Humana Tells Justices to Skip ERISA Attorneys’ Fee Battle

A decision declining to award attorneys’ fees to a patient who sued Humana Health Plan of Texas Inc. over denied benefits didn’t create a circuit split and shouldn’t be reviewed by the U.S. Supreme Court, the insurer told the justices.

The U.S. Court of Appeals for the Fifth Circuit’s 2019 decision denying a request for attorneys’ fees doesn’t conflict with the First Circuit’s 2014 decision awarding fees in an earlier Employee Retirement Income Security Act lawsuit, the insurer said in a May 15 brief. And the Fifth Circuit’s decision is unpublished and “fact-bound,” posing “no obstacle to future claimants,” the insurer said.

Humana is responding to a petition for Supreme Court review filed by a plan participant raising questions under ERISA’s attorneys’ fee provision. The high court recently signaled interest in this case by ordering Humana to file this response, a move that increases the chances the case will be heard from 1% to 5%, according to a Bloomberg Law analysis.

The case stems from a dispute between Humana and a teenager with an eating disorder who sought coverage for several months she spent at a residential treatment facility in Utah. Humana initially won in court, but the Fifth Circuit revived the lawsuit on appeal after finding the district court gave too much deference to the insurer. In so ruling, the Fifth Circuit effectively overturned a 1991 insurer-friendly decision that made it harder for patients to challenge benefit denials in court.

Despite this ruling, Humana won again at the district court level, and the Fifth Circuit affirmed. In that decision, the Fifth Circuit agreed that the teenager wasn’t entitled to attorneys’ fees because she didn’t achieve “some degree of success” on the merits of her claim for benefits.

The teenager urged the Supreme Court to review how the Fifth Circuit handled her fee request. In her view, she achieved enough success to warrant a fee award under ERISA, because her lawsuit led to a “ground-breaking decision” overruling prior case law and making it easier for people in Texas, Louisiana, and Mississippi to challenge benefit denials in court.

Humana disagrees, saying the issue raised by the teenager hasn’t yet matured in the district courts or caused a true circuit split.

Humana is represented by Soltero, Sapire, Murrell PLLC, Mitchell Williams, and Squire, Patton, Boggs LLP.

The case is Ariana M. v. Humana Health Plan of Tex., U.S., No. 19-980, opposition brief 5/15/20.