This case was last updated from PACER on 09/16/2021 at 11:21:35 (UTC).

C. v. Cigna Health and Life Insurance

Case Summary

On June 28th, 2021, Kelly C., individually and on behalf of K.B. a minor, (“Plaintiffs”) represented by Brian S. King filed a labor - employee benefit lawsuit against Cigna Health and Life Insurance Company, (“Defendant”) for allegedly wrongfully denying insurance coverage to the Plaintiffs. This case was filed in the U.S. District Court for the District of Utah with Judge Cecilia M. Romero presiding. 

 

In the complaint, the Plaintiff alleged that “K.B. was adopted from an orphanage in Russia around the time that she was a year old. When K.B. was about five years old, she began seeing a therapist and was diagnosed with attention deficit disorder. When she was in the eighth grade, she was diagnosed with Reactive Attachment Disorder. K.B.’s therapist recommended that she be placed in a residential treatment program . . . K.B. sought out risky relationships, often with older men, and also started abusing alcohol to the point of blacking out. In an effort to provide K.B. with the support that she needed, she began attending an outdoor behavioral health program called Evoke.”

 

The Plaintiff also alleged that “Following her discharge from Evoke, K.B. was admitted to New Haven on November 27, 2018. In a letter dated December 24, 2018, Cigna denied payment for K.B.’s treatment. The letter gave the following justification for denying payment: Insufficient clinical information has been provided by the facility to support the medical necessity for continued stay at Residential Mental Health Treatment for Children and Adolescents from 12/21/2018 forward. Therefore, this request is denied.”

 

The Plaintiff also alleged that “Kelly reminded Cigna of its obligations under ERISA including taking into account all of the information she provided, providing the information she needed to perfect the appeal, acting in K.B.’s best interest, and utilizing an appropriately qualified reviewer.”

 

Further, “Kelly listed the Plan’s requirements for admission to a residential treatment center as well as the definition of a medically necessary service. She stated that since K.B.’s “treatment is medically necessary according to Cigna criteria, Cigna’s denial has no basis.” She requested that Cigna process the appeal in compliance with MHPAEA. In a letter dated July 9, 2019. Cigna upheld the denial of payment for K.B.’s treatment.”

 

Plaintiff even further alleged that “The denial of benefits for K.B.’s treatment was a breach of contract and caused Kelly to incur medical expenses that should have been paid by the Plan in an amount totaling over $90,000.”

 

There are two claims for relief laid down by the Plaintiff. The first for a Claim for Recovery of Benefits Under 29 U.S.C. §1132(a)(1)(B)). The second claim is for alleged violations of MHPAEA Under 29 U.S.C. §1132(a)(3)).

 

In the prayer for relief, the Plaintiffs request the Court to order a judgment in the total amount that is owed for K.B.’s medically necessary treatment at New Haven under the terms of the Plan, plus pre and post-judgment interest to the date of payment; appropriate equitable relief under 29 U.S.C. §1132(a)(3) as outlined in Plaintiffs’ Second Cause of Action; attorney fees and costs incurred pursuant to 29 U.S.C. §1132(g); and for such further relief as the Court deems just and proper.

 

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Case Details Parties Documents Dockets

 

Case Details

  • Case Number:

    2:21-CV-00401

  • Filing Date:

    06/28/2021

  • Case Status:

    Pending - Other Pending

  • Case Type:

    Labor - Employee Benefit

Judge Details

Presiding Judge

Cecilia M. Romero

 

Party Details

Plaintiff

Kelly C.

Defendant

Cigna Health and Life Insurance

Attorney/Law Firm Details

Plaintiff Attorneys

Samuel Martin Hall

Attorney at BRIAN S KING PC

420 E South Temple Ste 420

Salt Lake City, UT 84111

Brian S. King

Attorney at BRIAN S KING PC

420 E South Temple Ste 420

Salt Lake City, UT 84111

Brent J. Newton

Attorney at BRIAN S KING PC

420 E South Temple Ste 420

Salt Lake City, UT 84111

 

Court Documents

#4

(#4) AMENDED COMPLAINT against All Defendants. filed by Kelly C.. (King, Brian) (Entered: 08/26/2021)

#3

(#3) ORDER TO PROPOSE SCHEDULE - Plaintiff must propose a schedule to defendant in the form of a draft Attorney Planning Meeting Report within the earlier of fourteen(14) days after any defendant has appeared or twenty-eight (28) days after any defendant has been served with the complaint. See order for additional instructions. Signed by Magistrate Judge Cecilia M. Romero on 6/29/21. (alf) (Entered: 06/29/2021)

2 #1

Civil Cover Sheet Civil Cover Sheet

#2

(#2) COMPLAINT against Cigna Health and Life Insurance (Filing fee $ 402, receipt number AUTDC-4043987) filed by Kelly C.. (Attachments: #1 Civil Cover Sheet Civil Cover Sheet) Assigned to Magistrate Judge Cecilia M. Romero (King, Brian) (Entered: 06/28/2021)

#1

(#1) Case has been indexed and assigned to Magistrate Judge Cecilia M. Romero. Plaintiff Kelly C. is directed to E-File the Complaint and cover sheet (found under Complaints and Other Initiating Documents) and pay the filing fee of $ 402.00 by the end of the business day.NOTE: The court will not have jurisdiction until the opening document is electronically filed and the filing fee paid in the CM/ECF system. Civil Summons may be issued electronically. Prepare the summons using the courts #PDF version and email it to utdecf_clerk@utd.uscourts.gov for issuance. (nmt) (Entered: 06/28/2021)

 

Docket Entries

  • 08/26/2021
  • View Court Documents
  • Docket(#4) AMENDED COMPLAINT against All Defendants. filed by Kelly C.. (King, Brian) (Entered: 08/26/2021)

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  • 06/29/2021
  • View Court Documents
  • Docket(#3) ORDER TO PROPOSE SCHEDULE - Plaintiff must propose a schedule to defendant in the form of a draft Attorney Planning Meeting Report within the earlier of fourteen(14) days after any defendant has appeared or twenty-eight (28) days after any defendant has been served with the complaint. See order for additional instructions. Signed by Magistrate Judge Cecilia M. Romero on 6/29/21. (alf) (Entered: 06/29/2021)

    Read MoreRead Less
  • 06/28/2021
  • View Court Documents
  • Docket(#2) COMPLAINT against Cigna Health and Life Insurance (Filing fee $ 402, receipt number AUTDC-4043987) filed by Kelly C.. (Attachments: #1 Civil Cover Sheet Civil Cover Sheet) Assigned to Magistrate Judge Cecilia M. Romero (King, Brian) (Entered: 06/28/2021)

    Read MoreRead Less
  • 06/28/2021
  • View Court Documents
  • Docket(#1) Case has been indexed and assigned to Magistrate Judge Cecilia M. Romero. Plaintiff Kelly C. is directed to E-File the Complaint and cover sheet (found under Complaints and Other Initiating Documents) and pay the filing fee of $ 402.00 by the end of the business day.NOTE: The court will not have jurisdiction until the opening document is electronically filed and the filing fee paid in the CM/ECF system. Civil Summons may be issued electronically. Prepare the summons using the courts #PDF version and email it to utdecf_clerk@utd.uscourts.gov for issuance. (nmt) (Entered: 06/28/2021)

    Read MoreRead Less
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