“FA” are the privacy-protecting initials for a three-year-old boy, one of whose parents works for Neiman Marcus, making FA a beneficiary of the Neiman Marcus Group LLC Health and Welfare Benefit Plan. The plan, governed by the Employment Retirement Security Act of 1974 (ERISA), provides health benefits—although apparently not complete benefits, as the plan has refused to pay for two different treatments for FA’s autism spectrum disorder (ASD).
The class for this action is all persons who are participants in or beneficiaries of the Neiman Marcus Group LLC Health and Welfare Benefit Plan in effect or renewed on or after October 3, 2009 and/or the relevant limitations period who receive or require Applied Behavior Analysis (ABA) therapy and/or Neurodevelopmental Therapy (NDT) (speech, occupational and physical therapies) for the treatment of developmental mental health conditions, including autism spectrum disorder.
According to the complaint, FA needs Neurodevelopmental Therapy (NDT), which includes speech, occupational, and physical therapies to treat developmental health conditions, and Applied Behavior Analysis (ABA) therapy, which can improve the health and well-being of persons with developmental mental health conditions such as ASD.
Unfortunately, the complaint alleges that the plan excludes coverage of the NDT and ABA therapies to treat developmental mental health conditions.
The complaint cites the federal Mental Health Parity Act, which took effect on October 3, 2009 and was intended to reduce discrimination in health coverage against mental health and addiction problems. The act requires plans to cover “all outpatient, intermediate and inpatient services that are medically necessary to treat mental health conditions, if it also covers those services for medical/surgical conditions.” It also requires that limitations on services to treat mental health conditions are “no more restrictive” than those applied to medical and surgical benefits.
According to the complaint, the plan says it covers only speech, occupational, and physical therapy for “non-chronic conditions, and acute illnesses and injuries” but does not cover those same services for developmental disabilities like ASD. This, the complaint alleges, is precisely against the “parity” for mental health services required by law.
The complaint claims that this selective exclusion violates the Mental Health Parity Act, the Affordable Care Act, and implementing regulations under ERISA. The complaint asks that the court provide a clarification of rights to benefits under the plan and stop the plan from continuing to exclude NDT and ABA for mental health conditions.
Article Type: LawsuitTopic: Employment
Most Recent Case Event
Neiman Marcus Health Plan Mental Health Parity ERISA Complaint
October 24, 2017
According to the complaint, three-year-old FA has autism spectrum disorder (ASD) and needs Neurodevelopmental Therapy (NDT) and Applied Behavior Analysis (ABA) therapy. Unfortunately, the complaint alleges that the health plan he’s on covers only speech, occupational, and physical therapy for “non-chronic conditions, and acute illnesses and injuries” but does not cover those same services for developmental disabilities. This, the complaint alleges, is a violation of federal ERISA, the Affordable Care Act, and the Mental Health Parity Act, which requires that limitations on services to treat mental health conditions are “no more restrictive” than those applied to medical and surgical benefits.
neiman_marcus_erisa_complaint.pdfCase Event History
Neiman Marcus Health Plan Mental Health Parity ERISA Complaint
October 24, 2017
According to the complaint, three-year-old FA has autism spectrum disorder (ASD) and needs Neurodevelopmental Therapy (NDT) and Applied Behavior Analysis (ABA) therapy. Unfortunately, the complaint alleges that the health plan he’s on covers only speech, occupational, and physical therapy for “non-chronic conditions, and acute illnesses and injuries” but does not cover those same services for developmental disabilities. This, the complaint alleges, is a violation of federal ERISA, the Affordable Care Act, and the Mental Health Parity Act, which requires that limitations on services to treat mental health conditions are “no more restrictive” than those applied to medical and surgical benefits.
neiman_marcus_erisa_complaint.pdf