Campbell v. United Healthcare Ins. Co.

Full title: LEAH CAMPBELL, Plaintiff, v. UNITED HEALTHCARE INSURANCE COMPANY…

Court: United States District Court, Central District of California

Date published: Aug 20, 2024

2:23-cv-08823-RGK-E (C.D. Cal. Aug. 20, 2024)

Opinion

2:23-cv-08823-RGK-E

08-20-2024

LEAH CAMPBELL, Plaintiff, v. UNITED HEALTHCARE INSURANCE COMPANY, INSPERITY HOLDINGS, INC., and DOES 1-10, Defendants.

R. Gary Klausner Judge

[PROPOSED] JUDGMENT ORDER

R. Gary Klausner Judge

THIS MATTER having come before the Court by way of trial briefing (Fed. R. Civ. P. 52) by Plaintiff Leah Campbell (“Plaintiff”) and Defendants UnitedHealthcare Insurance Company (“United”) and Insperity Holdings, Inc. (“Insperity”) (collectively, “Defendants”) seeking judgment; and

The Court having considered the trial briefing in support of and in opposition; and for good cause show;

IT IS on this 20^th day of Aug, 2024, ORDERED that, for the first cause of action for benefits in the Second

Amended Complaint (“SAC”) under ERISA § 502(a)(1)(B), judgment is entered as follows:

1. For the claim related to services by Emergency Surgical Assistant (the “Assistant Claim”), judgment for Defendants as “Defendants did not abuse their discretion in denying the Assistant Claim.” (Order at 5.)

2. For the claim related EGD services, judgment for Defendants as “Defendants did not abuse their discretion in denying the EGD Claim.” (Order at 5.)

3. As to the claim by Emsurgcare (the “Surgeon Claim”), the Court “REMANDS the Surgeon Claim to Defendants for reevaluation” for United to “consider the UCR rate as the Plan required,” and enters judgment for Plaintiff as to the Surgeon Claim. (Order at 6.)

ORDERED that, for the second cause of action in the SAC under ERISA for statutory penalties, judgment is entered in favor of Defendants.

ORDERED that, to the extent that either Plaintiff or Defendants seek attorneys' fees and costs, they shall file a motion within 30 days of entry of this judgment. Plaintiffs shall be limited to seeking attorneys' fees and costs related to the Surgeon Claim. Defendants shall be limited to seeking attorneys' fees and costs related to the Assistant Claim, EGD Claim, and the second cause of action.

ORDERED that the Court will retain jurisdiction during the revaluation/remand period as to the Surgeon Claim.