The Ehrlich Law Firm News

Jeffrey Isaac Ehrlich, Appeals Attorney
California Appellate Law Specialist

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Ehrlich Law Firm wins landmark ruling establishing that health-plan administrators are subject to suit for negligent administration of the health plan

Judge David Mintz had been fighting lung cancer for years.  When it recurred, his doctors said his only chance was a treatment called radio-frequency ablation (“RFA”).  Blue Cross was the third-party administrator of Mintz’s CalPERS health plan. Blue Cross denied the claim for RFA on the grounds that it was excluded as experimental.  But it failed to notify Mintz that under state law, the plan was required to pay for experimental treatment if an independent medical review determined it would be more beneficial for the patient than conventional treatment.  Mintz was unable to obtain RFA, and died while his lawsuit was pending. The trial court dismissed his case on demurrer, and the Court of Appeal reversed, finding that third-party administrators can be held liable for their negligent administration of the plan. Mintz v. Blue Cross of California, 172 Cal.App.4th 1594 (2d Dist. 2009).