• Filing. Published in U.S. District Court for the District of Utah on July 22, 2020 (Case no. 2:17-cv-01328-DAK-JCB).
  • Background. Plaintiffs third amended complaint asserts an ERISA cause of action based on the Federal Parity Act.  The Court quotes Judge Kimball’s earlier decision denying the Defendant’s requested dismissal of the Parity claim when he stated:

As a final matter, “[t]he nature of Parity Act claims is that they generally require further discovery to evaluate whether there is a disparity between the availability of treatments for mental health and substance abuse disorders and treatment for medical/surgical conditions.” It is for that reason that “[c]ourts in this jurisdiction favor permitting Parity Act claims to proceed to discovery to obtain evidence regarding a properly pleaded coverage disparity.”

As a result, Plaintiffs then filed a motion for Leave to Conduct Discovery seeking information from January 1, 2013 to the present related to:

  • Defendants’ administration of medical/surgical claims;
  • Residential treatment coverage criteria;
  • Defendants claim is confidential, proprietary, and business-sensitive;
  • Hospice care coverage criteria; and
  • The processing of claims for certain types of programs/facilities and about policies and plans unrelated to the Plan.

 

Defendant’s opposed the motion saying Plaintiff’s motion is neither relevant nor proportional to the needs of the case.

  • Holding. Judge Jared C. Bennett upheld Plaintiff’s motion for discovery with some limited exceptions.
  • Analysis. The Judge reviewed each element of the discovery requests and ruled in favor with several limited exceptions:
    • The Plaintiff’s agreed to limit the timeframe from 2014 and going forward based on when the plaintiff was in care; and
    • The Judge limited the scope of the discovery regarding the processing of claims for outdoor behavioral healthcare programs, wilderness programs, transitional living programs, or other sub-acute inpatient treatment facilities or programs for mental health or substance use disorders because those topics were too broad. (He also noted that Plaintiffs did not provide a counter-argument to Defendant’s challenge).