Wit v. United Behavioral Health

Wit vs. United Behavioral Health (UBH) is a landmark case, potentially setting a precedent for how care will be covered for Americans seeking treatment for mental health and addiction.

In a robust and comprehensive 100-plus-page decision in 2019, the United States District Court of Northern California found that UBH adopted and implemented medical necessity guidelines that deviated from generally accepted clinical standards of care for mental health and addiction. For the remedy, the Judge ordered UBH to reprocess upwards of 67,000 coverage claims for 50,000 patients (half of whom were children) in line with these accepted clinical standards of care. However, in March 2022, a three-judge panel of the U.S. Ninth Circuit Court of Appeals reversed the District Court’s order with a seven-page ruling, holding that insurers need not evaluate coverage consistently with generally accepted standards of care. In January 2023, the same three-judge panel issued a corrected ruling that replaced the March 2022 ruling. This new ruling held that – even though UBH violated both its fiduciary duty by creating medical necessity criteria that put its self-interest ahead of plan members’ and the laws of four states – the 67,000 claims would not be reprocessed.

A number of states, agencies, and advocates – including The Kennedy Forum -submitted amici objecting to the ruling, arguing its findings were contrary to decades of precedent and maintaining that the ruling would profoundly impair plan members’ rights to health coverage under federal law, emboldening insurers to make decisions out of step with clinical standards.

In August 2023, the same three-judge panel issued a third ruling vacating its January 2023 opinion and replacing it with a new opinion (1) holding that plaintiffs in the case did have standing to bring their claims forward; (2) holding that the district court did not err in certifying three classes to pursue the fiduciary duty claim, but reversing the district court’s certification of the denial of class benefits; (3) holding that the district court erred to the extent it determined that the ERISA plans required UBH’s care utilization review guidelines to be coextensive with generally accepted standards of care and reversing the judgment on the plaintiff’s denial of benefits claim; and (4) remanding to the district court to answer the threshold question of whether the fiduciary duty claim was subject to the plans’ administrative exhaustion requirement.

After the District Court entered additional orders in the case, UBH filed a petition for a writ of mandamus in January 2024, asking the Ninth Circuit to order the District Court to comply with earlier appellate rulings. This petition sought to dismiss the issue of reprocessing denied claims and left unaddressed the pending fiduciary duty and state law claims regarding standards of care.

In September 2024, the Ninth Circuit issued a memorandum directing District Court Judge Spero to comply with its prior rulings, further calling into question whether any remedy in the case could include the reprocessing of claims.

In August 2025, the District Court reaffirmed that the plaintiffs’ fiduciary breach claims against United Behavioral Health remain viable. Judge Spero continued to hold that UBH violated its fiduciary duties of loyalty and care by prioritizing its financial interests over those of plan members when crafting internal coverage guidelines between 2011 and 2017. This ruling is a clear win for the class: it affirms that key fiduciary claims survive and underscores that plan fiduciaries must act in the interests of participants, not profits. At the same time, the decision confirms that reprocessing of claims is no longer a potential remedy in this case, consistent with earlier Ninth Circuit rulings.

With these new developments in Wit v. United Behavioral Health, there is continued optimism about what lies ahead for ensuring Americans’ rights to mental health and addiction coverage in alignment with clinical standards. The District Court’s next step will be to consider proposals from the parties on how to proceed.

Notably, Judge Spero’s findings about the “generally accepted standards of care” for mental health and substance use services have been enshrined into the laws of multiple states, including the Kennedy Forum’s sponsored legislation, California Senate Bill 855. These laws prohibit self-dealing by health plans, require them to cover mental health and substance use disorder claims pursuant to guidelines developed by clinical specialty nonprofit associations, are not subject to the Ninth Circuit’s review, and are binding on all commercial health plans underwritten in these states.

What’s Next

The court has ordered the parties to confer and submit proposals by September 12, 2025, on how the case should proceed. Plaintiffs are expected to press for robust injunctive and declaratory relief to ensure that UBH’s practices comply with ERISA fiduciary standards going forward.

Case Developments

August 2025

On remand from the Ninth Circuit, the District Court reaffirmed that UBH breached its fiduciary duties of loyalty and care by designing internal coverage guidelines to favor its financial interests over those of participants. The ruling secures a significant victory for the class, while leaving for future proceedings the determination of liability to the class and the scope of remedies.

September 2024

The Ninth Circuit grant’s UBH’s petition in a memorandum directing Judge Spero to comply with its earlier rulings, casting further doubt on whether reprocessing of denied claims could remain a remedy in the case.

January 2024

UBH filed for a writ of mandamus, asking the Ninth Circuit to require the District Court to comply with previous rulings. The petition sough to eliminate the possibility of reprocessing denied claims while leaving fiduciary duty and state law claims intact.

August 2023

The Court of Appeals for the Ninth Circuit (3-judge panel) released a third ruling in which they reconsidered portions of the District Court findings, vacating its January 2023 ruling, potentially opening the door for some plaintiff claims to be reprocessed. The panel granted a panel rehearing and instructed the district court to resolve a question over the plan’s administrative exhaustion requirement, a positive movement forward from January’s ruling.

March 2023

15 states plus Washington, D.C., the U.S. Department of Labor, and advocates including The Kennedy Forum submitted amici briefs supporting a rehearing of the case by the Ninth Circuit Court of Appeals.

January 2023

The Court of Appeals for the Ninth Circuit (3-judge panel) released a new ruling in which they affirmed in part, reversed in part, and remanded for further proceedings. The panel determined that even though UBH violated both its fiduciary duty by creating medical necessity criteria that put its self-interest ahead of plan members’ and the laws of four states – more than 50,000 individuals denied mental health or addiction coverage have no right to reprocessing of their claims.

June 2022

Plantiff’s response to UBH’s June 2022 reply brief

United Behavioral Health’s reply brief (UBH’s response to the appeal).

April-May 2022

Appeal to en banc review (full panel of judges review instead of a small panel).

March 2022

The Court of Appeals for the Ninth Circuit (3-judge panel) reversed the District Court’s ruling. In a paragraph-long decision, the three judge panel determined that it’s “not unreasonable” for health insurers’ coverage determinations to be inconsistent with generally accepted standards of mental health and addiction care.

May 2021

Plaintiffs responded to the UBH appeal with their own court filing, contesting UBH’s legal bases on appeal. Additionally, The Kennedy Forum and 25 other advocacy organizations filed an amicus brief —alongside political leaders like California Attorney General Rob Bonta and the U.S. Department of Labor, which filed its own amicus brief—in support of the lower court’s ruling.

March 2021

UBH attorneys appealed the District Court ruling.

November 2020

Judge Spero issued a ruling related to the remedy phase of this case. The ruling in the remedy phase of Wit v. UBH required the company to reprocess 67,000 claims using medical necessity criteria established by mental health and addiction clinical specialty associations.

February 2019

Judge Joseph Spero of the United States District Court for the Northern District of California issued the findings of fact and conclusions of law in Wit v. United Behavioral Health (UBH), a class action brought against the country’s largest behavioral health insurer. The 2019 decision ruled that UBH’s care utilization review guidelines — named the “Level Of Care Guidelines” — were inconsistent with the generally accepted standards of care utilized by the medical community. Rather than following standards that require treating chronic and co-existing treatments together, the court found that UBH followed internally-developed guidelines that limited coverage to solely “acute” episodes or crises.

Key Legal Documents