Plaintiff, a four-year-old boy with autism, proposed a class action under the unfair competition law (UCL) against defendant, his health care service plan, alleging that it breached its contract and violated the Mental Health Parity Act, Health & Saf. Code, § 1374.72, by categorically denying coverage for behavioral and speech therapies. The Superior Court of Los Angeles County, California, sustained the plan's demurrer. Plaintiff appealed.
Overview: elements of promissory estoppel
The court concluded that there was a reasonable possibility that plaintiff could establish the requisite community of interest for a class action under the UCL, Bus. & Prof. Code, § 17200 et seq. The complaint sufficiently alleged that the plan had a uniform policy of categorically denying coverage for health care services to treat autism spectrum disorders without determining whether the services were medically necessary for individual plan members. Plaintiff was not requesting an injunction requiring the plan to provide behavior analysis therapy or speech therapy to all plan members with an autism spectrum disorder, nor was he seeking a judicial declaration that those therapies were medically necessary for each member of the putative class. Rather, the claim was limited to questions relating to whether the plan categorically denied coverage for the therapies. The doctrine of judicial abstention did not preclude the UCL claim because resolution of the claim did not require the trial court to make individualized determinations of medical necessity or to decide complex issues of economic policy or other matters over which an administrative agency had exclusive jurisdiction.
Outcome
The court reversed the order sustaining the demurrer to the class action allegations for violation of the UCL and remanded the matter to the trial court for further proceedings.