September 22, 2021 opinions

Posted on by tadbartlett

Unpublished

  • P. v. Blue Cross and Blue Shield of Texas, 20-30361, appeal from W.D. La.
    • per curiam (Ho, Oldham, Wilson), Oldham, J., concurring; insurance, ERISA
    • Reversing district court’s grant of plaintiff’s summary judgment motion and denial of defendant’s cross-motion for summary judgment, regarding defendant insurer’s decision to only cover a portion of plaintiff’s daughter’s months-long stay and treatment at inpatient clinic following her fifth suicide attempt. (Defendant was the plan administrator of the plaintiff’s employee welfare benefit plan, bringing it within ERISA).
    • The Defendant determined that plaintiff’s daughter’s stay at the inpatient clinic was only medically necessary for ten days, and did not cover the remaining 39 days of inpatient care she received. After an administrative appeal and an independent review, the Defendant covered an additional five days of the inpatient care. The Court held that this determination of medical necessity was not an abuse of the Defendant’s discretion as an ERISA plan administrator.
    • Judge Oldham concurred, and explained that, while the per curiam opinion properly applied the Court’s precedents, he believed that the standard of review employed by the Court ought to be reconsidered. “The substantial-evidence standard of review we apply comes from half-century old cases about pension plans under the Labor Management Relations Act. And we’ve continued to apply this same standard even after the Supreme Court told us it lacked a sound justification. The second puzzling thing about our standard of review is how it compares to substantial-evidence review in administrative law cases. Even though our ERISA standard of review uses the same name, it is notably more deferential than ordinary substantial-evidence review. These two features make me wonder whether our current standard for reviewing benefit denials under ERISA is justifiable.”
  • Garcia-Flores v. Garland, 20-60127, petition for review of BIA order
    • per curiam (Barksdale, Willett, Duncan), immigration
    • Dismissing in part and denying in part Mexican citizen’s petition for review of BIA order dismissing his appeal of the Immigration Judge’s (IJ) denying his applications for: cancellation of removal; and post-conclusion voluntary departure.
  • U.S. v. Dhingra, 21-20032, appeal from S.D. Tex.
    • per curiam (Smith, Stewart, Graves), criminal, sufficiency of evidence
    • Affirming convictions of making a false statement in connection with the purchase of a firearm and possession of a firearm by a person adjudicated mentally ill or committed to a mental institution.