Zuckerman Win Hailed as “Brown v Board” for the Mental Health Movement
In 2019, Zuckerman Spaeder delivered a game-changing legal win for mental health parity. Representing thousands of adults and adolescents, Zuckerman Spaeder took the nation’s largest mental health claims administrator to trial for systematically denying the coverage promised to plan holders. In March, the United States District Court for the Northern District of California issued a “scathing” (NY Times) ruling against United Behavioral Health (UBH) that former U.S. Rep. Patrick Kennedy called “the Brown vs. Board of Education for the mental health movement.”
Under the leadership of D. Brian Hufford and Jason Cowart, who have collectively spent decades utilizing the Employee Retirement Income Security Act of 1974 (ERISA) for the benefit of patients and providers, and Caroline Reynolds, who led the trial team, the firm developed and vindicated a groundbreaking legal strategy. This approach asserted that UBH violated its ERISA fiduciary duties by deliberately developing and using internal coverage guidelines that were much more restrictive than the “generally accepted medical standards” referenced in the written terms of the employer-sponsored health plans that UBH was administering. The court emphatically agreed, holding that the guidelines were “unreasonable,” and UBH’s financially-driven use of them “breached its fiduciary duty” under ERISA “by violating its duty of loyalty, its duty of due care, and its duty to comply with plan terms…”
The court’s remedy is expected to provide relief to tens of thousands of plaintiffs. Its liability ruling has already sent shockwaves through the behavioral healthcare industry, reminding those who administer ERISA plans that they must honor the fiduciary duties they owe to those who seek mental healthcare. Zuckerman’s trial win also demonstrates how effective it has been in using a form of “Legal Jiu-Jitsu” — pursuing claims against insurer administrators by utilizing the very ERISA doctrines they have long promoted.