A Winning Combination

SMP Law Clerk Assists in Major Win in Denial of Care Case

On Behalf of | Aug 6, 2015 | Firm News |

Smith, McDowell & Powell law clerk Kimberly Van Spronsen, and fellow law school students Aaron Claxton and Rick Lebherz, contributed arguments and research to help reverse a decision wherein healthcare costs had been denied to a Medicare patient for treatment for a brain tumor.

During her recent fall semester at McGeorge School of Law, Kimberly interned with its Elder & Health Law Clinic, where she had the opportunity to help represent the family of a deceased individual who had been previously denied coverage for Grade IV Glioblastoma (a highly aggressive brain tumor) treatment.  The patient underwent craniotomy surgery which successfully removed almost 100% of the tumor, but Medicare refused to reimburse the cost, asserting that it was an out-of-plan-service.  A year later, the patient passed away and an appeal was made by his estate to reverse the decision of denying coverage.

Through diligent research and hard work, Kimberly helped prepare an argument which would support one of the estate’s assertions that the procedure was specialized and therefore qualified for coverage.  McGeorge MSL (Masters of Science in Law) student, Patrick Browning, MD worked with the team as well, providing expert witness testimony, which was heard when the case was brought before an administrative judge.  The judge heard from both sides and considered the evidence and briefs submitted, before releasing his opinion that the decision to deny coverage should be reversed.  “It was rewarding to see a favorable result for our clients, after having worked so hard,” Van Spronsen said when asked about her work on this issue.

Everyone at Smith, McDowell & Powell are proud to work alongside Van Spronsen, and to witness what is surely the start of a long and successful career.  Click here to read more about the work performed by the McGeorge Legal Clinics, which have been helping members of the community since 1964.