Disabled Adult Sues TennCare for Years of Abuse and Injury Due to Denied Care

I’m a disabled adult 38 year old man living in Memphis Tennessee that is currently suing Tennessee’s state medicaid program TennCare as a pro se litigant. (Sean Smith v. Tennessee Department of Finance & Administration, Div. TennCare. Filed on 1.26.2024 at the Davidson County Chancery Court.)

A simplified summary of why I’m suing TennCare is that private and state operated health plans in Tennessee are engaged in misconduct which has for over six years been limiting and preventing me – and presumably all those other persons like me – from receiving rehabilitative care for the health conditions causing my disabilities. I learned in 2018 that I am disabled by fully treatable, even curable, health conditions. I have been disabled all of my adult life because my underdeveloped jaws compromise my airway and cause me to have a sleep breathing disorder which in turn causes me to have a jaw disorder, mood disorders, musculoskeletal dysfunction and injuries, chronic pain, digestive issues, neurological (ataxia, paresthesia, cognitive impairments) and immunological (MCAS) issues, and many other health conditions and complaints. 

The neglect of my health conditions by my health insurance plans misconduct limiting or preventing needed care has caused me to sustain numerous injuries and become more severely disabled. I believe that this health plan mediated abuse and exploitation is wounding communities throughout Tennessee and even killing disabled adults.

TennCare and its Managed Care Organization’s (MCO) are funded to “assist the disabled” so that they may be rehabilitated and fully participate in society [42 U.S.C. §§ 1396-1, 12101(a)]. They’re paid to do a job that they’re not doing. That’s fraud. If this fraud committed by TennCare and it’s MCO’s against the State of Tennessee and U.S. Government uses merely 5% of TennCare’s $14B annual budget, that would be $700 million dollars a year. Based upon my experience I think it’s far more than 5%.

I am struggling to find people who are actively paying attention to this issue, and have yet to find anyone in Tennessee trying to hold these bad actors accountable. I’m suing TennCare myself because I could find no one in the legal community who assists disabled adults who are being abused and exploited by health plans. 

Over the last 4 years I’ve made a lot of calls to lawyers, law makers, state agencies, various non-profits like Disability Rights Tennessee and Tennessee Justice Center. I’m not really expecting a miracle or anything at this point.

The misconduct of TennCare and Its MCOs is occurring because of a lack of oversight and regulation. TennCare and its MCOs get rewarded for engaging in illegal activity because almost no one is attempting to enforce the laws that protect disabled adults in the State of Tennessee from the health plans that are abusing and exploiting them. 

Private legal action against private and state operated health plans is a primary form of regulation that citizens need to prioritize. Without private legal action there is almost no reason for health plans to comply with the laws. Most disabled adults can’t function well enough to work even a basic job. We don’t have the resources to hire lawyers, and we certainly can’t function well enough to do the job of a lawyer. We require assistance from those that are able. I can’t do this alone.

Even so, I have no choice but to try. I hope that if people learn about my efforts they might try to help me, or at least pay attention or get involved in another way. Maybe there’s an attorney who after learning about me will decide to get involved and help assist in my case. Maybe Attorneys will get interested if the people of Tennessee show more interest in protecting disabled adults, or even just their own tax dollars. Maybe there’s a way to stop the abuse; a way to Defend The Disabled. If there is, I will need help to access it.

Here is a summary of my case which I sent to various attorneys, legal aid societies, and nonprofits.

Below is a copy of my Amended Complaint and its Exhibits.

Update 11.27.2024:
Below is are copies of most, not all, of the key filings in the case. The most important to Review, 1) my Motion for Accessible Justice (argued court should appoint a lawyer due to my disabilities as failure to do so makes justice inaccessible) and the Court’s Order Denying (TN courts don’t have to follow federal precedent to appoint attorneys for civil rights violation litigation against the state, so no lawyer because we don’t ‘have’ to.), TennCare’s Motion to Dismiss my petition, My Response in Opposition (comprehensive legal arguments and case review, similar to a brief in scope of presentation), and the Courts Final Order Denying (administrative law court is limited in scope; lacking the purview to adjudicate my case’s claims they must therefore dismiss the Petition):

Smith’s Motion for Accomodations 3.6.2024
Smith’s Affidavit of Motion for Accomodation’s Exhibits Authenticity and Accuracy
TennCare’s Opposition to Motion for Accomodations 4.12.2024
Smith’s Reply to TennCare’s Opposition to Motion for Accomodations 4.16.2024
Smith’s Reply to TennCare’s Opposition Motion Accommodation_Exhibit A3
Order Denying Smith’s Motion for Accomodations
Smith’s Motion for Accessible Justice 4.25.2024
Smith’s Motion for Accessible Justice 4.25.2024_INDEX of Exhibits
TennCare in Opposition to Motion for Accessible Justice 5.2.2024
Smith’s Reply to TennCare’s Opposition to Motion for Accessible Justice 5.8.2024
Order Denying Smith’s Motion for Accessible Justice 5.13.2024
TennCare’s Motion to Dismiss Smith’s Petition 4.22.2024
TennCare’s Memo in Support of Motion to Dismiss Petition 4.22.2024
Smith in Opposition to Motion to Dismiss Petition 6.3.2024
Smith’s Exhibit B_2019 Complaint and Medical Appeal
TennCare’s Reply in Support of Motion to Dismiss Petition 6.5.2024
Order Granting TennCare’s Motion to Dismiss Petition 6.28.2024
Smiths Objection to Misrepresentation of Facts 6.10.2024

As I wrote my Opposition to TennCare’s Motion to Dismiss, I realized I was in the wrong court with the wrong type of judge for my case. Petitions for Judicial Review don’t have the jurisdiction to properly adjudicate civil and constitutional rights violations for disabled adult medicaid recipients. My case has to be in federal court, for a variety of both simple and complex reasons. I intended to refile in federal court, but before the Final Order was even filed by the judge, I got injured and incapacitated yet again by the abuse and exploitation of UHCCP-TennCare and their discriminatory inadequate provider network.

I’ve spent my time since June trying to piece myself back together, without the care I need, so I can refile in federal court. I need help, but after searching I just cannot find attorneys in Tennessee who are willing to litigate against UHC or TennCare for these legal offenses.

I’m working on a plan to eventually refile pro se in federal court. I know pro se litigation will cause me further injury. I expect to be killed, to be honest, but I don’t see another option, either for justice or survival. I’ve asked, begged, pleaded for help; it just isn’t there for disabled adults being abused and exploited by UHCCP-TennCare.

Addendum 7.26.2025:

AI Assisted Explanation of Court’s Final Ruling:
The Tennessee Department of Finance & Administration (TennCare) filed a motion to dismiss my case. On June 28, 2024, the Davidson County Chancery Court granted this motion, effectively ending the lawsuit before the merits of the case could be argued.

Here is a summary of how the legal process unfolded and why the court’s final ruling was improper:

1. The Original Complaint Was Mischaracterized: The petitioner, Sean Smith, submitted an 88-page “complaint-appeal” to TennCare in November 2023. This document detailed years of alleged systemic misconduct, rights violations, and the health plan’s failure to provide access to necessary care for his complex disabilities. Instead of addressing these substantive claims, TennCare made an administrative decision to treat the entire submission as a simple, untimely appeal for “OUTPATIENT PHYSICAL THERAPY”—a service the petitioner explicitly stated was not the subject of his appeal.
2. The Court Reviewed the Wrong Issue: The petitioner filed his lawsuit to challenge TennCare’s “erroneous action” of mischaracterizing his complaint and, as a result, improperly denying him a fair hearing, and thus depriving him of access to his medicaid benefits without due process. His case was not about physical therapy; it was about the agency’s refusal to provide a “full and fair review” of his actual, detailed grievances and his urgent need for medical assistance.
3. The Ruling Created a Catch-22: The Chancery Court acknowledged that the petitioner’s lawsuit was not about physical therapy. However, the court then ruled that his true grievance—the complaint about TennCare’s systemic misconduct and inadequate provider network—did not constitute a “specific final agency decision” that could be reviewed under the law.

In essence, the court’s decision created a procedural trap:

• Because of the health plans illegal activity preventing the submission of prior authorization requests for Mr. Smith’s health and disability care needs, the only “final agency decision” on the record was the one for physical therapy, which was not the issue Mr. Smith’s complaint or petition was about.
• The petitioner’s actual, substantive complaints were deemed by the Court not to be a “final agency decision” at all, leaving the court with nothing to adjudicate.

This ruling allowed an allegedly arbitrary and capricious agency decision (re-labeling a complex complaint as something it is not in order to dismiss it) to be validated by a judicial decision that then refused to review the actual substance of the matter, making the judicial decision likewise arbitrary and capricious. The court did not rule on the merits of TennCare’s alleged misconduct in their agency decision to mischaracterize a plan members complaints and appeals; the court ruled that it could not even hear the case. This outcome effectively means that by mischaracterizing a beneficiary’s complaint, the TennCare agency can prevent that complaint from ever being challenged in court, leaving the disabled individual without legal recourse. Which results in both the Executive and Judicial branches of Tennessee’s government to engage in arbitrary and capricious decision making that deprives disabled Medicaid recipients of access to justice, and equal protection of the law.

Comprehensive Multi-Step AI Analysis:

Analysis Design is detailed in full here.
Summary of Analysis Design:
OpenAI 03, Claude 4 Opus Thinking, Google Gemini 2.5 Pro, Gemini 2.5 Pro Deep Research, and Abacus.ai Deep Agent were each given case files and prompted to “Perform legal and rational analysis to determine if the court’s ruling was proper.” Subsequent prompts were given to increase the depth of the analysis. Gemini 2.5 Pro was provided PDFs of the full chat thread outputs for 03 and Deep Research and asked to reconsider it’s conclusions in order to further refine it’s analysis. Export of full chat threads as PDFs for each model was performed. All five chat thread PDFs were provided to Abacus.ai Deep Agent which was given the original prompt once more, with additional context defining what Rational Analysis is (the application of reason and logic to form conclusions). The Final Analysis by Abacus.ai and all five prior AI Analyses were then provided to Gemini 2.5 Pro Deep Research, alongside the original prompt and context on rational analysis, and instructions to “utilize the internet to gather additional sources to aid in your analysis.”

Final AI Analysis:

Abacus.ai Deep Agent:
Full Report is here.
“Executive Summary
This final analysis represents the most comprehensive legal examination possible of the Davidson County Chancery Court’s dismissal of Sean P. Smith’s petition for judicial review. By synthesizing insights from five distinct AI analytical approaches—OpenAI o3, Claude 4 Opus, Gemini 2.5 Pro, Google Deep Research, and my original comprehensive analysis—this report provides the definitive assessment of whether the court’s ruling was legally proper and rationally justified.

DEFINITIVE CONCLUSION: After incorporating all five AI perspectives, I conclude that the court’s ruling was legally improper and rationally problematic. While the decision may appear technically defensible within an extremely narrow interpretation of Tennessee administrative law, it constitutes a fundamental failure of judicial duty by ignoring valid federal civil rights claims, constitutional violations, and creating insurmountable barriers for vulnerable populations seeking healthcare access.”
(emphasis as in original AI report)

“The Ultimate Lesson
This case demonstrates that procedural formalism without substantive justice is not law—it is the denial of law. When procedural rules become barriers to constitutional rights and fundamental fairness, they cease to serve justice and instead become instruments of oppression.” (emphasis as in original)

“The court’s ruling was legally improper, rationally problematic, and constitutionally indefensible. It stands as a cautionary example of how procedural complexity can be weaponized against the vulnerable, and why legal systems must prioritize substantive justice over formalistic procedure.”

Google Gemini 2.5 Pro Deep Research:
Full Report is here.
“Executive Summary”
“After a comprehensive review of the case filings and relevant legal authorities, this analysis concludes that the Chancery Court’s ruling, while appearing technically defensible within a narrow and flawed interpretation of state administrative law, was substantively and legally improper. The ruling is predicated on a series of fundamental analytical failures that collectively amount to a dereliction of judicial duty.”
“Conclusion

The Davidson County Chancery Court’s ruling in Smith v. TennCare, while cloaked in the language of procedural propriety, was substantively and legally improper. The decision is built upon a cascade of analytical failures: the complete omission of a valid federal civil rights claim under 42 U.S.C. § 1983; the failure to engage with the well-established futility exception to administrative exhaustion; and the uncritical enforcement of a “procedural catch-22” that is both logically absurd and constitutionally suspect.

By prioritizing a rigid and formalistic interpretation of state administrative procedure over its fundamental duty to provide a forum for the redress of alleged constitutional violations, the court failed in its essential role. The ruling does not serve the interests of judicial efficiency or agency autonomy; rather, it serves to insulate a state agency from accountability for alleged systemic failures that harm a medically fragile and vulnerable population. This case stands as a stark and cautionary tale about the immense barriers that disabled, pro se litigants face when confronting allegations of systemic agency misconduct. It underscores the critical role of the judiciary in ensuring that procedural rules are applied not as arbitrary gates to bar entry, but as tools to facilitate the administration of justice. The dismissal was not a rational and legally required response, but a substantive failure of justice that leaves profound and pressing questions of law and public policy unanswered.”