Representative Cases

Lead trial and appellate counsel defending numerous health care service plans and insurance companies in dozens of individual and putative class actions, in both ERISA and non-ERISA contexts, in multiple states, alleging failure to cover medically necessary residential treatment and other levels of mental health and substance use treatment. Those actions that have gone to trial have led to wins that have been upheld on appeal. This work includes, for example:

• Lead counsel for a health care service plan in a putative ERISA class action challenging practices with respect to autism therapy. Defeated class certification in full. Plaintiff elected not to appeal. Disposed of remaining individual claim on standing grounds.
• Lead trial and appellate counsel for a health care service plan in a putative ERISA class action alleging systemic failure to arrange for residential treatment. Prevailed on a precertification motion for summary judgment, defeated subsequent motion for reconsideration, and prevailed on appeal.
• Lead trial counsel for a national health insurer in a putative nationwide ERISA class action alleging systemic failure to adequately cover residential treatment. Filed a motion to dismiss the entire action. Before the motion could be heard, plaintiff voluntarily dismissed the class claims and settled the remaining individual claim.
• Lead trial and appellate counsel representing a health care service plan and health insurer in a series of high-profile putative class actions involving alleged failure to deliver medically necessary mental health treatment to members. Settled one putative class action on a nonclass basis, obtained complete dismissal of another plaintiff’s claims on ERISA preemption grounds, defeated class certification of another action, substantially narrowed one remaining class action through pleading challenges and motion practice, and disposed of final action on summary judgment. Serving as lead counsel on appeal.
• Lead counsel for a health care service plan in a putative class action alleging “patient dumping” of severely mentally ill members. Before class certification, negotiated and administered a nonmonetary classwide settlement.
• Appellate counsel representing a trade group in an amici curiae brief supporting an appeal in a high-profile federal case involving mental health guidelines.

Representing a health care service plan in a high-profile investigation by the California attorney general into mental health parity practices.

Lead trial counsel defending a health care service plan in a putative class action alleging constitutional violations arising out of UIM recoupment practices. Prevailed at bench trial.

Lead counsel for a health care service plan in a putative class action alleging systematic underpayment of out-of-network claims over a ten-year period. Defeated class certification in full. Plaintiffs elected not to appeal.

Lead counsel for a health care service plan in a putative class action alleging systematic improper cancellation of health coverage. Defeated class certification in full. Plaintiffs elected not to appeal.

Lead counsel representing a national health care service plan in a high-profile putative nationwide class action alleging failure to review medical records as part of medical necessity determinations. Served a Rule 11 motion promptly after the case was filed. Within the 21-day safe harbor period and before the deadline to respond to the complaint, the plaintiff voluntarily dismissed the entire action.

Took over a putative class action filed against a health care service plan, after four years of litigation. Drafted a motion for judgment on the pleadings and, within four months, obtained complete dismissal.

Represented a health care service plan and health insurer in one of the first cases challenging conduct under the Affordable Care Act. Defeated class certification and drafted successful appellate papers.

Lead counsel representing a health care service plan in a putative class action alleging failure to give timely notice of premium increases. Prevailed on a precertification motion for summary judgment and defeated a subsequent motion for a new trial, leading to dismissal of the entire action.

Lead counsel for two out-of-state insurance companies in related putative nationwide class actions alleging failure to serve premium notices, as well as individual claims for breach of contract and bad faith. Drafted motions for summary judgment on all the individual claims, leading to voluntary dismissal. Negotiated a voucher-based settlement of the remaining class claims, valued at a small fraction of the companies’ potential liability.

Represented a health insurer in a putative class action alleging its recoupment practices violated unfair competition laws. Before the deadline to respond to the complaint, secured voluntary dismissal of the entire action.

Lead counsel for a health care service plan in a class action alleging violations of the California Reconstructive Surgery Act. Negotiated and administered a nonmonetary classwide settlement.

Lead counsel for several health care service plans and a health insurer in a series of seven ERISA and non-ERISA class actions relating to Class III spinal devices. Obtained partial summary judgment on a key issue of contract interpretation involving coverage of FDA-approved medical devices. Oversaw three ERISA class settlements and three nonclass settlements.

Represented a health insurer in an ERISA lawsuit alleging failure to pay for medically necessary spinal surgery. Less than one week after sending an email to the plaintiff detailing the grounds for a planned motion to dismiss, the plaintiff voluntarily dismissed the entire complaint.

Represented a health insurer in a lawsuit filed by an out-of-network emergency provider alleging underpayment of emergency treatment. Drafted a motion to dismiss. Rather than oppose it, the plaintiff voluntarily dismissed the entire action.

Lead appellate counsel representing trade groups in an amici curiae brief supporting a petition for rehearing en banc on an issue of first impression under Section 1557 of the Affordable Care Act.

Member of the trial team defending a health care service plan in a high-profile administrative action brought by a regulator seeking the second-largest fine in agency history. Settled on the eve of trial.

Represented a health care service plan in a lawsuit and related regulatory action involving coverage of brand and generic prescription drugs.