Ninth Circuit Affirms Denial of ERISA Medical Benefits for Residential Mental Health Treatment Under “Medical Necessity” Guidelines.
Ninth Circuit Affirms Denial of ERISA Medical Benefits for Residential Mental Health Treatment Under “Medical Necessity” Guidelines.
In R.R.; E. R. v. California Physicians’ Service, d/b/a Blue Shield of California, No. 24-6337, 2026 WL 207507 (9th Cir. Jan. 27, 2026), Plaintiffs-Appellants R.R. and his son E.R. sued…
Sixth Circuit Finds Termination of Residential Mental Health Coverage Arbitrary and Capricious Under ERISA but Affirms Dismissal of Parity Act Claim
In T.E. v. Anthem Blue Cross & Blue Shield, No. 25-5407, ---F.4th----, 2026 WL 172050 (6th Cir. Jan. 22, 2026), the Sixth Circuit held that Anthem Blue Cross and Blue…
Texas District Court Recommends Significant ERISA Fee Award, Approves Out-of-District Rates and Rejects Proportionality Arguments
In Dwyer v. UnitedHealthcare Insurance Co., No. 1:17-cv-00439-RP (W.D. Tex. Jan. 21, 2026), on remand from the Fifth Circuit, a magistrate judge in the Western District of Texas issued a…
Ninth Circuit Vacates ERISA Benefit Denials Where Plan Misapplied “Hospital” Definition
In Delgado, et al. v. ILWU-PMA Welfare Plan, No. 24-1845, 2026 WL 161403 (9th Cir. Jan. 21, 2026) (Before: Wardlaw, N.R. Smith, and Miller, Circuit Judges), the Ninth Circuit held…
Ninth Circuit Holds ERISA Preempts Provider’s State-Law Misrepresentation Claims Against Insurer
In Healthcare Ally Management of California, LLC v. United Healthcare Services, Inc., No. 24-5178, 2025 WL 3485391 (9th Cir. Dec. 4, 2025), the Ninth Circuit affirmed the dismissal of a…
Sixth Circuit Holds ERISA Completely Preempts State-Law Claims Challenging Insurer’s Reimbursement Practices
In Patterson v. UnitedHealth Group, Inc., No. 25-3175, ---F.4th----, 2025 WL 3458953 (6th Cir. Dec. 2, 2025), the Sixth Circuit affirmed the dismissal of a putative class action alleging that…
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