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Brooklyn Law School Files Federal Complaint Challenging Private Health Insurance Company

September 30, 2016

The Disability and Civil Rights Clinic at Brooklyn Law School recently filed a complaint against two health insurance companies, Group Health Incorporated (GHI) and EmblemHealth. The complaint alleges that GHI and EmblemHealth together violated a contract with a person with a disability that provided her with private duty nursing services. The complaint also alleges that GHI and EmblemHealth violated Section 1557 of the Affordable Care Act (ACA) by refusing to provide the plaintiff with private duty nursing services in the community, as well as in the plaintiff’s home. The complaint was brought as a class action, given that there are many other people who may be unable to receive private duty nursing services to support them in the community.

The named plaintiff is a person with a significant disability who requires the assistance of a private duty nurse due to complex medical needs. The plaintiff wants to participate in a day habilitation program in the community, which offers opportunities for skills development and socialization with persons in the community. The plaintiff must do so with the assistance of a nurse. The complaint alleges that the plaintiff cannot do so because the defendant refused to pay for the nursing services, stating that the plaintiff’s Comprehensive Benefits Plan only covers nursing services rendered “at home or at a hospital.”

The facts alleged in the complaint may have important implications for persons with disabilities with significant health care needs who pursue employment in the community. If this population cannot receive necessary nursing services outside the home under the defendant’s benefits plans, and if provisions like those described are widespread in benefit plans, they may be rendered unable to work in the community.

For more information, read the publically available complaint.