Our client came to Kantor & Kantor, LLP after unsuccessfully seeking treatment from Kaiser for a severe eating disorder (bulimia). For four months, she tried to obtain appropriate treatment, but Kaiser offered only inconsistent appointments with unqualified personnel. Without appropriate treatment, her condition worsened and she became suicidal. Even at that point, Kaiser advised our client that there was no appropriate treatment program available within the Kaiser system. Our client’s family researched the question and found a program that was designed specifically to treat the condition. Pursuant to the terms of her Plan, our client requested Kaiser to authorize a referral to that program, and that Kaiser pay for her treatment. Kaiser refused.
Fearful for her daughter's life, our client's mother arranged to admit her to the program at the family’s expense. Our client remained in a special facility as an in-patient for about a month. On appeal, Kaiser upheld its denial of the claim, and never even responded to our client's request for a list of available providers within the Plan.
Based on our lawsuit, the court held that Kaiser's behavior was wrongful, unreasonable, irrational, and contrary to the evidence, the terms of the Plan and applicable law. Kaiser was further ordered to pay all fees and costs of our client's treatment, and attorney’s fees and costs related to the litigation.