OAKLAND – The U.S. District Court of the Northern District of California has ruled in favor of the defendants in a dispute over the alleged barriers a man claims deterred him from maximizing his medical benefits.
On March 27, District Judge Haywood S. Gilliam Jr. granted Cisco Systems and UnitedHealthcare Insurance's motions for judgment and denied plaintiff Andrew “Kip” Sides' cross motion for judgment.
Sides, who represented himself in the case, claimed that the defendants failed to extend benefits to him under his Cisco’s health care plan. His plan was under the Employee Retirement Income Security Act of 1974 and he has had the plan since January 2000, the ruling states.
Sides claimed that under Cisco he has always been paid, but the company made it extremely hard to maximize his benefits.
According to the ruling, Sides alleged 11 claims were not handled in a timely fashion or denied for no reason. He also claimed that Cisco didn’t act on claiming reimbursements from UHIC.
"The court finds that Mr. Sides has not shown through substantial evidence that UHIC’s decisions were clearly erroneous. The court reaches this conclusion after careful consideration of the administrative record," Gilliam wrote.
Gilliam also determined that Sides did not exhaust all his administrative remedies, according to administrative record.
It was also decided by Gilliam that Sides requested relief that is not authorized by ERISA. In his motion, Sides wanted relief from “an injunction that requests defendants to...give an accounting of his past claims, administer periodic and proper accounting for future benefits, provide visibility into the claims processing process, and grant Mr. Sides access to Cisco’s benefits case management system,” according to Gilliam's ruling.
"Mr. Sides does not describe how any of his requested relief, such as auditing his medical claims and removing conflicts of interest by preventing medical directors from pursuing sales or business objectives, would be implemented, let alone how these would remediate his alleged injuries," the ruling states.