Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_17-cv-03095/USCOURTS-cand-3_17-cv-03095-9/pdf.json

Nature of Suit Code: 791
Nature of Suit: Employee Retirement Income Security Act (ERISA)
Cause of Action: 28:1332 Diversity-Petition for Removal

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United States District Court

Northern District of California

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

BRIAN H. & ALEX H.,

Plaintiffs,

v.

BLUE SHIELD OF CALIFORNIA, et al.,

Defendants.

Case No. 17-cv-03095-MMC 

ORDER DENYING PLAINTIFFS’

MOTION FOR JUDGMENT;

GRANTING DEFENDANTS’ CROSSMOTION FOR JUDGMENT

Re: Dkt. Nos. 81, 85

Before the Court are two motions: (1) Motion for Judgment, filed December 21, 

2018, by plaintiffs Brian H. and Alex H.; and (2) Cross-Motion for Judgment, filed January 

23, 2019, by defendant California Physicians’ Service dba Blue Shield (“Blue Shield”).

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The matter came on regularly for hearing on August 2, 2019. David M. Lilienstein of DL 

Law Group appeared on behalf of plaintiffs. Joseph E. Laska of Manatt, Phelps & 

Phillips, LLP appeared on behalf of defendants. 

Having read and considered the parties’ respective written submissions and the 

arguments of counsel at the hearing, the Court, for the reasons stated on the record at 

the hearing, rules as follows: 

1. The evidence presented does not support plaintiffs’ contentions that, in denying 

plaintiffs’ claims for benefits under the Blue Shield PPO Health Plan: (a) Blue Shield 

failed to specify, or make available on plaintiffs’ request, the guidelines on which it relied 

 

1 Although the cross-motion is also brought on behalf of Trinet Group Inc. Section 125, 

Section 129, and Flexible Spending Account Spending Plan (“Trinet Plan”), and Trinet 

Group, Inc. (“Trinet Group”), judgment in favor of those defendants was entered on

March 12, 2019. 

Case 3:17-cv-03095-MMC Document 120 Filed 08/07/19 Page 1 of 2
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United States District Court

Northern District of California

in evaluating plaintiffs’ claims; (b) Blue Shield failed to provide specific reasons for 

denying plaintiffs’ claims; (c) Blue Shield provided inconsistent and changing grounds for 

denying plaintiffs’ claims; or (d) Blue Shield’s reliance on the reports and opinions of its 

medical reviewers was improper. 

2. Plaintiffs have not submitted admissible evidence as to the “generally accepted 

professional standard[]” (see AR BSC000394) used for treating mental health disorders in 

adolescents and, consequently, have not shown the guidelines used by Blue Shield to 

evaluate plaintiffs’ claims were inconsistent with any such standard, or that the residential 

mental health treatment services received by Alex H. were in keeping with any such

standard. 

In light of the above, the Court finds Blue Shield, in denying plaintiffs’ claims, did 

not “(1) render[] a decision without explanation, (2) construe[] provisions of the plan in a 

way that conflicts with the plain language of the plan, or (3) rel[y] on clearly erroneous 

findings of fact,” see Boyd v. Bert Bell/Pete Rozelle NFL Players Retirement Plan, 410 

F.3d 1173, 1178 (9th Cir. 2005), and, consequently, finds Blue Shield did not abuse its 

discretion in rendering such decision. 

Accordingly, plaintiffs’ Motion for Judgment is hereby DENIED and defendants’ 

Cross-Motion for Judgment is hereby GRANTED. 

IT IS SO ORDERED.

Dated: August 7, 2019 

MAXINE M. CHESNEY

United States District Judge

Case 3:17-cv-03095-MMC Document 120 Filed 08/07/19 Page 2 of 2