Filing. Filed in U.S. District Court for the District of Utah, Central Division on November 21, 2019 (Case no. 2:18-cv-976 RJS DBP).
Background. Plaintiff’s filed suit on behalf of their dependent under ERISA and the Federal Parity Law. The Plaintiff’s dependent has a history of behavioral health (including bipolar disorder) and substance abuse. Based on the recommendations of her psychiatrist, she attended a therapeutic boarding school, a wilderness program and a residential treatment program. The legal dispute focuses on Cigna’s denial of coverage for the wilderness program because the care was not medically necessary and wilderness is an excluded benefit, and Cigna’s denial of coverage for residential treatment because the dependent’s “symptoms do not meet ‘Cigna’s Behavioral Health Medical Necessity Criteria for continued stay at a Residential Mental Health Treatment for Children and Adolescents…Less restrictive levels of care are available for safe and effective treatment…” All of the denials were upheld during the appeals process.
Holding. Defendant filed a Partial Summary Judgement Motion to dismiss Plaintiff’s Parity Act claim — in addition to a Short Form Discovery Motion to limit Plaintiff’s discovery requests. The Court denied the Short Forum Discovery Motion until the Summary Judgement Motion regarding the Parity Act claim can be determined.
Additional findings. The Court noted that “Defendants seek to avoid discovery about the Parity Act claim arguing they have already filed a motion for partial summary judgment on the claim and Plaintiffs’ argument about the alleged violations “are groundless.’” The Court notes that the “Defendants cannot avoid discovery into the Parity Act claims simply because a motion for partial summary judgment has been filed.” “(D)iscovery is not simply a fishing expedition, rather, it could be critical to a Parity Act claim.”