Obtained defense trial judgment on behalf of client, a national provider of industry-leading workers’ compensation products, and physician network in a wrongful termination suit brought by an orthopedic surgeon, which included claims of breach of contract, violation of B&P Section 17200, retaliation, violation of fair process, negligent infliction of emotional distress, defamation, misrepresentation and violation of the Knox-Keene Act. Plaintiff sought damages in excess of $4 million. The case was also upheld by the California Court of Appeal. 

Obtained defense award on behalf of a large health plan in a multimillion-dollar provider dispute after multi-month binding arbitration regarding managed care risk pools. Also recovered award of attorney’s fees as prevailing party, which was upheld on appeal by the California Court of Appeal.

Obtained fully favorable defense award in binding arbitration on behalf of Life & Health Plan in a multimillion-dollar dispute brought by a Taft-Hartley Trust Fund regarding enrollee eligibility.

Acted as co-lead national counsel for a Pharmacy Benefit Manager (PBM) in multi-district litigation involving allegations of unlawful business practices related to formulary decisions and pharmacy rebate arrangements with a large pharmaceutical company.

Obtained non-suit on first day of jury trial from an Orange County Superior Court judge in a consumer lawsuit regarding allegations of bad faith and unlawful business practices. Successfully obtained numerous judgments following the granting of demurrers without leave to amend in various state courts throughout California in member litigation on federal preemption grounds, including Medicare, ERISA and FEHBA.

Obtained Temporary Restraining Order in Orange County Superior Court on behalf of large health plan against national hospital chain, preventing unlawful termination of managed care contract that would have resulted in potential patient harm in having to immediately reassign thousands of enrollees to alternate providers in the middle of care.

Obtained voluntary dismissal on behalf of a large health plan from plaintiffs in a class action involving allegations of unlawful business practices pertaining to third-party liability recovery practices.

Obtained summary judgment from state court on behalf of specialized behavioral health plan in a bad faith and unlawful business practices claim related to the denial of residential treatment for anorexia.

Obtained summary judgment on behalf of a large health plan in a bad faith and unlawful business practices case involving allegations of wrongful denial of out-of-network services where claim was that appropriate services were not available within the HMO network.

Obtained summary judgment on behalf of a large health plan in a bad faith and unlawful business practices case involving allegations of wrongful denial of proton beam radiation therapy for prostate cancer.

Successfully defended large health plan in numerous lawsuits brought by hospital and medical groups involving contract and risk pool disputes.

Successfully defended a large health plan and provider groups in claims brought by non-contracting emergency providers regarding reasonable and customary charges.

Successfully defended a large health plan in numerous Administrative Law Judge hearing through the Social Security Administration as well as the Medicare Appeals Council on Medicare coverage disputes.

Successfully defended specialized vision plan in interference with business practices claim brought by terminated provider.

 

 

Representative Matters

Obtained defense trial judgment on behalf of client, a national provider of industry-leading workers’ compensation products, and physician network in a wrongful termination suit brought by an orthopedic surgeon, which included claims of breach of contract, violation of B&P Section 17200, retaliation, violation of fair process, negligent infliction of emotional distress, defamation, misrepresentation and violation of the Knox-Keene Act. Plaintiff sought damages in excess of $4 million. The case was also upheld by the California Court of Appeal. 

Obtained defense award on behalf of a large health plan in a multimillion-dollar provider dispute after multi-month binding arbitration regarding managed care risk pools. Also recovered award of attorney’s fees as prevailing party, which was upheld on appeal by the California Court of Appeal.

Obtained fully favorable defense award in binding arbitration on behalf of Life & Health Plan in a multimillion-dollar dispute brought by a Taft-Hartley Trust Fund regarding enrollee eligibility.

Acted as co-lead national counsel for a Pharmacy Benefit Manager (PBM) in multi-district litigation involving allegations of unlawful business practices related to formulary decisions and pharmacy rebate arrangements with a large pharmaceutical company.

Obtained non-suit on first day of jury trial from an Orange County Superior Court judge in a consumer lawsuit regarding allegations of bad faith and unlawful business practices. Successfully obtained numerous judgments following the granting of demurrers without leave to amend in various state courts throughout California in member litigation on federal preemption grounds, including Medicare, ERISA and FEHBA.

Obtained Temporary Restraining Order in Orange County Superior Court on behalf of large health plan against national hospital chain, preventing unlawful termination of managed care contract that would have resulted in potential patient harm in having to immediately reassign thousands of enrollees to alternate providers in the middle of care.

Obtained voluntary dismissal on behalf of a large health plan from plaintiffs in a class action involving allegations of unlawful business practices pertaining to third-party liability recovery practices.

Obtained summary judgment from state court on behalf of specialized behavioral health plan in a bad faith and unlawful business practices claim related to the denial of residential treatment for anorexia.

Obtained summary judgment on behalf of a large health plan in a bad faith and unlawful business practices case involving allegations of wrongful denial of out-of-network services where claim was that appropriate services were not available within the HMO network.

Obtained summary judgment on behalf of a large health plan in a bad faith and unlawful business practices case involving allegations of wrongful denial of proton beam radiation therapy for prostate cancer.

Successfully defended large health plan in numerous lawsuits brought by hospital and medical groups involving contract and risk pool disputes.

Successfully defended a large health plan and provider groups in claims brought by non-contracting emergency providers regarding reasonable and customary charges.

Successfully defended a large health plan in numerous Administrative Law Judge hearing through the Social Security Administration as well as the Medicare Appeals Council on Medicare coverage disputes.

Successfully defended specialized vision plan in interference with business practices claim brought by terminated provider.

 

 

Events

Obtained defense trial judgment on behalf of client, a national provider of industry-leading workers’ compensation products, and physician network in a wrongful termination suit brought by an orthopedic surgeon, which included claims of breach of contract, violation of B&P Section 17200, retaliation, violation of fair process, negligent infliction of emotional distress, defamation, misrepresentation and violation of the Knox-Keene Act. Plaintiff sought damages in excess of $4 million. The case was also upheld by the California Court of Appeal. 

Obtained defense award on behalf of a large health plan in a multimillion-dollar provider dispute after multi-month binding arbitration regarding managed care risk pools. Also recovered award of attorney’s fees as prevailing party, which was upheld on appeal by the California Court of Appeal.

Obtained fully favorable defense award in binding arbitration on behalf of Life & Health Plan in a multimillion-dollar dispute brought by a Taft-Hartley Trust Fund regarding enrollee eligibility.

Acted as co-lead national counsel for a Pharmacy Benefit Manager (PBM) in multi-district litigation involving allegations of unlawful business practices related to formulary decisions and pharmacy rebate arrangements with a large pharmaceutical company.

Obtained non-suit on first day of jury trial from an Orange County Superior Court judge in a consumer lawsuit regarding allegations of bad faith and unlawful business practices. Successfully obtained numerous judgments following the granting of demurrers without leave to amend in various state courts throughout California in member litigation on federal preemption grounds, including Medicare, ERISA and FEHBA.

Obtained Temporary Restraining Order in Orange County Superior Court on behalf of large health plan against national hospital chain, preventing unlawful termination of managed care contract that would have resulted in potential patient harm in having to immediately reassign thousands of enrollees to alternate providers in the middle of care.

Obtained voluntary dismissal on behalf of a large health plan from plaintiffs in a class action involving allegations of unlawful business practices pertaining to third-party liability recovery practices.

Obtained summary judgment from state court on behalf of specialized behavioral health plan in a bad faith and unlawful business practices claim related to the denial of residential treatment for anorexia.

Obtained summary judgment on behalf of a large health plan in a bad faith and unlawful business practices case involving allegations of wrongful denial of out-of-network services where claim was that appropriate services were not available within the HMO network.

Obtained summary judgment on behalf of a large health plan in a bad faith and unlawful business practices case involving allegations of wrongful denial of proton beam radiation therapy for prostate cancer.

Successfully defended large health plan in numerous lawsuits brought by hospital and medical groups involving contract and risk pool disputes.

Successfully defended a large health plan and provider groups in claims brought by non-contracting emergency providers regarding reasonable and customary charges.

Successfully defended a large health plan in numerous Administrative Law Judge hearing through the Social Security Administration as well as the Medicare Appeals Council on Medicare coverage disputes.

Successfully defended specialized vision plan in interference with business practices claim brought by terminated provider.

 

 

Representative Matters

Defense Verdict Secured for The Peninsula Beverly Hills After Month-Long Jury Trial

Gary Pancer (Partner-Los Angeles, CA), Kelley Harman (Of Counsel-Los Angeles, CA), and Aria Aghalarpour (Associate-Los Angeles, CA) of Wilson Elser secured a complete defense verdict in Los Angeles County Superior Court, Santa Monica, on behalf of their client, The Peninsula Beverly Hills (the "Hotel"). The verdict followed a three-week-long jury trial, preceded by two weeks of extensive pre-trial motion practice and jury selection. General Counsel for the Hotel's owner, Michael Tenner, was present throughout the entirety of the proceedings.

Plaintiff, a 68-year-old woman, claimed that she ordered a decaffeinated iced tea at the Hotel's Roof Garden restaurant at lunch on January 30, 2021, but was allegedly served caffeinated tea. At trial, the plaintiff attempted to establish liability through testimony from family members who were present at the lunch, as well as a friend who had worked at the Hotel for 17 years. Wilson Elser presented testimony from Hotel leadership, including the former Assistant Director of Food and Beverage, the Hotel Manager, and the Managing Director, establishing clear, reliable beverage service protocols that were followed, including the use of separate containers and visual markers to distinguish decaffeinated beverages.

Plaintiff relied on expert testimony from a physician who opined that caffeine consumption caused plaintiff's cardiac symptoms. We countered with expert analysis by a research cardiologist and electrophysiology expert, who explained that it is medically implausible for a single instance of alleged caffeine consumption to reverse an ablation or cause long-term arrhythmias, and that no physiological basis supports the plaintiff's theory.

After approximately two hours of deliberation, the jury returned a defense verdict, finding The Peninsula Beverly Hills was not negligent. Notably, the jury resolved the case at the first question on the verdict form and never reached the issue of causation. Post-verdict discussions confirmed the jury would have unanimously found for the defense on causation as well. The hotel is pursuing recovery of substantial expert fees and litigation costs in excess of $200,000.

Gary S. Pancer, Kelley E. Harman and Aria A. Aghalarpour

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