Attorney Mantese on Groundbreaking Autism Case

Troy MIAttorney Gerard Mantese appears to have struck a very substantial blow to bad faith health insurance companies that routinely deny claims for treatment of autistic children. In a groundbreaking case, Mantese forced Blue Cross Blue Shield to concede that it was wrong to categorize behavioral therapy for autistic children as experimental treatment and use that argument to deny claims.

"The notion that behavior therapy is experimental is absurd and indefensible," says Mantese. "I think with this victory here in Michigan it makes it difficult for other insurance companies to ignore or deny coverage."

His client and the 100 other Blue Cross Blue Shield insured families with autistic children will now have their claims paid back to May 1, 2005 by virtue of an out of court settlement. For the families, it is a life-changing event. "This care is expensive," says Mantese. "Sometimes families had to choose between paying for care for their children and paying their mortgage. Some people didn't have the funds to pay for this care and many families are deeply in debt over it."

The settlement also allows Blue Cross Blue Shield policyholders who have not made a claim to the insurer, but who have paid for treatment for autistic children out of their own pockets, to be reimbursed for costs.

When Mantese agreed to challenge Blue Cross on behalf of the family of Christopher Johns, one of the first things he did was begin to review the scientific data on autism. "We reviewed the literature and once we did, we knew that the claim by Blue Cross or any other insurer that the established care was ineffective would be baseless," says Mantese.

Mantese, who prides himself and his firm on being thorough in their approach to every case, then wanted to see the treatment at work. "This therapy is based on decade's old principles of behavioral therapy--and after I met with doctors and psychologists at Beaumont Hospital in Troy and saw their work and their results, it was clear to me these children needed to have access to this care," he says.

In the lead up to the trial, Mantese filed a motion to compel Blue Cross to produce internal documents showing that its own research indicated that behavioral therapy does work for autistic children. "Once we took the depositions of the top doctors at Blue Cross and we reviewed their files it was like the emperor had no clothes on," says Mantese. "They simply had no defense."

Since the settlement, Mantese says his phone is ringing off the hook with inquiries from other families across the country that have been denied claims for treatment for their autistic children based on the similar arguments that behavioral therapy is ineffective.

Mantese & Rossman is a relatively small firm with six lawyers. Mantese says the firm likes to take on cases that will have "some societal impact". This one may indeed have that kind of horsepower that Mantese seeks in his cases. He says he is aware of a number of other healthcare providers who take a similar position about claims for the coverage of autistic children. "We are looking at them," says Mantese. "They are in our sites."

Gerard Mantese graduated first in his class, summa cum laude, from the St. Louis University School of Law in 1982. He previously graduated from the University of Missouri, summa cum laude, in only three years and received the Senator Symington Scholarship for graduating with a perfect 4.0 grade point average. In 1982, Mr. Mantese joined the Detroit law firm of Honigman Miller Schwartz and Cohn, where he was elected partner after just 4 years. In 1994, he formed his own firm.