United States First Circuit

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Doe v. Harvard Pilgrim Health Care, Inc., 17-2078

Reinstated a lawsuit alleging that a health insurance company improperly denied coverage for in-patient mental health services. After several unsuccessful administrative appeals, the insured sued the insurance company under ERISA, claiming that all of her time spent at a mental health residential treatment facility was medically necessary and thus should have been covered under an employer-provided healthcare plan. On appeal, the First Circuit vacated an order granting summary judgment for the insurance company, holding that the district court should have allowed the insured to supplement the administrative record.

Appellate Information

  • Decided
  • Published 2018/09/06


  • Kayatta


  • United States First Circuit


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