United Behavioral Health (UBH) and the Alcatel-Lucent Medical Expense Plan, an employee health plan now owned by Nokia, have filed a petition for a writ of certiorari before the U.S. Supreme Court. They are seeking to overturn a decision of the U.S. Court of Appeals for the Tenth Circuit affirming Utah’s court ruling against them for failing to cover a middle school student’s inpatient mental health treatment and awarding the family benefits. The case is United Behavioral Health et al. v. David K. et al., case number 23-586, Supreme Court of the United States.
A three-judge panel of the Tenth Circuit found that UBH had improperly handled and denied the family’s claim for inpatient mental health benefits for their daughter, Amy K., because it had failed to conduct a full and fair review of their claim. The company’s review, which failed to acknowledge the opinion of Amy’s doctors, resulted in the approval of a three-month inpatient stay instead of the 12-month inpatient stay recommended by her doctors after repeated hospitalizations from multiple suicide attempts.
Amy’s family first filed suit against UBH and the plan in 2017. The family notified the court of Amy’s death just days before the oral argument in UBH’s appeal before the Tenth Circuit in October 2022. Ultimately, the Tenth Circuit panel not only upheld the Utah trial court’s June 2021 decision to award the family damages but also refused to remand the claims to the plan administrator, finding it unnecessary due to its arbitrary and capricious actions.
In its cert petition, UBH argues that courts cannot impose requirements on ERISA plan administrators that neither Congress nor the U.S. Department of Labor (DOL) have imposed. More specifically, UBH argues that the court cannot require it to explain why it disagrees with the claimant’s treating physician’s recommendations. According to UBH, the panel’s holding in this respect directly contradicts the U.S. Supreme Court’s ruling in Black & Decker Disability Plan v. Nord and decisions of the Second, Fifth, Ninth, and Eleventh Circuit Courts of Appeal.
UBH acknowledged that the DOL could adopt regulations requiring plans to discuss treating provider options in its decisions, as it did by amending its disability regulations 13 years ago. However, the DOL amended only its disability regulations, not its health benefits regulations.
UBH also challenged the Tenth Circuit panel’s refusal to consider portions of the administrative record under the arbitrary and capricious standard of review. The company claimed that the panel’s decision changed the judicial review process used by most circuits and undermined congressional intent to explain benefits decisions in simple and understandable terms. According to UBH, these changes increase the burdens on the benefits plans.
