Attorney, Goldberg Segalla LLP

Recently, the Second Circuit in Krauss v. Oxford Health Plans, Inc. et al., affirmed the lower court's dismissal of allegations that the health insurance plan violated Employee Retirement Income Security Act (ERISA) and Women's Health and Cancer Rights Act (WHCRA) by declining to fully reimburse medical expenses incurred by participant for bilateral breast reconstruction after breast cancer surgery. The Court held that the decision to pay the participant according to the usual and customary rate was within the administrator's discretion and the denial of compensation for private nursing costs did not violate ERISA. Further, under a separate de novo review, the plan's reduced payment did not violate WHCRA. For more information, contact Jeff Kingsley or Kimberly Whistler.