Facts

Sanjiv Goel M.D. Inc. sued Motion Picture Industry Pension and Health Plan, involving a contract dispute.

PLAINTIFF'S CONTENTIONS:
Plaintiff admitted the subject patient, who was an enrollee of defendant's health plan, on two separate dates in October 2012. Plaintiff limited the disclosure of the patient's identification information pursuant to the Health Insurance Portability and Accountability Act. Plaintiff rendered the medically necessary care to the plaintiff and charged defendant $166,268 for the services, but defendant only paid $660 of the total. Defendant refused to pay the balance, prompting plaintiff to sue defendant for breach of contract and quantum meruit. Plaintiff argued defendant's refusal to pay was arbitrary and/or capricious.

DEFENDANT'S CONTENTIONS:
Defendant denied the allegations and asserted various affirmative defenses.

Damages

Goel sought recovery of the principal sum of $165,608, plus interest and reasonable attorney fees and costs.

Result

The court found Goel's claims were preempted by ERISA and the matter proceeded in a bench trial. Then, finding MPI did not abuse its discretion in denying Goel's claims, it ultimately entered judgment in favor of the defense.

Other Information

FILING DATE: March 18, 2014.