A panel of the U.S. Court of Appeals for the Tenth Circuit recently heard oral arguments in the case of K. et al. v. United Behavioral Health et al., case number 21-4088. The judges appeared skeptical of United Behavioral Health’s challenge to the district court’s 2021 ruling. That court found that United and an Alcatel-Lucent employee medical plan violated the ERISA by denying inpatient mental health treatment coverage for an employee’s child.
D.K., an employee of Alcatel-Lucent, and K.K., the employee’s spouse, first filed suit against the insurer and plan in December 2017, seeking reimbursement for their daughter A.K.’s treatment at an inpatient mental health facility. The plaintiffs alleged violations of ERISA and the Mental Health Parity Act, although only the ERISA claim remains on appeal.
After an adverse ruling, United and Alcatel-Lucent appealed. The U.S. Department of Labor (DOL) also participated as amicus for the plaintiffs during oral arguments. DOL attorneys argued that the Tenth Circuit should uphold the district court’s ruling. They contended that the district court had properly applied federal regulations and case law in deciding that United had violated its fiduciary duty under ERISA to review fully and fairly the health benefits claim for A.K.
During oral arguments, the panel expressed concern at United’s “perfunctory engagement” in reviewing the claim and its failure to justify or mention the treating physicians’ opinions that the care was medically necessary. Although United argued that the circuit court in two unpublished cases had found that a benefits plan was not required to discuss contrary provider opinions, the panel appeared unmoved.
Upon questioning by the panel, the attorney for the patient and the family replied that there was no contemporaneous discussion about the necessity of the child’s treatment or care but, rather, repeated denials of the claims “based on the evidence.”
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