C.
C. v. California Physicians Service
Opinion
Trial Court Opinion
BACKGROUND
From December 1, 2017 through November 30, 2019, Plaintiff C.C. participated in a Full PPO group health plan issued by Blue Shield.2 Plaintiff J.C. was a beneficiary of the plan during this period.3 The plan is a fully insured employee welfare benefit plan governed by the Employee Retirement Income Security Act of 1974 (“ERISA”).
1 Docket no. 9, filed May 23, 2021. 2 Declaration of Leslie Crawford (“Crawford Decl.”) ¶ 3, Docket no. 9-1, filed April 23, 2021. 3 Id. 4 Complaint ¶ 3, Docket no. 2, filed January 22, 2021. Plaintiffs allege that J.C. exhibited troubling behaviors requiring mental health treatment.5 Plaintiffs allege that from January 29, 2018 to August 29, 2019, J.C. was admitted to Kolob Canyon Residential Treatment Center (“Kolob”), a facility in Utah that treats mental health, behavioral, or substance abuse problems in adolescents.6 Plaintiffs allege that they sought
coverage from Blue Shield for treatment at Kolob, but that Blue Shield denied their requests for coverage and subsequent administrative appeals.7 Plaintiffs allege they then sought an independent medical review from a California state regulatory agency, the California Department of…