On Tuesday, Advanced Physical Medicine of Yorkville, Ltd. filed a complaint in the Northern District of Illinois against Cigna Health and Life Insurance Company and Ritchie Bros. Auctioneers (America), Inc. for Cigna’s alleged failure to cover the costs of a patient’s covered healthcare appointments and treatments under the Employee Retirement Income Security Act (ERISA).
Between January and March 2021, a patient of Advanced Physical Medicine had 17 visits for chiropractic manipulative treatments and therapeutic exercises which were covered under a Cigna healthcare plan. The patient is an assignee of the plaintiff, who has the right to “pursue recovery of benefits due under the Plan for the Services and to bring derivative actions on his behalf to recover such benefits.” The plaintiff claimed that Cigna agreed to pay for these services but “at an incorrect and discounted amount.” The plaintiff appealed twice to Cigna and received confusing responses. On November 4th, 2021, Advanced Physical Medicine appealed for a third time for the outstanding balance of $8,147.92, to which they still have not received a response.
The plaintiff is hoping to receive payment as legally owed under ERISA for the patient’s appointments and treatments as Cigna “failed to provide the specific reason or reasons for denial” and did not “provide Plaintiff with the reviewing physician’s report or any communication relevant to the Patient’s adverse benefit determination upon written request” as required by law. Thus, Advanced Physical Medicine is suing to recover benefits and statutory penalties.
Advanced Physical Medicine is seeking statutory damages of $110 dollars per day starting from July 26th, 2021 until the documents are delivered, attorney’s fees and costs, and other relief.
The plaintiff is represented by the Law Offices of McLaughlin & Associates, P.C.
