A 10th U.S. Circuit Court of Appeals panel on Wednesday seemed conflicted over whether Banner Health’s employee health insurance plan could deny coverage for a nurse’s knee surgery based on external medical guidelines rather than its own doctors’ opinions.  The Court also considered whether Banner was allowed to shorten the Statute of Limitations for ERISA claims (without giving notice to the insured).

Thomas Bulger of Silvern & Bulger, who argued for plaintiff Jennifer Weiss, told the three-judge panel during arguments held via teleconference that Banner’s decision was arbitrary and capricious in violation of the Employee Retirement Income Security Act of 1974 because the company simply ignored opinions that went against its bottom line.

The Court concluded that Banner could not shorten the SOL without notice in this case (in an important win for Colorado workers).  Unfortunately, the Court also upheld Banner's denial of the surgery.  This case is an important reminder that ERISA cases are complex, and often require an experienced lawyer.    For the full article click here