Case Background

Dan C. sued Anthem Blue Cross Life and Health Insurance Company and others over denied mental health benefits under an ERISA-governed plan. The dispute centered on claims for R.C.’s residential treatment at Intermountain. The plaintiff alleged that Anthem failed to provide required mental health coverage despite state and federal parity laws mandating equal treatment of mental and physical health conditions.

Cause

The plaintiff claimed Anthem breached fiduciary duties under ERISA by using MCG “level of care guidelines” biased against residential treatment approvals. Anthem allegedly failed to disclose the use of these guidelines, used unqualified medical directors, and hired third-party reviewers with financial incentives to deny claims. The company allegedly violated the California Mental Health Parity Act and the Federal MHPAEA by denying medically necessary mental health care. The plaintiff also accused Anthem of misinterpreting the plan to maximize profits, ignoring appeal rights, and refusing to pay claims it knew were valid.

Injury

The denial allegedly deprived the plaintiff of necessary mental health treatment