Lexology May 10, 2022
Plan sponsors must understand the intersection of claims procedures under the Employee Retirement Income Security Act (ERISA), and the mandate to keep individually identifiable health information confidential, under the Health Insurance Portability and Accountability Act (HIPAA). This understanding is particularly important when plan sponsors receive letters or requests for information from third parties. The U.S. Court of Appeals for the Fourth Circuit attempts to reconcile the two procedures in the case of Kenneth Wilson v. UnitedHealthcare Insurance Company, No. 20-2044.
Facts of the Case
Kenneth Wilson’s minor son, JW, received residential mental health treatment. The insurer denied coverage for the treatment as medically unnecessary. The Wilsons hired a lawyer to contest the denial of coverage, who requested all relevant documents...
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