San Jose Neurospine sues Cigna Health and Life Insurance Company to recover ERISA benefit claims

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On Monday, the California Spine and Neurosurgery Institute filed a lawsuit in the Northern District of California against Cigna Health and Life Insurance Company for failing to pay insurance claims under the Employee Retirement Income Security Act (ERISA).

According to the complaint, California Spine and Neurosurgery Institute is a California-based company doing business as San Jose Neurospine (SJN). Complaint says SJN specializes in sophisticated surgical procedures involving minimally invasive spinal procedures

complex reconstruction of the spine. In addition, the complaint states that CIgna Health and Life Insurance Company is a Connecticut-based insurance company and, among other things, an insurer and administrator of ERISA-covered health benefit plans.

The complaint states that from April 1, 2015 to November 22, 2021, SJN provided eight surgical services to seven different patients insured under Cigna’s health benefit plans. SJN alleges that prior to each of these procedures, office staff contacted Cigna to verify the patient’s coverage before performing the surgery. The complaint alleges that Cigna confirmed coverage for each of the patients under an ERISA plan for an out-of-network provider. Once SJN received verification that the specified procedure was covered by a Cigna ERISA plan, it provided the surgical services to the patient.

However, SJN alleges that Cigna refused to pay the claims for the eight surgeries and failed to provide an adequate explanation. Accordingly, SJN has commenced this lawsuit to recover payment of ERISA plan benefit claims against Cigna and attorneys’ fees. SJN is represented by Williams Wollitz Hakakian PC.

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