Lewis Brisbois Secures Dismissal of Health Care ERISA Matter

Los Angeles, Calif (August 12, 2019) – Los Angeles Partner Elise D. Klein recently secured the summary judgment dismissal of an Employee Retirement Income Security Act (ERISA) suit brought against our clients, Harvard Pilgrim and United Behavioral Health, in a Utah federal court. The suit alleged the organizations had wrongfully denied coverage for the mental health treatment of an adolescent girl at a boarding school.

The plaintiffs, the girl’s parents, claimed their health plan did not prevent them from seeking to recover benefits for out-of-network services that had not been preauthorized. However, Ms. Klein argued the plan said exactly the opposite, to which the court agreed, holding that the plan’s language clearly states that out-of-network services would not be reimbursed without prior authorization.

The court also found that the girl’s treatment was not medically necessary and therefore granted our motion for summary judgment.

Ms. Klein is the Chair of Lewis Brisbois’ Life Health Disability & ERISA Practice. She has more than twenty years of experience in insurance and health insurance law.

Read more about this case on Law360 here (subscription required).

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