G&R was retained as co-counsel to represent the appellant before the Ninth Circuit Court of Appeals in the action styled Cal. Spine & Neurosurgery Inst. V. Blue Cross of Cal., Case No. 19-15192. By Order dated June 30, 2020, the Ninth Circuit Court of Appeals ruled in favor of G&R’s client reversing district court’s finding of no waiver where plaintiff alleged it “submitted a reimbursement claim to [the insurer] indicating it was acting as the member’s assignee, and [the insurer] partially denied the claim on a basis other than the anti-assignment provision.”
The appeal involved a dispute over whether the defense of an anti-assignment provision, which is commonly included in ERISA benefit plans, could be waived by the plan administrator. The Ninth Circuit found that the District Court erred in determining that waiver was inapplicable and the defense of an anti-assignment provision could be waived.
The Ninth Circuit relied, in part, on Spinedex Physical Therapy USA Inc. v. United Healthcare of Ariz., Inc., 770 F.3d 1282, 1296 (9th Cir. 2014), which was also litigated by Joseph Garofolo. In Spinedex Physical Therapy USA, Inc., the Ninth Circuit held that “an administrator may not hold in reserve a known or reasonably knowable reason for denying a claim, and give that reason for the first time when the claimant challenges a benefits denial in court.”