Yale New Haven Health filed suit in US District Court in Connecticut seeking roughly $4.1 mn from Ironshore Indemnity, alleging the insurer refused to reimburse costs tied to an employee’s bone marrow transplant.
The complaint states the employee underwent transplant and related treatment in 2023 and 2024 totaling approximately $5.2 mn.
The health system’s plan carried a $1.1 mn deductible under a stop-loss policy issued by Ironshore. After satisfying the deductible, Yale New Haven Health says it paid about $4.1 mn to providers and now seeks recovery of that amount plus attorney’s fees and additional damages.
According to the filing, the employee participated in a self-insured health plan backed by Ironshore’s stop-loss coverage. Yale New Haven Health asserts it paid all required premiums and complied with policy obligations.
In July 2024, Ironshore denied coverage, citing alleged incompleteness and inaccuracy in disclosures made during underwriting.
The lawsuit contends the health system acted in good faith and provided information it believed was complete and accurate.
The complaint alleges breach of contract and breach of the covenant of good faith and fair dealing. Representatives of Ironshore and its parent, Liberty Mutual, did not immediately comment.
Stop-loss disputes often hinge on underwriting disclosures and eligibility determinations in high-cost medical cases.
According to Beinsure analysts, transplant claims represent some of the largest exposures in employer-sponsored health plans, frequently testing policy wording and disclosure standards. The court has not ruled on the merits of the claims.
