May 15, 2012 -- Two attorneys who’ve successfully sued insurance companies for failing to pay for autism treatments held a workshop in Portland last week to help families struggling with the same situation.
Megan Glor, a Portland attorney who represented Lisa McHenry’s family in a case against PacificSource, was successful in requiring the insurer to pay for Applied Behavior Analysis treatment.
Fairly intensive, this individualized treatment focuses on helping people adapt to their environment and different social settings.
Families facing the same dilemma, Glor said, can either pursue a class action lawsuit or individual action, adding that it’s difficult to get an administrative appeal or court order. “It’s so grossly unfair,” Glor said. “You’re up against huge adversaries.”
Seattle-based attorney Eleanor Hamburger has filed seven lawsuits against insurers in Washington for refusing to pay for autism treatments. Families heading toward similar litigation can file an appeal without the help of an attorney. “Chances are, you’re going to be denied,” Hamburger said.
In such cases, Glor’s office helps families determine a budget because they’re resources are usually stretched thin since they’re already paying for therapies such as Applied Behavior Analysis.
Glor also handles disability cases, which are different because there’s a pot of money being pursued by plaintiffs, while autism lawsuits usually require insurance companies to pay for therapy, she said.
In the McHenry case, the court found that Applied Behavior Analysis therapy was firmly supported by decades of research and was not experimental. Those findings destroyed many of the arguments made by insurance companies to deny coverage.
Although the McHenry’s also won a small amount of money from their lawsuit, the biggest benefit of the ruling was that PacificSource must now cover future treatments.
Glor advised people attending the workshop to make certain they keep their communication with insurance companies in writing and confirm verbal statements in the same manner. Families should also request their insurance plan documents, guidelines and standards and consider legal representation for their appeal, as it could be their only chance to establish a record if they end up in court.
Insurance companies have an obligation to communicate with their members and respond to information requests in a timely manner, said Glor, adding, “They have to act in good faith.”
There are also advantages to pursuing class action lawsuits against the insurance companies. Hamburger called that approach is a “big hammer” that can be useful in bringing about “system-wide reform.”
Rulings are expected this summer in some of the cases Hamburger has filed in Washington against insurance companies. If those rulings are successful, she may pursue similar action in Oregon, she said.
Read the earlier stories about autism that appeared in The Lund Report by clicking here.
