Brian H. et. al. v. Blue Shield of California

Filing 94

ORDER GRANTING IN PART AND DENYING IN PART PLAINTIFFS' MOTION FOR JUDGMENT; GRANTING IN PART AND DENYING IN PART DEFENDANTS' CROSS-MOTION FOR JUDGMENT; REMANDING FOR FURTHER PROCEEDINGS. Signed by Judge Maxine M. Chesney on March 11, 2019. (mmclc2, COURT STAFF) (Filed on 3/11/2019)

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IN THE UNITED STATES DISTRICT COURT

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FOR THE NORTHERN DISTRICT OF CALIFORNIA

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BRIAN H. and ALEX H.,
Plaintiffs,

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v.

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BLUE SHIELD OF CALIFORNIA, et al.,

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United States District Court
Northern District of California

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Defendants.

Case No. 17-cv-03095-MMC
ORDER GRANTING IN PART AND
DENYING IN PART PLAINTIFFS’
MOTION FOR JUDGMENT;
GRANTING IN PART AND DENYING
DEFENDANTS’ CROSS-MOTION FOR
JUDGMENT; REMANDING FOR
FURTHER PROCEEDINGS

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Before the Court are two motions: (1) Motion for Judgment, filed December 21,

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2018, by plaintiffs Brian H. and Alex H.; and (2) Cross-Motion for Judgment, filed January

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23, 2019, by defendants California Physicians’ Service dba Blue Shield (“Blue Shield”),

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Trinet Group Inc. Section 125, Section 129, and Flexible Account Spending Plan (“Trinet

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Plan”), and Trinet Group, Inc. (“Trinet Group”). The matter came on regularly for hearing

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on March 8, 2019. Katie J. Spielman and David M. Lilienstein of DL Law Group

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appeared on behalf of plaintiffs. Joseph E. Laska and Anastasia Bondarchuk of Manatt,

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Phelps & Phillips, LLP appeared on behalf of defendants.

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Having considered the parties’ respective written submissions and the arguments

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of counsel at the hearing, the Court, for the reasons stated on the record at the hearing,

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finds:

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1.

Blue Shield misconstrued the Blue Shield PPO Health Plan (“the Plan”); in

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particular, Blue Shield failed to consider whether the services for which plaintiffs’ claim

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was made were “furnished under generally accepted professional standards.” (See

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Administrative Record at BSC000394.)

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2.

Plaintiffs have failed to show that either Trinet Plan or Trinet Group is in any

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manner liable for payment of benefits due under the Plan or that either of said defendants

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violated any provision of the Employee Retirement Income Security Act or any of the

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terms of the Plan.

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Accordingly, the Court hereby GRANTS IN PART and DENIES IN PART plaintiffs’

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motion, and hereby GRANTS IN PART and DENIES IN PART defendants’ cross-motion,

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as follows:

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1.

As to Blue Shield, judgment is granted in favor of plaintiffs and the matter is

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hereby REMANDED to Blue Shield for consideration of plaintiffs’ claim for benefits under

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a standard consistent with this order. See Saffle v. Sierra Power Co. Bargaining Unit
Long Term Disability Income Plan, 85 F.3d 455, 461 (9th Cir. 1996) (holding “remand for

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United States District Court
Northern District of California

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reevaluation of the merits of a claim is the correct course to follow when an ERISA plan

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administrator, with discretion to apply a plan, has misconstrued the [p]lan and applied a

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wrong standard to a benefits determination”).

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2.

As to Trinet Plan and Trinet Group, judgment is granted in favor of said

defendants.
IT IS SO ORDERED.

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Dated: March 11, 2019
MAXINE M. CHESNEY
United States District Judge

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