Caldwell

INTRODUCTION

18 In this ERISA action, defendants insurance companies denied coverage for plaintiff’s 19 surgical treatment of lipedema. Defendants move to dismiss plaintiff’s complaint under 20 21 FRCP 12(b)(6). For the reasons set forth below, defendant’s motion is GRANTED IN PART AND 22

DENIED IN PART.

STATEMENT

23 Lipedema is a chronic, progressive, painful, and immobilizing condition involving an 24 abnormal buildup of adipose tissue (body fat). After plaintiff Mary Caldwell was diagnosed 25 with Stage 3 lipedema, her physician proposed treatment with specialized liposuction. 26 Caldwell alleges that specialized liposuction is the only available therapy for lipedema. 27 Defendants UnitedHealthCare Insurance Company and United HealthCare Services, Inc. 28 1 (together, “United”) denied her coverage. They stated “these procedures are not proven to be 2 helpful for people with your condition. Your plan does not cover for unproven services.” 3 United denied Caldwell’s subsequent appeal stating that neither the clinical information nor 4 peer-reviewed literature supported the use of specialized liposuction for lipedema. Thus, United 5 deemed the procedure an unproven…