Health Care Plan Provider’s Conspiracy / Scheme to Underpay Insurance Claims Submitted by Providers and Beneficiaries Not “Errors or Omissions” and Reinsurance Policies Covering Professional Liability Policies Not Implicated

Reinsurers Not Responsible for Coverage of Claims Against Medical Insurance Claims Service Brought Under Conspiracy Theory Pursuant to RICO

Amicus Curious

In June, a Court of Appeals panel in Indiana issued an unpublished, and therefore, non-binding, opinion speaking to an issue that has significant relevance for several of our insurer and employer clients, and third-party claims administrators with whom we work.

The insurance coverage case, Wellpoint, Inc., et al. v. National Union Fire Ins. Co., et al, arose out of allegations in the underlying lawsuits that a network of health insurance companies, Wellpoint, Inc. and Wellpoint Health Networks, Inc., eventually merged into Anthem (hereafter referred to simply as Wellpoint unless otherwise indicated), conspired with other health insurance companies to deny medical providers’ and doctors’ claims for reimbursement of health care services.

The Underlying Lawsuits – The Alleged Conspiracy 

The plaintiffs in the first underlying suit were members of a health plan issued by Wellpoint, which permitted beneficiaries to use the services of out-of-network providers.  The plaintiffs filed an action in Connecticut…

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