UNITED STATES COURT OF APPEALS December 5, 2023

Christopher M. Wolpert FOR THE TENTH CIRCUIT Clerk of Court

IAN C.; A.C.,

Plaintiffs - Appellants,

v. No. 22-4082

UNITEDHEALTHCARE INSURANCE COMPANY,

Defendant - Appellee.

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CHAMBER OF COMMERCE OF THE UNITED STATES OF AMERICA,

Amicus Curiae.

Appeal from the United States District Court for the District of Utah (D.C. No. 2:19-CV-00474-HCN)

Brian Smith King of Brian S. King P.C., Salt Lake City, Utah, for Plaintiffs - Appellants.

Amanda Shafer Berman of Crowell & Moring LLP, Washington, D.C. (Amy M. Pauli, Neil Nandi, and Samuel H. Ruddy of Crowell & Moring LLP, Washington, D.C., and Jennifer S. Romano of Crowell & Moring LLP, Los Angeles, California, with her on the brief) for Defendant - Appellee.

Tara Morrissey, U.S. Chamber Litigation Center, Washington, D.C.; Meaghan VerGow, O’Melveny & Myers LLP, Washington, D.C., filed an amicus curiae brief on behalf of Defendant - Appellee, for the United States of America. Appellate Case: 22-4082 Document: 010110963219 Date Filed: 12/05/2023 Page: 2

Before BACHARACH, PHILLIPS, and EID, Circuit Judges.

PHILLIPS, Circuit Judge.

This appeal arises from an action under the Employee Retirement Income

Security Act of 1974 (ERISA), 29 U.S.C. §§ 1001–1461, to challenge the denial

of healthcare benefits through an employer-sponsored plan. Ian C., the plan

participant, claimed coverage for his son, A.C., the beneficiary, to receive care

at an inpatient residential treatment center, Catalyst Residential Treatment, for

mental-health and substance-abuse issues. The plan authorized

UnitedHealthcare Insurance Company (United), the claims fiduciary, to

determine A.C.’s eligibility for benefits under the plan. 1 After initially covering

A.C.’s treatment at Catalyst, United later denied coverage.

Ian C. internally appealed the adverse benefit determination, which

United upheld on appeal. Ian C. then pursued his case against United in federal

district court, where he alleged that United’s denial violated his right to receive

a “full and fair review” of his claim under 29 U.S.C. §§ 1133(2), 1104(a)(1). 2

1 United administered benefits for mental-health and substance-abuse services through its designee, United Behavioral Health. We refer to these entities collectively as “United.” 2 Ian C. and A.C. are both named plaintiffs on the complaint filed in the U.S. District Court for the District of Utah and are both named as appellants on the notice of appeal to this court. But for concision, we refer to the appellants collectively under the guise of “Ian C.,” as the covered plan participant and parent of the claimed beneficiary. 2 Appellate Case: 22-4082 Document: 010110963219 Date Filed: 12/05/2023 Page: 3

Ian C. argued that United arbitrarily and capriciously denied benefits to A.C.

by failing to address A.C.’s substance abuse as an independent ground for

coverage, by determining that A.C.’s continued treatment at Catalyst was not

medically necessary, by ignoring the opinions of A.C.’s medical providers, and

by misapplying the appropriate level-of-care guidelines. United denied these

claims, and the parties filed competing motions for summary judgment. Ruling

on dual motions for summary judgment, the district court decided in favor of

United. Ian C. now appeals the district court’s ruling that United’s decision to

deny benefits was not arbitrary and capricious and complied with ERISA.

Exercising jurisdiction under 28 U.S.C. § 1291, we agree with Ian C. that

United’s deci

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