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Chavez & Gertler Protects Rights of Californians to Sue for Denial of Medical Coverage

Chavez & Gertler is one of the attorneys for the plaintiffs in Anderson v. Kaiser Foundation Health Plan, Inc., which addresses an issue of urgent public importance:  whether one of California’s leading purveyors of health care can lawfully deny coverage for accepted behavioral and physical therapies required by children afflicted with ASD.

The plaintiffs in Anderson, parents of autistic children and the nonprofit organization Equal Coverage for Autism, claim that Kaiser has violated California’s Mental Health Parity Law (“MHPL”) by failing to provide children diagnosed with ASD full and equal access to medically necessary treatments under the same terms that it provides similar services to plan members who have other medical conditions.

While Anderson is pending, Chavez & Gertler filed a “friend of the court” or “amicus curiae” brief in another case, Arce v Kaiser Foundation Health Plan, Inc., which alleges similar denials of benefits for autism.  In a recent decision in that case, the Court of Appeal agreed with the amicus arguments and affirmed the right of consumers to bring class action lawsuits against health plans that systematically deny benefits for covered medical conditions such as ASD.

As a result of the Court’s decision, the plaintiffs will be allowed to litigate two questions of vital interest:  (1) whether Kaiser’s health plan contract excludes certain therapies for ASD because they are “non-health care” rather than “medical” services, and (2) whether, if it does, the exclusion violates the MHPL.

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