Jane Doe v. United Behavioral Health (U.S. Dist. Ct Northern Dist. of Cal, case no. 4:19-cv-07316-YGR, March 5, 2021). Judge Yvonne Gonzalez Rogers granted Plaintiff’s motion for partial summary judgement. The case centers around a health plan’s explicit exclusion of Applied Behavioral Analysis (ABA) an Intensive Behavioral Health Therapies (IBT) to support children who have been diagnosed with autism spectrum disorder. Plaintiffs brought two ERISA § 1132(a)(3) claims challenging the exclusions. United asserted that the ABA/IBT exclusions are not treatment limitations under the Federal Parity Law.
The Court held that United was a fiduciary under the ERISA framework. Judge Rogers also concluded that “On its face, the ABA/IBT exclusion creates a separate treatment limitation applicable only to services for a mental health condition (Autism). By doing so, the exclusion violated the plain terms of the Parity Act.”