News & Analysis as of

Employee Retirement Income Security Act (ERISA) › Denial of Insurance Coverage › Mental Health

Ogletree, Deakins, Nash, Smoak & Stewart,...

Ninth Circuit Affirms ERISA Plan Administrator’s Decision, Validates Use of Industry Guidelines and Medical Evidence

Ogletree, Deakins, Nash, Smoak & Stewart,... on

On March 5, 2019, Magistrate Judge Joseph C. Spero of the U.S. District Court for the Northern District of California issued his opinion in Wit v. United Behavioral Health, in which he attempted to significantly change how...more

Fishman Haygood LLP

U.S. Fifth Circuit Reverses District Court and Awards Benefits to ERISA Plan Participant for Hospitalization

Fishman Haygood LLP on

Case Background - When she was a preteen, E.D. began experiencing symptoms of anorexia nervosa. Her condition worsened, and her parents, the Dwyers, took her to Avalon Hills, a residential treatment facility....more

ArentFox Schiff

Ninth Circuit Reissues Opinion for the Second Time in Suit Challenging United Behavioral Health’s Mental Health Coverage...

ArentFox Schiff on

Last week, the US Court of Appeals for the Ninth Circuit, in its third opinion in the case, reversed a lower court’s decision allowing patients challenging United Behavioral Health’s (UBH) internal mental health coverage...more

Morrison & Foerster LLP - Left Coast Appeals

This Week At The Ninth: ERISA and FERC

Morrison & Foerster LLP - Left Coast Appeals on

This week, the Ninth Circuit considers ERISA claims alleging that a plan administrator unlawfully utilized internal guidelines more stringent than the terms of plaintiffs’ plans and the statute of limitations for an action by...more

Proskauer - Employee Benefits & Executive...

Ninth Circuit Defers to Plan Design and Administrative Discretion on Bounds of Mental Health Coverage

Proskauer - Employee Benefits & Executive... on

A recent decision by the U.S. Court of Appeals for the Ninth Circuit (Wit et al. v. United Behavioral Health and Alexander et al. v. United Behavioral Health) exemplifies the challenge in balancing a desire to cover evolving...more

Polsinelli

Ninth Circuit Reverses Landmark Wit Case Addressing Behavioral Health Coverage

Polsinelli on

The President and his administration continue to tout their efforts to strengthen coverage for behavioral health care, including significantly increasing behavioral health spending and strengthening parity between physical...more

Husch Blackwell LLP

New York District Court: The Choice of Medical Necessity Criteria is a Fiduciary Act

Husch Blackwell LLP on

We continue to see an increase in fiduciary litigation involving employer-sponsored group health plans, particularly litigation involving mental health. A recent New York Federal District Court case, Collins et al. v....more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor – June 2021: Sparsely Pleaded Parity Act Lawsuit Survives Motion to Dismiss

Hinshaw & Culbertson LLP on

In Nathan W. v. Anthem Bluecross Blueshield of Wisconsin, 2021 U.S. Dist. LEXIS 42127 (M (D. Utah Mar. 5, 2021), a federal court held that conclusory allegations of discriminatory medical necessity criteria were sufficient to...more

K&L Gates LLP

Recent District Court Decision Highlights the Importance of Adequate Behavioral Health Claims Processing Guidelines for ERISA...

K&L Gates LLP on

On this week’s episode, Carla DewBerry and Sarah Carlins discuss a recent California Federal District Court decision in David Wit v. United Behavioral Health, in which the court found that the defendant insurer violated ERISA...more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor - October 2020: Utah Court Rules ERISA Plan Was Wrong to Deny Coverage for Mental Health Care Received at...

Hinshaw & Culbertson LLP on

In Raymond M. v. Beacon Health Options, Inc., 2020 U.S. Dist. LEXIS 94615 (D. Utah, May 29, 2020), a Utah district court held that an ERISA plan improperly applied acute-level criteria when denying benefits for a...more

Hinshaw & Culbertson LLP

The LHD/ERISA Advisor - October 2020: Tenth Circuit Finds District Court Applied Wrong Standard of Review in Evaluating Plan...

Hinshaw & Culbertson LLP on

In Lyn M. v. Premera Blue Cross, 2020 U.S. App. LEXIS 23395 (10th Cir. July 24, 2020), the Tenth Circuit held that a district court had applied the wrong standard of review and incorrectly evaluated an ERISA plan...more

Bradley Arant Boult Cummings LLP

Could Possible Predictability Be Coming to Wilderness Therapy Coverage Disputes?

Bradley Arant Boult Cummings LLP on

Current trends in litigation regarding wilderness therapy coverage center on motion practice. Courts have been unpredictable with granting or denying defendants’ motions to dismiss and motions for summary judgment, and recent...more

King & Spalding

Federal District Court Rules United Unlawfully Denied Coverage for Mental Health and Substance Use Disorder Services Based on...

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On March 5, 2019, Chief Magistrate Judge Joseph C. Spero of the U.S. District Court for the Northern District of California ruled that United Behavioral Health (UBH), a subsidiary of UnitedHealth Group, violated its fiduciary...more

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