Case: Health Care & Benefits/Benefits Denial (D. Utah)

United Healthcare Insurance Company isn’t entitled to summary judgment on a plan participant’s claim for improperly denied benefits under the Employee Retirement Income Security Act, a federal district court in Utah ruled. The plan participant alleged that his daughter, a beneficiary, was approved for coverage of mental health care at a residential treatment center on three separate occasions but was later denied coverage in a peer-to-peer review. The court found that based on the review and an appeal, United Healthcare failed to make adequate factual findings and explain the grounds for its decision.