Ms. Berkowitz litigates complex healthcare disputes throughout the country. Representative examples include:
Humana v. Nguyen
Shortly after the district court granted summary judgment against an ERISA plan participant in favor of his insurance company, trial counsel retained us to brief (Our Opening Brief | Our Reply) and argue (Oral Argument Audio) the appeal. Over a vigorous dissent, a panel of the Fifth Circuit reversed, adopting the position advanced by Ms. Berkowitz that certain ministerial tasks commonly performed by health insurance companies do not necessarily support fiduciary standing under ERISA (Opinion). This 2-1 decision resolved significant confusion within the Fifth Circuit about who can sue plan participants.
Montanile v. Board of Trustees [Read more here]
After firm lawyers preserved the key legal issue through briefing and argument in the Eleventh Circuit, Ms. Berkowitz and her team persuaded the U.S. Supreme Court (Petition) to hear this important case about the scope of reimbursement rights available to federally regulated health insurance plans. In an 8-1 decision authored by Justice Thomas (Opinion), the Court adopted the position advanced by our firm’s merits briefing (Our Opening Brief | Our Reply) and argument.
Mallon v. Trover Solutions, Inc.
We represented lead plaintiffs in this putative class action in an appeal presenting important legal questions about the scope and mechanics of ERISA’s administrative exhaustion requirement. Ms. Berkowitz worked with a team of firm lawyers to prepare our Opening Brief and took the lead on our Reply Brief.
Catastrophically Injured Individual v. Health Plan Fiduciaries
Ms. Berkowitz and a team of firm lawyers represented a heroin addict who was rendered quadriplegic in a terrible car accident. Insisting that the accident was not covered, our client’s health plan refused to pay for any of the $1.3 million in medical bills resulting from the accident or to cover any future medical care. Without any need for litigation (Our Administrative Letter-Brief) (redacted), Ms. Berkowitz and her team were able to persuade the health plan to do an about-face and cover all relevant medical expenses.
Ms. Berkowitz represents several renowned substance abuse treatment facilities in connection with their complex and high-value disputes with health insurance companies. Ms. Berkowitz also advises these facilities on a variety of business matters with significant legal components, including revenue cycle management and regulatory compliance.