Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_17-cv-03095/USCOURTS-cand-3_17-cv-03095-7/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. and ALEX H.,

Plaintiffs,

v.

BLUE SHIELD OF CALIFORNIA, et al.,

Defendants.

Case No. 17-cv-03095-MMC 

ORDER GRANTING IN PART AND 

DENYING IN PART PLAINTIFFS’

MOTION FOR JUDGMENT;

GRANTING IN PART AND DENYING 

DEFENDANTS’ CROSS-MOTION FOR 

JUDGMENT; REMANDING FOR 

FURTHER PROCEEDINGS

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 defendants California Physicians’ Service dba Blue Shield (“Blue Shield”), 

Trinet Group Inc. Section 125, Section 129, and Flexible Account Spending Plan (“Trinet 

Plan”), and Trinet Group, Inc. (“Trinet Group”). The matter came on regularly for hearing 

on March 8, 2019. Katie J. Spielman and David M. Lilienstein of DL Law Group 

appeared on behalf of plaintiffs. Joseph E. Laska and Anastasia Bondarchuk of Manatt, 

Phelps & Phillips, LLP appeared on behalf of defendants. 

Having 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,

finds: 

1. Blue Shield misconstrued the Blue Shield PPO Health Plan (“the Plan”); in 

particular, Blue Shield failed to consider whether the services for which plaintiffs’ claim 

was made were “furnished under generally accepted professional standards.” (See

Administrative Record at BSC000394.) 

2. Plaintiffs have failed to show that either Trinet Plan or Trinet Group is in any 

Case 3:17-cv-03095-MMC Document 94 Filed 03/11/19 Page 1 of 2
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United States District Court

Northern District of California

manner liable for payment of benefits due under the Plan or that either of said defendants 

violated any provision of the Employee Retirement Income Security Act or any of the 

terms of the Plan.

Accordingly, the Court hereby GRANTS IN PART and DENIES IN PART plaintiffs’ 

motion, and hereby GRANTS IN PART and DENIES IN PART defendants’ cross-motion, 

as follows: 

1. As to Blue Shield, judgment is granted in favor of plaintiffs and the matter is 

hereby REMANDED to Blue Shield for consideration of plaintiffs’ claim for benefits under 

a standard consistent with this order. See Saffle v. Sierra Power Co. Bargaining Unit 

Long Term Disability Income Plan, 85 F.3d 455, 461 (9th Cir. 1996) (holding “remand for 

reevaluation of the merits of a claim is the correct course to follow when an ERISA plan 

administrator, with discretion to apply a plan, has misconstrued the [p]lan and applied a 

wrong standard to a benefits determination”). 

2. As to Trinet Plan and Trinet Group, judgment is granted in favor of said 

defendants. 

IT IS SO ORDERED.

Dated: March 11, 2019 

MAXINE M. CHESNEY

United States District Judge

Case 3:17-cv-03095-MMC Document 94 Filed 03/11/19 Page 2 of 2