Insurance – Plaintiff waited too long to sue over denial of benefits – Virginia Lawyers Weekly

Insurance – Plaintiff waited too long to sue over denial of benefits  Virginia Lawyers Weekly

Plaintiff David B's erisa action against Anthem Blue Cross and Blue Shield was time barred by a one-year limitations period in the edva court. Insurance – Plaintiff waited too long to sue over denial of benefits Where the plaintiff did not bring his § 502(a) ERISA action within one year, it was time barred. Plaintiff David B sues defendant Anthem Blue Cross and Blue Shield, the insurer and claims administrator of his employee health plan. His claims arise under the Employee Retirement Income Security Act of 1974, or ERISA. Plaintiff challenges defendant’s denial of benefits for his daughter’s residential mental health treatment, which defendant denied for lack of medical necessity.

The parties have filed cross motions for summary judgment. The Parity Act prohibits insurance plans from applying treatment limitations to mental health benefits that are “more restrictive” than those applied to “medical and surgical benefits . . . under the plan.” To bring an as-applied challenge, as plaintiff does here, he must: “(1) identify what unequal [treatment] limitation allegedly violated the [Parity Act]; (2) identify medical or surgical analogues to the mental health treatment at issue; and (3) compare this limitation as it relates to [R.B.’s] mental health treatment with medical or surgical analogues to how a plausible disparity.” Since the plan confers discretionary authority on its administrator, the court’s