9th Circuit: Insureds’ Fiduciary Claims Survive, But Not ERISA Benefits Class

Mealey's (August 23, 2023, 2:34 PM EDT) -- SAN FRANCISCO — Allegations that an insurer interpreted plan guidelines in a self-interested way, thus putting Employee Retirement Income Security Act insureds’ contractual benefits at risk, demonstrate a traceable injury for fiduciary claims, but because a benefits-based class included individuals whose denials were only partly based on the challenged guidelines, it was improperly certified, and to the extent that the ruling mandated that plans cover all treatments within the generally accepted standards of care, the judge erred, the Ninth Circuit U.S. Court of Appeals said Aug. 22 after panel rehearing....