COVINGTON, KY (December 11, 2013) -- A Toyota worker has sued the car manufacturer for denying insurance claims for his children's hospital treatment for autism on the basis that it was "educational." The complaint was filed just months after GM and Chrysler began voluntarily offering their employees insurance coverage for the treatment, applied behavior analysis (ABA).
The complaint was brought in U.S. District Court by Joseph Lucas of Westmont, IL, against Toyota, which manages its North American manufacturing operations out of Erlanger, KY, and Anthem Blue Cross and Blue Shield, which administers claims for Toyota. Toyota self-insures its employee health benefit plan.
Lucas said his three children started receiving up to 30 hours weekly of ABA therapy for autism in 2011 from medical professionals at Nationwide Children's Hospital in Columbus, Ohio. Toyota denied his insurance claims on the basis the ABA services were considered “primarily educational in nature,” according to the complaint.
"Children’s Hospital is one of the leading pediatric hospitals in the United States. Children’s Hospital is not a school," the complaint said.
"To conclude...that Children’s Hospital is operating the Center for Autism Spectrum Disorders to impart substantive education to children with ASD...is to ignore the clear evidence about the hospital’s program," the complaint said. "Defendants’ conclusion demonstrates either a fundamental and quite basic misunderstanding of ABA services provided to children with ASD or is an intentional effort to avoid paying covered claims."
Represented by Robert Starks of Parry Deering Futscher & Sparks, PSC, Lucas seeks reimbursement with interest for his claims.