HARRISBURG, PA (October 4, 2013) -- A Pennsylvania court's ruling that families have no right to appeal adverse decisions on insurance claims - but insurance companies do, is "absurd and intolerable" and should be reversed, Autism Speaks has argued in a friend-of-the-court brief filed with the Pennsylvania Supreme Court.
The case (Anthony Burke v Independence Blue Cross) involves a six-year-old boy with autism whose family was denied coverage for ABA provided by his parochial school. The family won the case in Common Pleas trial court in 2011, but the decision was later overturned in Superior Court on appeal which found that only insurance companies, and not families, have the right to contest decisions.
The Autism Speaks Legal Resource Center (ASLRC) filed a friend-of-the-court brief on behalf of Burke before the Supreme Court, which is considering only the issue of whether families enjoy the same right as insurance companies to bring appeals. Dan Unumb, the executive director of the ASLRC, worked with the Philadelphia law firm of Dechert LLP in preparing the brief which was filed by lead counsel Cheryl Krause.
The appeals court on its own initiative, and without briefings or arguments, reached its decision based on a "novel and unsupportable reading" of Pennsylvania's 2008 autism insurance reform law, Autism Speaks argued. The result could have a "potentially devastating impact to the over 20,000 Pennsylvanians struggling with autism," according to the brief.
The 2008 law states that the right of appeal was provided to “[a]n insurer or covered individual or an authorized representative”.
In enacting the 2008 law, Autism Speaks argued, "the Legislature intended to both end discrimination by insurers in providing coverage for autism treatment and prevent insurers from shifting their responsibilities under the law to the public purse. A meaningful right to judicial appeal by policyholders is essential to carry out these intentions."
The 2008 law was designed to serve as a national "gold standard" which included a superior review process. At no time, did lawmakers even raise the issue of denying families a right of appeal, the brief notes.
"Individuals with autism are as entitled to access to the courts as are insurance companies," Autism Speaks argued, urging the Supreme Court to return the case to Superior Court for a full appeal hearing of the trial court decision.