Kantor & Kantor, LLP: Ninth Circuit Issues Final Ruling That Requires Health Plans to Cover Residential Treatment for Eating Disorders

Blue Shield's Second Rehearing Request Denied Along With Plea for Rehearing En Banc

Jul 12, 2012, 18:09 ET from Kantor & Kantor, LLP

LOS ANGELES, July 12, 2012 /PRNewswire/ -- Kantor & Kantor, LLP announced today that the Ninth U.S. Circuit Court of Appeals has denied an insurer's second request for rehearing of a significant decision in favor of people suffering from nine enumerated mental health conditions – eating disorders in particular. The Court confirmed its June 4, 2012, decision that the California Mental Health Parity Act requires health plans to provide coverage of "all medically necessary treatment" for "severe mental illnesses" under "the same financial terms as those applied to physical illnesses." In that decision, Harlick v. Blue Shield of California, the Court held that health plans in California are obligated to pay for residential treatment for people with eating disorders even if the policy excludes residential treatment. In today's decision, the majority summarily denied Blue Shield's request for rehearing and rehearing en banc (before all judges of the Court).

"The finality of this decision is exciting news for people with mental illness and those who love them, both in California and around the country," said Lisa Kantor of Kantor & Kantor, LLP, who represents the plaintiff Jeanene Harlick.  "The majority held firm in its analysis of the plain meaning of the Mental Health Parity Law. We are confident other courts around the country will take note of the majority opinion's common sense reasoning."

Jeanene Harlick has suffered from anorexia for more than 20 years. In 2006, her physicians recommended treatment at a facility qualified to treat eating disorders.  Although Blue Shield agreed to pay for the treatment, after 10 days it denied coverage, saying the plan did not cover residential treatment even though the insurer agreed the treatment was medically necessary. 

In July 2008, Kantor sued Blue Shield on Harlick's behalf, arguing, among other things, that Blue Shield's health plan violated the California Mental Health Parity Act.  Blue Shield argued that it properly denied coverage under the terms of the plan, and the district court agreed. Harlick appealed, and the Ninth Circuit ruled in her favor.

Blue Shield requested a rehearing and a rehearing en banc.  The California Department of Insurance filed a Brief of Amicus Curiae (friend of the Court), opposing Blue Shield's requests and supporting Harlick's position.  The Department of Managed Healthcare did not file a brief in the matter, despite its responsibility for regulating health care service plans in California. 

On June 4, 2012, the Court denied the request for rehearing and rehearing en banc, withdrew its prior opinion of August 26, 2011, and issued a majority opinion by Judge William A. Fletcher with a dissenting opinion by Judge N.R. Smith.  Blue Shield immediately filed another request for rehearing and rehearing en banc, which was denied by the Court today.

For more information about Lisa Kantor and legal assistance for eating disorders, follow this link: http://www.kantorlaw.net/Areas_of_Practice/Eating_Disorders.aspx.

About Kantor & Kantor, LLP

Kantor & Kantor is one of the largest law firms in the country exclusively representing plaintiffs who have been denied insurance benefits under life, health, disability and long-term care policies. The firm has extensive experience with the complex appeals process and federal court litigation of ERISA matters, as well as the handling of Insurance Bad Faith matters.  For more information, log on to www.kantorlaw.net, call (800) 446-7529, or follow the firm at www.californiainsurancelawyerblog.com.

SOURCE Kantor & Kantor, LLP