.C.
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.

 

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