What is this Settlement About?

UMR, Inc. (“UMR”) is a third-party administrator of employer-sponsored health benefit plans. The Acting Secretary of the U.S. Department of Labor (“DOL”) filed suit against UMR, alleging that two types of health benefits were improperly denied. First, DOL alleged that health benefit claims for emergency room (“ER”) visits were improperly denied because it was determined that the participant or beneficiary was not experiencing a medical emergency. Second, DOL alleged that health benefit claims for urinary drug screening (“UDS”) were improperly denied because it was determined that the participant’s or beneficiary’s drug screening was not medically necessary.

Although UMR disputes DOL’s allegations, UMR and DOL have agreed to settle their dispute through a Consent Order and Judgment (“Consent Judgment”). The Consent Judgment provides payment to participants and beneficiaries for certain health benefit claims for ER visits (“Covered ER Claims”) and UDS treatment (“Covered UDS Claims”).

What Does this Settlement Provide?

The Consent Judgment provides for cash payments to participants and beneficiaries for Covered ER Claims and Covered UDS Claims.

If you have a Covered UDS Claim, you may be eligible for two different payments:

• Baseline Payment: all eligible participants or beneficiaries will receive a Baseline UDS Payment of $68.85 for each Covered UDS Claim.  No additional action is necessary to receive a Baseline UDS Payment.
• Additional UDS Payment: if you have documentation that you paid more than $68.85 out-of-pocket for a Covered UDS Claim, you may provide that documentation, which may entitle you to an Additional UDS Payment of up to $103.27 per Covered UDS Claim, for a total of up to $172.12.

If you have a Covered ER Claim, and you have documentation that you paid an amount out of pocket for Covered ER Claim(s), you may provide that documentation, which may entitle you to a Proven ER Payment of up to $353.22 per Covered ER Claim.

These benefits are described in more detail in the Notice you received in the mail and in the Consent Decree and Judgment, available on the Important Documents page.

To check if you have a Covered UDS Claim or Covered ER Claim that may be eligible for a Baseline UDS Payment, Additional UDS Payments, or Covered ER Payment, please visit the Review Your Covered Claims page of this website. This secure page will provide you with information regarding your original claim(s) including the claim number(s), claim date(s), and provider name(s).

THE SETTLEMENT ADMINISTRATOR IS READY TO ASSIST YOU. PLEASE DO NOT TELEPHONE OR CONTACT THE COURT, THE CLERK OF THE COURT, OR DEFENDANTS OR DEFENDANTS’ COUNSEL REGARDING THIS CASE. ALL QUESTIONS SHOULD BE DIRECTED TO THE SETTLEMENT CLAIMS ADMINISTRATOR.