On March 5, 2019, Magistrate Judge Joseph C. Spero of the U.S. District Court for the Northern District of California issued his opinion in Wit v. United Behavioral Health, in which he attempted to significantly change how Employee Retirement Income Security Act (ERISA)–governed health plans were administered, particularly third-party administrators’ reliance on medical necessity guidelines and the application of the abuse of discretion standard. The Ninth Circuit ultimately reversed the portions of the decision that were the most troublesome for ERISA plans and third-party administrators.

In K.K.; I.B. v. Premera Blue Cross, issued on February 6, 2025, the Ninth Circuit provided another indication that the approach taken by the district court in the Wit matter is in the past. There, the Ninth Circuit affirmed the district court’s grant of summary judgment in favor of the ERISA plan administrator and the self-funded plan.

Quick Hits

• On February 6, 2025, the Ninth Circuit affirmed a lower court’s grant of summary judgment in favor of an ERISA health benefits plan administrator and the plan, concluding that the denial of benefits for a plaintiff’s treatment was reasonable and based on credible, contemporaneous medical evidence.
• The Ninth Circuit’s decision underscores the importance of using validated medical necessity guidelines and supports plan administrators’ discretion in making benefits determinations under ERISA.
• The Ninth Circuit emphasized that ambiguity and...

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