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Case: Health Care & Benefits/Benefits Denial (9th Cir.)

June 30, 2020, 1:24 PM

The Ninth Circuit vacated and remanded the decision of a federal district court in California upholding the denial of coverage for the rare health condition of an employee’s minor son, finding that it was not clear which party made the decision to deny coverage. The employee brought an ERISA action against the Entertainment Industry Flex Plan after finding discrepancies in the record as to which company—Anthem Blue Cross Life & Health Insurance Co. or Anthem UM Services Inc.—decided that his son’s intravenous immunoglobulin treatment wasn’t a medically necessary treatment for his rare autoimmune disease. The Ninth Circuit determined that the...

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