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D.T. v. NECA/IBEW Family Medical Care Plan

United States District Court, W.D. Washington, Seattle

December 18, 2019

D.T., by and through his parents and guardians, K.T. and W.T., individually, on behalf of similarly situated individuals, and on behalf of the NECA/IBEW Family Medical Care Plan, Plaintiff,
v.
NECA/IBEW FAMILY MEDICAL CARE PLAN, THE BOARD OF TRUSTEES OF THE NECA/IBEW FAMILY MEDICAL CARE PLAN, SALVATORE J. CHILIA, ROBERT P. KLEIN, DARRELL L. MCCUBBINS, GEARY HIGGINS, LAWRENCE J. MOTER, JR., KEVIN TIGHE, JERRY SIMS, AND ANY OTHER INDIVIDUAL MEMBER OF THE BOARD OF TRUSTEES OF NECA/IBEW FAMILY MEDICAL CARE PLAN, Defendants.

          ORDER DENYING THE PARTIES' MOTIONS FOR SUMMARY JUDGMENT

          THE HONORABLE RICHARD A. JONES UNITED STATES DISTRICT JUDGE

         This matter comes before the Court on Plaintiff's Motions for Partial Summary Judgment (Dkt. ## 77, 97) and Defendants' Motion for Summary Judgment (Dkt. # 100). The Court has considered all of the evidence presented together since many of the issues overlap. Having thoroughly considered the parties' briefing and the relevant record, the Court finds oral argument unnecessary. For the reasons that follow, the Court DENIES the parties' Motions.[1] Dkt. ## 77, 97, 100.

         I. BACKGROUND

         This case involves benefits coverage for children with developmental mental health conditions such as Autism Spectrum Disorder (“ASD”). Plaintiff D.T. (“Plaintiff”) is a three-year old boy who has been diagnosed with ASD. Plaintiff is covered as a dependent-beneficiary under the Defendant NECA/IBEW Family Medical Care Plan (the “Plan”). The Plan is a multiemployer health and welfare plan within the meaning of Section 3(2) of the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1002(1), that has been established pursuant to an agreement entered into between the International Brotherhood of Electrical Workers (“IBEW”) and the National Electrical Contractors Association (“NECA”) for the purpose of providing major medical benefits to covered employees. Dkt. ## 11-1, 11-2. The Plan is administered by a Board of Trustees, also named as defendants in this action (collectively, the “Defendants”).

         Plaintiff was prescribed Applied Behavior Analysis (“ABA”) and neurodevelopmental therapy to treat his ASD. Dkt. # 17-1, Exs. B-D. However, Plaintiff was denied coverage for these treatments, both initially and on appeal. After the Board of Trustees denied the appeals, the Plan's legal counsel sent Plaintiff's parents a letter outlining the basis for the denial of coverage. Dkt. # 11-5; Dkt. # 11-6. The Plan also denied coverage of ABA and neurodevelopmental therapies for other Plan beneficiaries. Dkt. No. 17-1, Exh. C.

         On January 4, 2017, Plaintiff brought this class action lawsuit alleging that Defendants' denial of ABA and neurodevelopmental therapies on the basis of its Developmental Delay Exclusion violates the Employee Retirement Income Security Act (“ERISA”) and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (“Federal Parity Act”). Plaintiff asserted three ERISA claims against Defendants: (1) recovery of benefits; (2) breach of fiduciary duty; and (3) equitable relief. Id. at ¶¶ 26-39.

         On June 8, 2018, Plaintiff moved to certify the class. Dkt. # 34. The Court granted class certification and defined the class to include:

         All individuals who:

1) Have been, are or will be participants or beneficiaries under the NECA-IBEW Family Medical Care Plan at any time on or after January 4, 2011; and
2) Require neurodevelopmental therapy (speech, occupational or physical therapy) or applied behavior analysis therapy to treat a qualified mental health condition.

         Definition: The term “qualified mental health condition” shall mean a condition listed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association to which defendants applied and/or currently apply the Plan's Developmental Delay Exclusion.

         Dkt. # 54. On September 12, 2019, Plaintiff filed a Motion for Partial Summary Judgment as to the Class's eligibility to benefits under the plain language of the Plan's terms. Dkt. # 77. Plaintiff later filed a second Motion for Partial Summary Judgment regarding the Federal Mental Health Parity Act. Dkt. # 97. Defendants also filed a Motion for Summary Judgment regarding the Federal Mental Health Parity Act. Dkt. # 100.

         II. LEGAL STANDARD

         Summary judgment is appropriate if there is no genuine dispute as to any material fact and the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(a). The moving party bears the initial burden of demonstrating the absence of a genuine issue of material fact. Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). Where the moving party will have the burden of proof at trial, it must affirmatively demonstrate that no reasonable trier of fact could find other than for the moving party. Soremekun v. Thrifty Payless, Inc., 509 F.3d 978, 984 (9th Cir. 2007). On an issue where the nonmoving party will bear the burden of proof at trial, the moving party can prevail merely by pointing out to the district court that there is an absence of evidence to support the non-moving party's case. Celotex Corp., 477 U.S. at 325. If the moving party meets the initial burden, the opposing party must set forth specific facts showing that there is a genuine issue of fact for trial in order to defeat the motion. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 250 (1986). The court must view the evidence in the light most favorable to the nonmoving party and draw all reasonable inferences in that party's favor. Reeves v. Sanderson Plumbing Prods., 530 U.S. 133, 150-51 (2000).

         Despite this mandate, the court need not, and will not, “scour the record in search of a genuine issue of triable fact.” Keenan v. Allan, 91 F.3d 1275, 1279 (9th Cir. 1996); see also White v. McDonnel-Douglas Corp., 904 F.2d 456, 458 (8th Cir. 1990) (the court need not “speculate on which portion of the record the non-moving party relies, nor is it obliged to wade through and search the entire record for some specific facts that might support the nonmoving party's claim”). The opposing party must present significant and probative evidence to support its claim or defense. Intel Corp. v. Hartford Accident & Indem. Co., 952 F.2d 1551, 1558 (9th Cir. 1991). Uncorroborated allegations and “self-serving testimony” will not create a genuine issue of material fact. Villiarimo v. Aloha Island Air, Inc., 281 F.3d 1054, 1061 (9th Cir. 2002); T.W. Elec. Serv. v. Pac Elec. Contractors Ass'n, 809 F.2d 626, 630 (9th Cir. 1987).[2]

         III. ...


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