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Angie Shewan

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Angie represents health care clients, including health plans and health care insurers, in complex litigation matters. She is particularly experienced in handling ERISA and MHPAEA litigation.

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On September 8, the Department of Labor’s Employee Benefits Security Administration (EBSA) issued Field Assistance Bulletin No. 2026-03, outlining how it will enforce the Mental Health Parity and Addiction Equity Act’s (MHPAEA) nonquantitative treatment limitation (NQTL) requirements going forward. The bulletin follows through on EBSA’s January 2026 announcement identifying mental health/substance use disorder (MH/SUD) benefit barriers as a national enforcement priority, and responds to sustained industry complaints that prior NQTL enforcement and comparative analyses requirements created confusion and unnecessary compliance burdens.

In an unpublished memorandum decision, the Ninth Circuit in R.R. v. California Physicians’ Service d/b/a Blue Shield of California, affirmed the insurer and administrator’s denial of benefits for a dependent’s residential mental health treatment under an ERISA‑governed plan. The court applied abuse‑of‑discretion review and concluded that the denial was supported by the plan’s medical‑necessity criteria and the administrative record. The dissent, however, argued that the majority failed to meaningfully account for a structural conflict of interest and for the administrator’s handling of treating‑provider evidence and prior failed lower levels of care.

Colorado House Bill 25-1002, effective January 1, 2026, amends Colorado Revised Statutes § 10-16-104(5.5) to require health benefit plans to use nationally recognized, not-for-profit clinical criteria when making coverage and utilization review determinations for behavioral health, mental health, and substance use disorder treatment. The statute establishes a uniform approach to coverage and utilization review and tightens state-level expectations for compliance with the federal Mental Health Parity and Addiction Equity Act (MHPAEA).

As discussed here and here, D.K. et al. v. United Behavioral Health et al. is a case that has been carefully watched in the health benefits space for its impact on what health plan administrators must include in adverse benefit determination letters. In D.K., the Tenth Circuit held health plan administrators cannot rely…

As discussed here, D.K. et al. v. United Behavioral Health et al. is a case that has been carefully watched in the health benefits space for its potential to change what health plan administrators must include in adverse benefit determination letters. On May 15, 2023, the Tenth Circuit issued its opinion affirming the district…

As discussed here, administrators’ health plan benefit denial letters have recently been under scrutiny by the courts. For example, in D.K. et al. v. United Behavioral Health et al., the Tenth Circuit is reviewing a district court’s decision that health plan benefit denial letters must contain more fulsome discussions of the administrator’s determination…

In recent years, several lawsuits have challenged wilderness therapy program exclusions in health plans. Not only do members typically assert a claim for benefits, alleging a denial of wilderness therapy benefits was improper under their health plan, but they also insist the plan’s exclusion that serves as the basis for the denial violates the Mental…

Under ERISA claims procedure regulations, group health plans must provide a “full and fair” review of all claims submitted by plan participants. These claims procedure regulations provide a list of minimum standards, including determinations within a certain timeframe, specific content requirements of adverse notifications, and the opportunity to submit evidence through an internal administrative appeal…

In October 2022, the Tenth Circuit heard oral argument in D.K. et al. v. United Behavioral Health et al., a case that could significantly impact what health plans must include in any notification to claimants of an adverse benefit determination, i.e. benefit denial letters.

Under ERISA’s claims procedure regulations, there is an express list…