Ninth Circuit Affirms Denial of Coverage for Residential Treatment, Finding Plan Administrator’s Reliance on InterQual Criteria to be Reasonable
Ninth Circuit Affirms Denial of Coverage for Residential Treatment, Finding Plan Administrator’s Reliance on InterQual Criteria to be Reasonable
In K.K.; I. B. v. Premera Blue Cross, et al., No. 23-35480, 2025 WL 415721 (9th Cir. Feb. 6, 2025), Plaintiffs, K.K. and her daughter I.B., sought recovery of benefits…
Seventh Circuit Affirms ERISA Fund’s Denial of Out-of-Network Medical Treatment
In Est. of Gifford v. Operating Eng’rs 139 Health Benefit Fund, No. 23-3356, __F.4th__, 2025 WL 79102 (7th Cir. Jan. 13, 2025), the Seventh Circuit Court of Appeals affirmed the…
Tenth Circuit Finds Plaintiffs Lack Standing to Bring Parity Act Claim and Affirms Award of ERISA Statutory Penalties Against Health Insurance Company
The Tenth Circuit Court of Appeals recently decided S. v. Premera Blue Cross, No. 22-4056, __F.4th__, 2024 WL 4356319 (10th Cir. Oct. 1, 2024), a case involving claims for mental…
Third Circuit Upholds Dismissal of Putative ERISA Class Action Alleging MetLife Unlawfully Kept $65 Million in Drug Rebates for Its Own Benefit
In Knudsen v. MetLife Grp., Inc., No. 23-2420, __F.4th__, 2024 WL 4282967 (3d Cir. Sept. 25, 2024), Plaintiffs are former employees of MetLife Group, Inc. and participants in the MetLife…
Fifth Circuit Orders United Healthcare to Pay for Minor’s Partial-Hospitalization Treatment for Anorexia Nervosa
In Dwyer v. United Healthcare Ins. Co., No. 23-50439, __F.4th__, 2024 WL 4230125 (5th Cir. Sept. 19, 2024), the Fifth Circuit reversed the district court’s judgment in favor of United…
Eighth Circuit: ERISA Health Plan’s Counterclaim Seeking Equitable Right to Settlement Funds Does Not Establish Subject-Matter Jurisdiction in Federal District Court
In Kellum v. Gilster-Mary Lee Corp. Grp. Health Benefit Plan, No. 23-2765, __F.4th__, 2024 WL 3930833 (8th Cir. Aug. 26, 2024), a dispute where a self-funded health plan removed an…
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