Westlaw News

10th Circuit split over Banner's power to deny coverage based on external guidelines

A 10th U.S. Circuit Court of Appeals panel on Wednesday seemed conflicted over whether Banner Health’s employee health insurance plan could deny coverage for a nurse’s knee surgery based on external medical guidelines rather than its own doctors’ opinions.

Thomas Bulger of Silvern & Bulger, who argued for plaintiff Jennifer Weiss, told the three-judge panel during arguments held via teleconference that Banner’s decision was arbitrary and capricious in violation of the Employee Retirement Income Security Act of 1974 because the company simply ignored opinions that went against its bottom line.

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