UnitedHealthcare loses Ninth Circuit appeal
UnitedHealthcare lost an appeal in the Ninth Circuit over a wrongly denied claim and was ordered to pay fees and penalties, according to legal reporting. The ruling highlights a recent judicial decision against the insurer in benefits litigation (news.bloomberglaw.com).
A federal appeals court said UnitedHealthcare wrongly denied Leah Campbell’s health claim and must now pay attorney fees and statutory penalties. (ca9.uscourts.gov) The U.S. Court of Appeals for the Ninth Circuit ruled on April 13, 2026, in two related appeals from Campbell’s case against UnitedHealthcare Insurance Company and Insperity, Inc. The panel said the insurer abused its discretion in denying benefits tied to services from Emergency Surgical Assistants under an employee health plan governed by the Employee Retirement Income Security Act. (ca9.uscourts.gov) The judges said UnitedHealthcare kept sending Campbell the same denial rationale instead of clearly explaining what was missing from her claim. The memorandum said the company “stonewalled” her with “cookie-cutter denial letters” rather than engaging in the “meaningful dialogue” required in benefits cases. (ca9.uscourts.gov) The panel also said UnitedHealthcare counted as a plan administrator because the plan stated that the employer and UnitedHealthcare “share responsibility for administering the plan.” That finding mattered because plan administrators can face penalties for failing to turn over plan documents after a request. (ca9.uscourts.gov) Benefits fights like this one arise under the Employee Retirement Income Security Act, the federal law that governs many job-based health plans. In these cases, courts often focus less on a doctor’s bill itself than on whether the insurer followed the plan rules and gave the patient a fair chance to answer a denial. (ca9.uscourts.gov) That procedure question has become a recurring problem for UnitedHealthcare in the Ninth Circuit. In July 2025, the same court revived a separate challenge over UnitedHealthcare denial letters in a T-Mobile plan case, saying the notices did not adequately explain why claims were rejected. (robertsdisability.com) In another Ninth Circuit decision from April 2024, judges revived a proposed class action alleging UnitedHealthcare used a tougher review process for out-of-network mental health and substance use disorder treatment than for comparable medical and surgical care. The court said those allegations could proceed under federal parity and benefits law. (ca9.uscourts.gov) Campbell first sued in October 2023 in the Central District of California after her dispute over the surgical assistant charges. The district court entered judgment for UnitedHealthcare in August 2024, and Campbell appealed to the Ninth Circuit in September 2024 and February 2025 in the two related appeals. (dockets.justia.com, dockets.justia.com, dockets.justia.com) Bloomberg Law reported that the Ninth Circuit ordered fees and penalties after finding the claim had been wrongly denied. The case now returns with UnitedHealthcare on the losing end of an appeal that turned on how it explained, and failed to document, its denial. (news.bloomberglaw.com, ca9.uscourts.gov)
