Morgan Manley’s representation of the breast cancer survivor seeking help at the New York Civil Court was supposed to end on the September morning they met. Yet, the “profound injustice” of the woman’s case—the $10,000 debt her insurer alleged she owed for a reconstruction her doctor told her would be covered under her policy—convinced the 3L Fordham Law student not only to represent the woman via the Consumer Litigation Clinic but work throughout winter break to ensure a successful resolution to her case.
The insurer’s decision to subject the woman’s claim to a $2,500 annual cap for surgery in 2009 violated its own policy (which did not mention a cap for reconstruction) and the federal Employee Retirement Income Security Act (ERISA), which requires that a policy that covers a mastectomy must also cover reconstruction, Manley argued, persuading the insurance company to settle the woman’s federal suit in the process.
Manley, with the aid of Clinical Associate Professor Marcella Silverman, succeeded in getting the insurer to reimburse her client the $1,700 she paid her doctor for the reconstruction, pay the doctor $5,000 for his claims, and pay another $2,800 for attorney fees. The doctor accepted that reduced payment, dropping a separate civil court suit against Manley’s client.
Obtaining justice for her client was a “humbling experience,” Manley said. The woman, who is in her 60s and diabetic, would have been paying off her debt associated with the reconstruction for the rest of her working life had the clinic not taken her case, Silverman added.
“She kept saying to us ‘Congratulations’ like we were the ones who should be celebrating and not her, like we weren’t just advocates but her teammates,” Manley recalled of the client. “That was really rewarding.”
The case was for the Consumer Litigation Clinic the first involving medical debt, Silverman said, noting she and Manley were unfamiliar with ERISA laws prior to the case. The result is even more impressive considering the fact that Manley researched, wrote, and submitted her complaint in less than a week over winter break in early January.
After filing a motion for discovery in November and receiving a trickle of documents, the case took an urgent turn on January 10 when Manley received paperwork that the insurer’s final administrative denial was nearing the six-year statute of limitations for a court challenge. She sat on Silverman’s office floor combing through the statutes in the days that followed. The professor’s unfailing work ethic and support motivated Manley to work harder and longer in developing her client’s case, the student reflected.
So did the client’s case, which Silverman described as “a labor of love” for Manley.
The client advised her doctor she could not afford to pay for the reconstructive surgery on her $35,000 annual salary, and would have the reconstruction only if she did not have to pay. Her doctor assured her he had received pre-approval for her reconstructive surgery from the insurance company. That did not mean the insurance company would cover the entire surgery cost, Silverman noted.
After the insurer capped her surgery costs, the client used borrowed funds to pay the doctor $1,700. The doctor filed a civil suit against her in 2014, seeking to recoup the rest of the outstanding debt.
“This woman would have fallen between the cracks” without legal representation, Professor Silverman said. “She didn’t have the money to hire a lawyer. This was a not a case that she could have successfully navigated herself with the complications of the insurer.”
Manley met the client while serving as a volunteer lawyer for the day under Silverman’s supervision and a student practice order. After Manley and her clinic partner Ashley Hawes interviewed the client at length, a motion for discovery was made in the doctor’s civil suit against their client.
Studying the woman’s inadequate employment-related insurance policy provided Manley a firsthand appreciation of the safety net the Affordable Care Act has provided for low-income workers, she said. The case also taught Manley to “go with your gut” when you have a good set of facts, even if you don’t at first know what the law is. She credited the clinical experience with providing her a chance to work on litigation in a “safe environment” that she hopes will allow for a quicker transition to post-graduation employment than she would have without the experience.