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
The extent to which a health plan may exclude coverage for mental health treatment modalities has become an active area in ERISA litigation. In Doe v. United Behavioral Health, 2021 U.S. Dist. LEXIS 43146 (N.D. Cal. March 5,...more
Hinshaw's LHD/ERISA Advisor remains committed to bringing you recent legal developments that may guide your life, health, and disability litigation strategy and claims decisions....more
In Gill v. Unum Life Ins. Co. of Am., 2020 U.S. Dist. LEXIS 219416 (N.D. Cal. Nov. 23, 2020), a California federal court held that an ERISA claim administrator properly limited benefits to 24 months under the plan's mental...more
In Jessica U. v. Health Care Service Corp., a Montana district court held that an ERISA plan administrator improperly denied benefits for mental health residential treatment based solely on so-called "Milliman Care...more
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
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
10/14/2020
/ Appeals ,
Denial of Insurance Coverage ,
Dependents ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
ERISA Litigation ,
Medical Necessity ,
Mental Health ,
Plan Administrators ,
Reversal ,
Reversible Error ,
Standard of Review ,
Summary Judgment
In Julie L. v. Excellus Health Plan, Inc., 2020 U.S. Dist. LEXIS 47734 (W.D.N.Y. March 19, 2020), a New York district court rejected the plaintiff's claims that a health insurer improperly imposed stricter medical necessity...more