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
2/27/2025
/ Abuse of Discretion ,
Appeals ,
Denial of Insurance Coverage ,
Employee Retirement Income Security Act (ERISA) ,
Health Insurance ,
Insurance Claims ,
Insurance Litigation ,
Medical Necessity ,
Mental Health ,
Plan Administrators ,
Summary Judgment
In Josef K. v. California Physicians’ Service, No. 18-cv-06385-YGR (U.S. District Court for the Northern District of California, June 3, 2019), Judge Yvonne Gonzalez Rogers concluded that an independent medical review (IMR)...more
Behavioral health claims administrators and plan sponsors alike may be looking more closely at their care guidelines—and how they are applied—after a federal court ruled in a California class action that a claims...more
When applying de novo review to a claim for disability benefits under a group disability policy governed by the Employee Retirement Income Security Act of 1974 (ERISA), district courts must consider all the evidence and...more
Courts often do not clearly articulate what are key arguments in defending an action under the Employee Retirement Income Security Act of 1974 (ERISA) involving a claim for benefits based on subjective complaints. However,...more
Last week, the Ninth Circuit Court of Appeals issued its opinion in LeGras v. AETNA Life Insurance Company, No. 12-56541 (May 28, 2015), holding that the 180-day period to appeal a denial of a long-term disability claim was...more