P. v. United Healthcare Benefits Plan of California

• Court: District Court, N.D. California
• Decided: February 11, 2025
• Docket: 3:24-cv-06932
• Status: Unknown

Opinion

1 2 3 4 5 6 7 UNITED STATES DISTRICT COURT 8 NORTHERN DISTRICT OF CALIFORNIA 9 ETHAN P., 10 Case No. 24-cv-06932-RS Plaintiff, 11 v. ORDER GRANTING MOTION TO 12 DISMISS WITH LEAVE TO AMEND UNITED HEALTHCARE BENEFITS 13 PLAN OF CALIFORNIA, 14 Defendant.

15 16 Plaintiff Ethan P. alleges defendant United Healthcare Benefits Plan of California violated 17 the Employee Retirement Income Security Act of 1974 (“ERISA”) when it refused to cover 18 certain mental health treatment for his son. Plaintiff contends the treatment was medically 19 necessary, and was otherwise eligible for coverage under the employer-sponsored welfare benefit 20 plan in which he participated. The operative First Amended Complaint advances a claim for 21 recovery of benefits that United Healthcare does not challenge at the pleading stage. 22 The second claim for relief, however, entitled “breach of fiduciary duty,” includes an 23 assertion that United Healthcare, “[c]onsciously, unreasonably, intentionally, and without 24 justification, violat[ed] California’s Mental Health Parity Act, Health & Safety Code §1374.72, as 25 well as the Federal Mental Health Parity and Addictions Equity Act of 2008 (“MHPAEA”) which 26 specifically require that health care plans provide medically necessary diagnosis, care and 27 treatment for the treatment of specified mental health illnesses at a level equal to the provision of 1 moves to dismiss that portion of the second claim for relief that purports to state a violation of 2 those state and federal health parity acts. 3 Pursuant to Civil Local Rule 7-1(b), the motion to dismiss is suitable for disposition 4 without oral argument, and the hearing set for February 27, 2025, is vacated. This issue presented 5 by this motion is narrow, and the parties are to be commended for recognizing that by filing briefs 6 well under the page limits. That briefing also reveals the parties’ positions are not in significant 7 conflict. United Healthcare does not contend the second claim for relief, for “breach of fiduciary 8 duty” should be dismissed in its entirety. Rather, United Healthcare argues the first amended 9 complaint does not allege sufficient facts to state a claim for violation of either the state or federal 10 health parity acts—as part of a “breach of fiduciary duty” claim or otherwise. Plaintiff, in turn, 11 argues he has adequately alleged breach of fiduciary duty on other grounds, but offers no real 12 defense that the complaint alleges facts showing a violation of the parity acts. 13 In some circumstances, allegations that are insufficient to support a particular theory of 14 liability should simply be disregarded when included in an otherwise adequately pleaded claim for 15 relief. Here, however, it is appropriate to conclude that the First Amended Complaint fails to state 16 a claim for violation of the state and federal health parity acts, and to dismiss the second claim for 17 relief to the extent, but only to the extent, that it is based on a claim of such violations. Cf. Scott D. 18 v. Anthem Blue Cross Life & Health Ins. Co., 2024 WL 1123210, at *3 (N.D. Cal. Mar. 14, 2024) 19 (evaluating adequacy of allegations of parity act violation as an element of his breach of fiduciary 20 duty claim). 21 If plaintiff wishes to pursue a claim based on parity act violations in addition to the other 22 allegations he contends constitute breach of fiduciary duty, he may file an amended complaint 23 within 14 days of the date of this order. If no amended complaint is filed, the litigation shall 24 proceed on the First Amended Complaint with the understanding that the breach of fiduciary duty 25 claim does not include any claim that the alleged denial of benefits violated the state or federal 26 parity acts. 27 1 IT IS SO ORDERED. 2 3 Dated: February 11, 2025 4 RICHARD SEEBORG 5 Chief United States District Judge 6 7 8 9 10 11 a 12

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