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Managed care company commits fraud

Jury Trial

Christina a 15-month-old infant contracted encephalitis during a mosquito outbreak one rainy Fall in Florida. Her mother worked as a house cleaner and her father worked as a tire changer whose company employed a staff of six. Fortunately Christina's father had group health insurance because her medical condition was so severe that she was transferred from St. Mary's Hospital in West Palm Beach to Children's Hospital in Miami.

Christina remained in Children's Hospital for several months in a coma. When her hospital bills broke through the $75,000 range, Sentry Insurance refused to pay for any further medical care.

Because ERISA protects insurance companies, not consumers, attorney Edward M. Ricci was the only attorney in West Palm Beach to represent the family on a contingency basis and only accepted court ordered attorney fees.

Ricci won the coverage case in State court but three months later discovered that Sentry Insurance lied to Children's Hospital and got out of paying $150,000 on medical bills owed by making a "charitable contribution" to the hospital for $20,000.

Ricci encouraged and got the hospital to agree to co-counsel a case against Sentry Insurance for fraud. After a month long jury trial a lay jury composed of an accountant, an aeronautical engineer, a retired postal worker, a minister's wife and a church secretary awarded the Wilson family and Children's Hospital $10,150,000. The case was precedent setting in the challenging the application of ERISA law to blatant fraud by managed care companies.
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