Disability and Civil Rights Clinic Takes Aim at Health Insurance Company to Secure Client’s Civil Rights

Lauren Wechsler, a 30-year-old-woman with severe developmental disabilities, is no longer confined to her home following the year-long advocacy of students in the Disability and Civil Rights Clinic, under the direction of Professors Natalie Chin and Amy Mulzer. Students challenged the discriminatory actions of two private health insurance companies that left Lauren homebound despite her ability to participate in the community.

As a result of Lauren’s disabilities, she breathes through a tracheotomy tube and must be constantly monitored so she does not choke or stop breathing. She requires the care of a private duty nurse both inside and outside her home. These medically necessary services are covered by Lauren’s insurance providers, Group Health Incorporated (GHI) and Emblem Health.

For a number of years, Lauren has been attending Gateway, a day-habilitation program in the Bronx where she thrived with her friends, enjoyed wheelchair Zumba and community outings, and engaged in musicals and arts & crafts. Yet, Lauren’s insurance providers suddenly and arbitrarily prohibited the private duty nurse from taking Lauren anywhere outside the home, including to Gateway. The companies based this restriction on insurance contract language that described private duty nursing services as being provided “at home or in a hospital.” Cut off from the emotional, physical, and mental stimulation of Gateway, Lauren was homebound.

“As a result of her confinement, Lauren was suffering emotionally, physically and psychologically,” said Professor Natalie M. Chin, Director of the Disability and Civil Rights Clinic. “Her mental state declined because she was unable to attend Gateway, which provided her with community inclusion activities that promoted her independence, enabled her to socialize, and strengthened her daily living skills. What is even more shocking about GHI and EmblemHealth’s discriminatory policy is that it cost them nothing to accommodate Lauren’s disability.”

The Disability and Civil Rights Clinic began representing Lauren in January 2016. Last fall, Kim Kopff ‘16 and Sam Tarasowsky ‘16 conducted extensive fact-finding and legal research. They filed several internal appeals with the insurance companies on Lauren’s behalf, exhausting her administrative remedies and paving the way for a federal court challenge. During the Fall 2016 semester, Camillia Brown ‘18 and Catie Marie Martin ‘18 represented Lauren before the Southern District of New York. The federal case asserted disability-based discrimination under the Affordable Care Act and a contract claim.

Following oral argument by Brown and Martin, the Court ordered the insurance companies to turn over extensive and crucial discovery that otherwise would have been withheld. This month, after nearly a year of advocacy, the matter was resolved to the Parties’ mutual satisfaction.

“Lauren is beaming,” Lauren’s mother, Daisy Concepcion-Wechsler, wrote in an email to Professor Chin. “It’s the basic right that we have as humans and as Americans. It’s the right to liberty and pursuit of happiness. Thank you for restoring that and the belief that this belongs to everyone regardless of their status. Lauren is now gathering with her friends not because the fates allowed, but because all of you and Brooklyn Law allowed.”

“Brooklyn Law School’s Clinical program changes lives, and victories likes these are a reminder of our impact as a law school community,” Chin said.

The Disability and Civil Rights Clinic is focused on protecting and advancing the civil rights of adults with intellectual and developmental disabilities, and one of the only law school clinics in the country specializing in this area. The Clinic functions as a pro bono law firm, allowing students to represent low-income New Yorkers, and their families in a variety of civil legal matters, including housing, public benefits, access to health care, special education, parental rights, alternatives to guardianship, prisoners’ rights and discrimination in access to programs and services. The clinic also undertakes policy initiatives, provides advice, and disseminates information to individuals and institutions about the legal environment that service providers must navigate. Its mission is to promote the self-determination and independence of low-income adults with intellectual and developmental disabilities by providing direct legal services that protect individual rights and enhance access to services. Visit: www.brooklaw.edu/aaidd

Lewis Golinker of the Law Office of Lewis Golinker served as co-counsel.