NO PRIVATE RIGHT OF ACTION UNDER NEW YORK’S MENTAL HEALTH PARITY LAW (TIMOTHY’S LAW) (SECOND DEPT).

The Second Department determined that New York’s mental health parity law (Timothy’s Law, Insurance Law 3221(1)(5) and 4303(g)) did not create a private right of action over and above the administrative enforcement provisions. Plaintiff alleged the health insurance benefits administered by defendants were far more restrictive for mental health than for general medical claims:

… [T]he Court of Appeals has held that ” regardless of its consistency with the basic legislative goal, a private right of action should not be judicially sanctioned if it is incompatible with the enforcement mechanism chosen by the Legislature or with some other aspect of the over-all statutory scheme'” … . Thus, where “the legislature clearly contemplated administrative enforcement of the statute, “[t]he question then becomes whether, in addition to administrative enforcement, an implied private right of action would be consistent with the legislative scheme”‘” …  . …

… .[D]eterminations of whether the law had been violated require[] complex, fact-based determinations about medical necessity, and DFS [NYS Department of Financial Services] had implemented a comprehensive system to evaluate appeals following denials of coverage  … . … “[A]llowing people to litigate these issues in court might yield duplicative or inconsistent results” … . Kamins v United Healthcare Ins. Co. of N.Y., Inc., 2019 NY Slip Op 02507, Second Dept 4-3-19