Harlick v. Blue Shield’s Empirical Analysis

Citation profile

8 federal appellate · 5 district · 1 state decisions

Most-quoted passages

The sentences later courts lift from this opinion, ranked by how many decisions quote each — the parts of the opinion doing the work. These counts are smaller than the citation total above because most of the 44 citing decisions cite the case generally; a passage count includes only decisions quoting that exact language verbatim.

1. “29 U.S.C. § 1133 . The administrator must also give the claimant information about the denial, including the”

   3 later decisions quote this exact passage · from the majority
   e.g. Spinedex Physical Therapy USA Inc. v. United Healthcare of Arizona, Inc. · Nieves v. Prudential Insurance Co. of America

2. “the same entity makes the coverage decisions and pays for the benefits. This dual role always creates a conflict of interest, [citing Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 108 , 128 S.Ct. 2343 , 171 L.Ed.2d 299 (2008) ], but it is “more important ... where circumstances suggest a higher likelihood that it affected the benefits decision.” [Glenn, 554 U.S. at 117 , 128 S.Ct. 2343 ]. The conflict is less important when the administrator took “active steps to reduce potential bias and to promote accuracy,” id. such as employing a “neutral, independent review process,” or segregating employees who make coverage decisions from those who deal with the company’s finances. [Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955 , 969 n. 7 (9th Cir.2006) (en banc).] The conflict is given more weight if there is a “history of biased claims administration.” Glenn, 554 U.S. at 117 , 128 S.Ct. 2343 . Our review of the administrator’s decision is also tempered by skepticism if the administrator gave inconsistent reasons for a denial, failed to provide full review of a claim, or failed to follow proper procedures in denying the claim, (citations omitted).”

   1 later decision quote this exact passage · from the majority
   e.g. 43 F. Supp. 3d 994 - Echague v. Metropolitan Life Insurance

3. “We look first to the explicit language of the agreement to determine, if possible, the clear intent, of the parties .... ” (internal quotation omitted)). This interpretation involves two simple steps. First, coinsurance is part of the. Plan’s “Covered Expenses.” As the SPD explains, “[c]oinsurance is a percentage of the Covered Expenses that you pay.” The SPD provides that the retiree may be required to pay a set percentage of the “Covered Expense” as “coinsurance.” For example, for diagnostic labs and X-rays, the retiree must pay 25% of the “Covered Expenses” and the Plan will pay 75% of the”

   1 later decision quote this exact passage · from the majority
   e.g. 145 F. Supp. 3d 890 - Barling v. UEBT Retiree Health Plan