Welcome to the UBH Guidelines Class Action Lawsuit Website

On November 3, 2020, the Court issued its Remedies Order, available here, which granted relief to the Class to remedy UBH’s violations of ERISA. The Court has:

(a) issued a declaratory judgment that, among other things, UBH’s Guidelines are inconsistent with generally accepted standards of care;

(b) ordered UBH to adopt and use guidelines that are consistent with generally accepted standards of care, specifically The American Society of Addiction Medicine Criteria (the ASAM Criteria), the Level of Care Utilization System for Psychiatric and Addiction Services (LOCUS), the Child and Adolescent Service Intensity Instrument (CASII), and the Early Childhood Service Intensity Instrument (ECSII);

(c) ordered UBH to reprocess the Class members’ claims for benefits using these third-party guidelines [as noted below, however, this aspect of the District Court’s remedies order has been stayed pending UBH’s appeal]:

(d) mandated that UBH adopt training protocols to ensure its employees and executives are adequately trained on these third-party guidelines and UBH’s duties under ERISA;

(e) imposed an injunction requiring these reforms; and

(f) indicated its intent to appoint a Special Master to oversee reprocessing and the injunctive remedies.

Update March 2021: On February 12, 2021, the Ninth Circuit Court of Appeals granted UBH’s request to stay the portion of the Remedies Order that requires UBH to reprocess Class members’ claims for benefits (paragraph (c) above).  The stay will remain in effect, and UBH will not be required to reprocess any Class members’ claims, until UBH’s appeal is resolved.  All other portions of the trial Court’s Remedies Order remain in effect, including the its order requiring UBH to use specific guidelines going forward.

Prior Case History

On September 19, 2016, the Court certified three Classes in the above-captioned cases. These Classes consist of individuals whose claims for insurance benefits for outpatient, intensive outpatient, or residential treatment of a mental illness or substance use disorder were denied by UBH, based in whole or in part upon UBH’s Guidelines, during certain time periods. If you are a member of one or more of the Classes, you may be entitled to participate in the remedies the Court orders in this lawsuit.

The Wit State Mandate Class, The Wit Guideline Class, and the Alexander Guideline Class, as well as the criteria for Class membership, are more fully described in FAQ2.

This website is a summary of the lawsuit. It also describes who is eligible to be included in the classes and the effect of participating in this lawsuit as a Class member.

This is a civil lawsuit filed in the United States District Court for the Northern District of California. The complaint names as defendant United Behavioral Health (operating as OptumHealth Behavioral Solutions). On September 19, 2016, the Court appointed as Class Representatives for the Wit Guideline Class David and Natasha Wit, Lori Flanzraich, Cecilia Holdnak, Brian Muir, and Linda Tillitt. The Court appointed Brandt Pfeifer as Class Representative for the Wit State Mandate Class. The Class Representatives the Court appointed for the Alexander Guideline Class include Gary Alexander, David Haffner, and Michael Driscoll.

The trial in this case began October 16, 2017, and concluded on November 1, 2017, after which the parties submitted post-trial briefs.

On March 5, 2019, the Court publicly filed its post-trial Findings of Fact and Conclusions of Law, which found UBH liable for breaching its fiduciary duties to the Class members and for wrongfully denying the Class members’ claims for benefits by using Guidelines that conflicted with the Class members’ plans. The opinion is available here.

The Court then moved to consideration of remedies for the class members. The Court entered its Remedies Order on November 3, 2020. The Remedies Order is available here. 

UBH also filed a motion to decertify the Classes, which Plaintiffs opposed. The Court issued an order on November 3, 2020 that granted UBH’s motion in part, and denied the motion in part.  That order is available here. The order amended the Class definitions and directed that notice be given to affected Class members.  For more information, see FAQ2 and FAQ7.

Notwithstanding the Court’s Findings of Fact and Conclusions of Law on liability, UBH denies that it did anything wrong and denies that it breached any fiduciary obligations to Class members when it developed and adopted its Guidelines. UBH contends that its Guidelines are consistent with generally accepted standards of care, are consistent with the terms of each Class member’s health benefit plan, and do not need to be rewritten.

UBH also denies that it abused its discretion as a benefit plan administrator when it denied Class members’ requests for coverage. UBH asserts that its decisions to deny Class members’ requests for coverage were based on, as appropriate, applicable state law, the terms of each Class member’s health benefit plan, the circumstances of each Class member’s clinical situation, the sound clinical judgment of its reviewing clinicians, and generally accepted standards of care, including but not limited to generally accepted standards of care reflected in UBH’s Guidelines and any criteria mandated by state law. UBH maintains that it appropriately denied Class members’ requests for coverage in whole or in part because Class members were not entitled to some or all of the benefits they requested under the terms of their individual health benefit plans, and that UBH complied with applicable state law in determining Class members’ requests for coverage.

On December 3, 2020 UBH filed a notice of appeal to the United States Court of Appeals for the Ninth Circuit. According to the schedule set by the Court of Appeals, UBH’s appeal brief is due on March 15, 2021.  Plaintiffs’ response will be due on May 12, 2021.  UBH’s optional reply brief will be due on June 2, 2021.  An oral argument is scheduled to occur on August 11, 2021.

To learn more about the terms of the Court’s decisions, your options, and how your legal rights may be affected, please review the Lawsuit Documents and answers to the Frequently Asked Questions provided on this website.