Bynum v. Cigna Healthcare of North Carolina, Inc. 287 F.3d 305 (4^th Cir. 2002) – decided April 19, 2002 - United States Court of Appeals for the Fourth Circuit – Robert E. Hoskins

This case is one of my favorite cases of the thousands that I have handled in my career. I am so fond of this case because of the reason I agreed to represent the plaintiff in the first place. Bynum involved a coverage issue involving an ERISA governed health insurance plan. The infant, Katrina Bynum, had a misshapened skull and her doctor prescribed a cranial band (DOC). The cost of the device was $3,000.00. The insurer, Cigna, denied coverage asserting that the prescribed procedure was cosmetic. The family resided in North Carolina and could not find a lawyer who would take their case because of the small amount of money at issue. I agreed to handle the case only to help the family. I had no intention of making any money on the case. I tried desperately to get the case settled to no avail. Cigna fought me “tooth and nail”. I filed the case in South Carolina and Cigna tried to move the case to North Carolina. The Honorable G. Ross Anderson, Jr. denied Cigna’s motion to transfer the case. (Click here to see the order denying Cigna’s motion.) Thereafter, the parties argued the merits and the district court reversed Cigna’s claim decision and ordered Cigna to pay for the prescribed treatment. (Click here to see the district court’s order) Cigna appealed the decision to the United States Court of Appeals for the Fourth Circuit. The parties had to travel to Richmond, Virginia for oral argument. The Fourth Circuit affirmed the district court in reversing Cigna’s claim decision. The court held that the treatment was covered under the Cigna policy and did so by way of a published decision. (Click here to see the Fourth Circuit’s decision) The Fourth Circuit took care to note that Cigna had a significant conflict of interest in making its claim decision even though the procedure at issue only cost $3,000.00. It was apparent to the Fourth Circuit that Cigna had chosen Bynum’s cause to appeal as a “test” case. Apparently, Cigna was receiving many claims for coverage for the prescribed procedure and it was intent on denying all of them. Likely much to Cigna’s dismay, the Fourth Circuit assured that Cigna would pay for the procedure from the point of the decision forward absent a change in the language of its plan documents. So, the case evolved from me being intent on getting it settled as quickly as possible to help the family to a “quest”, of sorts, for both sides. Instead of helping just the family, we were able to get coverage for this procedure for many families who reside in the Fourth Circuit. In fact, in a sort of “domino” effect, the decision actually also helped folks who were not insured with Cigna. In 2006, the South Carolina Court of Appeals, relying solely on Bynum, held that coverage for the prescribed procedure is available to participants in the State of South Carolina’s self-funded health plan. (Click here to see the decision in James v. State of South Carolina Insurance Program, 371 S. C. 637; 640 S.E.2d 474; 2006 S.C. App. LEXIS 231 (Ct. App. SC 2006).) As of March of 2008, the Bynum decision had been cited in court opinions or law review articles over 30 times including by the United States Court of Appeals for the Tenth Circuit.