United States District Court, W.D. Washington, Seattle
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,
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
HONORABLE RICHARD A. JONES UNITED STATES DISTRICT JUDGE
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. Dkt. ## 77, 97, 100.
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
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.
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.
8, 2018, Plaintiff moved to certify the class. Dkt. # 34. The
Court granted class certification and defined the class to
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.
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.
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.
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).
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.