Ninth Circuit Reverses Dismissal of Health Insurance Lawsuit, Finds Insurance Company Violated ERISA

One of ERISA’s protections for insurance policyholders is the right to a meaningful dialogue with the insurance company about the claim. If the insurance company denies your claim, it must tell you why. If the company says that more information is needed before paying the claim, it must say so, and tell you what you need to provide in order to receive coverage.

This rule applies to any type of insurance governed by ERISA. But it is particularly important in health insurance claim disputes. Health claims are often decided in opaque explanations of benefits that shed little light on what the company is refusing to pay and why.

This was the situation in the Ninth Circuit Court of Appeals’ April 13, 2026 ruling in Campbell v. UnitedHealthcare. Campbell sued after UnitedHealthcare refused to pay her medical bills. After denying the claim, UnitedHealthcare failed to tell Campbell specifically why it refused to pay, refused to say what she needed to do in order to receive payment, and withheld documents about the claim that could have helped Campbell obtain coverage.

The trial court dismissed Campbell’s lawsuit, but the Ninth Circuit reversed. The appeals court found that UnitedHealthcare violated ERISA by refusing to meaningfully communicate with Campbell about the denial. The insurance stonewalled Campbell with “cookie-cutter” letters that ignored her arguments why her procedure was covered and just repeated the same rationale that her treatment was “not documented as performed.”

Further, the Court found UnitedHealthcare violated ERISA when it failed to tell her what additional information she needed to submit in order to get coverage. And, the insurance company failed to give Campbell the documents about her claim including those that evidenced her procedure should have been covered.

So, the Ninth Circuit sent the case back to the lower court with instructions to enter a ruling in Campbell’s favor. That decision is “unpublished,” meaning it is not binding precedent in future disputes. But it is a good reminder that ERISA’s procedural protections are important and that courts will enforce them.