John W Leardi

Granting a motion to compel production of the full administrative record notwithstanding Horizon’s purported exhaustion defenses in an action challenging the denial of treatment for certain mental and substance abuse disorders.

Reversing an order of the District Court reinstating GEICO’s declaratory judgment claim and holding that New Jersey law requires that disputes regarding PIP claims be submitted to statutorily mandated arbitration.

Upholding claims under ERISA brought by a putative class of office-based surgical facilities challenging the systemic denial of facility fees.

Granting summary judgment in favor of a putative class of healthcare providers challenging the legality of cross-plan offsets under ERISA.

Upholding counterclaims brought by Defendant podiatrists against their former billing service for breach of contract and other claims rooted in negligent management of medical claims and appeals.

Granting motion for final approval of class action settlement creating a $33 million dollar fund to compensate chiropractors affected by Horizon’s improper bundling policies.

Denying a motion to dismiss a class action brought under ERISA challenging the use of “cross plan offsets” to recover alleged overpayments to providers

Certifying a class of chiropractic physicians who treated patients insured by Horizon and were denied payments for certain services.

Granting motion for reconsideration and vacating prior order compelling arbitration of a plaintiff healthcare provider’s claims under the terms of a participating provider agreement.

Certifying a class of out of network healthcare providers pursuing claims under ERISA relative to retroactive adverse benefit determinations issued by Defendants.

Conditionally certifying a class of out of network healthcare providers pursuing claims under ERISA relative to retroactive adverse benefit determinations issued by Defendants.

Awarding injunctive relief to a professional chiropractic association on behalf of its members against a private insurance carrier for violations of ERISA relative to the carrier’s retroactive recoupment practices.

Granting partial summary judgment to provider plaintiffs and holding that retroactive recoupments resulted in arbitrary and capricious adverse benefit determinations under ERISA.

Reversing the District Court’s dismissal of claims brought by a Durable Medical Equipment provider under ERISA challenging post payment audit and recoupment practices on behalf of a putative class of licensed healthcare providers.

Upholding claims brought by a statewide putative class of chiropractic physicians under ERISA and under state law challenging Horizon’s policy of “bundling” reimbursement for adjunctive procedures into reimbursements for chiropractic manipulation.

The Court denied Defendant Insurers' motion for summary judgment and helding that retroactive recoupments from providers based upon coverage determinations can amount to adverse benefit determinations under ERISA, thus giving rise to claims thereunder.

Upholding claims under ERISA asserted by a putative class of licensed healthcare providers and several chiropractic professional associations against United Healthcare and Health Net

Partial Dismissal of state law claims asserted in Counterclaim/Third-Party Complaint based upon ERISA Preemption

Upholding concurrent claims under Sections 502(a)(1)(B) and 503 of ERISA as adequately pled in an action challenging the manner in which Defendant calculates benefits payable to insureds with primary coverage through Medicare.

Upholding claims under ERISA asserted by a putative class of licensed healthcare providers and several chiropractic professional associations against Aetna.

Upholding claims under ERISA asserted by a putative class of licensed healthcare providers and several chiropractic professional associations against multiple Blue Cross Blue Shield licensees.

Dismissing plaintiff’s complaint alleging civil violations of RICO by a no-fault insurance carrier, independent medical exam referral services, and physicians who perform independent medical examinations of patients.

Holding that the laws governing the scope of chiropractic in New Jersey permit chiropractic manipulation of articulations beyond those of the spine when there is a causal nexus between a condition of the manipulated structure and a condition of the spine.