Today five Justices of the United States Supreme Court reversed a California Federal District Court Judge's decision vacating a Clean Water Act rule enacted by the Trump Administration EPA.
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GreenStreet Cafe’s lunchtime rush had just ended on a recent afternoon, but the clamor of dishes in the kitchen hadn’t ceased. Business has finally picked up at the popular eatery in Miami’s Coconut Grove, known for its red velvet outdoor couches, a place where athletes and artists have dined over the past 30 years.
Still, owner Sylvano Bignon is heated.
A judge in March dismissed his lawsuit against GreenStreet’s insurers, which refused to pay for pandemic-related losses. Shutdowns and other restrictions cost him $2.5 million, Bignon said, and he had been hoping to get $1 million from the insurer. But because the owner’s insurance only covered “physical loss or damage,” the judge ruled, the Covid claim did not apply.
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On this week’s episode, Carla DewBerry and Sarah Carlins discuss a recent California Federal District Court decision in
David Wit v. United Behavioral Health, in which the court found that the defendant insurer violated ERISA by improperly denying behavioral health claims submitted by over fifty thousand beneficiaries. The presenters discuss the ways in which the insurer’s inadequate internal guidelines for the processing of behavioral health treatment claims led to the decision, and what this might mean for the design of behavioral health claims processing guidelines under ERISA regulated health plans in the future.