Bain v. Oxford Health Insurance: Judge Finds Insurer Liable for Breach of Fiduciary Duty Under ERISA As Medical Necessity Guidelines Were Inconsistent With Medical Standards of Care

In a recent decision by the U.S. District Court for the Northern District of California, Bain v. Oxford Health Insurance, 2020 WL 808236, the Court held that it is an abuse of discretion for an insurance company to rely on unreasonable medical necessity guidelines, to decide benefit claims, when these guidelines are inconsistent with the …

Read moreBain v. Oxford Health Insurance: Judge Finds Insurer Liable for Breach of Fiduciary Duty Under ERISA As Medical Necessity Guidelines Were Inconsistent With Medical Standards of Care

Ninth Circuit Rules that California’s Mental Parity Act Requires Health Insurers to Pay for Certain “Medically Necessary” Treatment for Mental Illnesses

In an important decision, the Ninth Circuit Court of Appeals ruled that California’s Mental Health Parity Act (“Parity Act” ) requires that health insurers cover certain medically necessary treatment for certain mental illnesses, even if the insurance policy explicitly excludes such coverage.  In Harlick v. Blue Shield of Calif., __ F.3d __ (9th Cir.  August …

Read moreNinth Circuit Rules that California’s Mental Parity Act Requires Health Insurers to Pay for Certain “Medically Necessary” Treatment for Mental Illnesses

Insurance Commissioner Jones Charges that Blue Shield Improperly Denied Health Insurance Coverage for Necessary Autism Treatment

California Insurance Commissioner Dave Jones recently announced that the California Department of Insurance is investigating whether Blue Shield of California Life and Health Insurance Company (“Blue Shield”) failed to comply with the California Mental Health Parity Act.  Specifically, Blue Shield is required to respond to an Order to Show Cause regarding its handling of claims …

Read moreInsurance Commissioner Jones Charges that Blue Shield Improperly Denied Health Insurance Coverage for Necessary Autism Treatment

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Address: 20321 SW Birch St. Suite 200
Newport Beach, CA 92660

Phone: 800-682-4137

We also have offices in Los Angeles, San Diego and San Francisco.

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