Simon v. Value Behavioral Health

• Decision Date: 11 February 2000
• Docket Number: INC,GREAT-WEST,PAN-AMERICAN,No. 98-55905,WAL-MAR,98-55905
• Citation: 208 F.3d 1073
• Parties: (9th Cir. 2000) STEPHEN SIMON, an individual and as assignee of assignors, Plaintiff-Appellant, v. VALUE BEHAVIORAL HEALTH, INC., GUARDIAN LIFE INSURANCE CO. OF AMERICA; VALUE HEALTH, INC.; ROBERT E. PATRICELLI, LTD.; AMERICAN PSYCHMANAGEMENT, INC; PREFERRED HEALTHCARE, LTD; HEALTH MANAGEMENT STRATEGIES INTERNATIONAL, INC.; THE PRUDENTIAL INSURANCE COMPANY; HEALTHCARE SYSTEMS, INC.; HEALTH RISK MANAGEMENT, HEALTH INSURANCE ASSOCIATION OF AMERICA; JOHN HANCOCK MUTUAL LIFE INSURANCE CO.; JOHN ALDEN LIFE INSURANCE COMPANY; COSTCARE, INC.; JOHN HANCOCK MUTUAL LIFE INSURANCE COMPANY EMPLOYEE BENEFIT PLAN; BLUE CROSS & BLUE SHIELD ASSOCIATION; BLUE CROSS & BLUE SHIELD OF ILLINOIS, INC.; BLUE CROSS/ BLUE SHIELD OF IOWA, INC.; BLUE CROSS/BLUE SHIELD OF KANSAS, INC.; BLUE CROSS/BLUE SHIELD OF MASSACHUSETTS, INC.; BLUE CROSS/ BLUE SHIELD OF MICHIGAN, INC.; EMPIRE BLUE CROSS/BLUE SHIELD; NEW YORK LIFE INSURANCE COMPANY; BLUE CROSS/BLUE SHIELD OF TEXAS, INC., Administrator and/or Trustee on Behalf of Paune Extrusions Company Employee Benefit Plan; BLUE CROSS/BLUE SHIELD OF VIRGINIA, INC., Administrator and/or Trustee on Behalf of Commonwealth University Employee Benefit Plan, Metro Inc. Information Services Employee Benefit Plan, Department of Motor Vehicles of the Commonwealth of Virginia Employee Benefit Plan, Linsky Plant Farm, Inc. Employee Benefit Plan, Memorial Hospital, Inc., Employee Benefit Plan, Virginia Polytechnic Institute and State University Employee Benefit Plan, Campbell County Transport Employee Benefit Plan, State of Virginia Employee Benefit Plan, Hodgerman's Company Employee Benefit Plan; AMERICAN GENERAL LIFE & ACCIDENT INSURANCE CO., Administrator and/or Trustee on Behalf of American General Life & Accident Insurance Co. Employee Benefit Plan; BENEFIT TRUST LIFE, Administrator and/or Trustee on Behalf of Lagrange Country Club, Inc. Employee Benefit Plan, Wood Tech, Inc. Employee Benefit Plan; BLUE CROSS OF ALASKA; BLUE CROSS OF WASHINGTON; SPECIALTY MEDIC
• Court: U.S. Court of Appeals — Ninth Circuit

Page 1073

208 F.3d 1073 (9th Cir. 2000)

STEPHEN SIMON, an individual and as assignee of assignors, Plaintiff-Appellant, v. VALUE BEHAVIORAL HEALTH, INC., GUARDIAN LIFE INSURANCE CO. OF AMERICA; VALUE HEALTH, INC.; ROBERT E. PATRICELLI, LTD.; AMERICAN PSYCHMANAGEMENT, INC; PREFERRED HEALTHCARE, LTD; HEALTH MANAGEMENT STRATEGIES INTERNATIONAL, INC.; THE PRUDENTIAL INSURANCE COMPANY; HEALTHCARE SYSTEMS, INC.; HEALTH RISK MANAGEMENT, HEALTH INSURANCE ASSOCIATION OF AMERICA; JOHN HANCOCK MUTUAL LIFE INSURANCE CO.; JOHN ALDEN LIFE INSURANCE COMPANY; COSTCARE, INC.; JOHN HANCOCK MUTUAL LIFE INSURANCE COMPANY EMPLOYEE BENEFIT PLAN; BLUE CROSS & BLUE SHIELD ASSOCIATION; BLUE CROSS & BLUE SHIELD OF ILLINOIS, INC.; BLUE CROSS/ BLUE SHIELD OF IOWA, INC.; BLUE CROSS/BLUE SHIELD OF KANSAS, INC.; BLUE CROSS/BLUE SHIELD OF MASSACHUSETTS, INC.; BLUE CROSS/ BLUE SHIELD OF MICHIGAN, INC.; EMPIRE BLUE CROSS/BLUE SHIELD; NEW YORK LIFE INSURANCE COMPANY; BLUE CROSS/BLUE SHIELD OF TEXAS, INC., Administrator and/or Trustee on Behalf of Paune Extrusions Company Employee Benefit Plan; BLUE CROSS/BLUE SHIELD OF VIRGINIA, INC., Administrator and/or Trustee on Behalf of Commonwealth University Employee Benefit Plan, Metro Inc. Information Services Employee Benefit Plan, Department of Motor Vehicles of the Commonwealth of Virginia Employee Benefit Plan, Linsky Plant Farm, Inc. Employee Benefit Plan, Memorial Hospital, Inc., Employee Benefit Plan, Virginia Polytechnic Institute and State University Employee Benefit Plan, Campbell County Transport Employee Benefit Plan, State of Virginia Employee Benefit Plan, Hodgerman's Company Employee Benefit Plan; AMERICAN

GENERAL LIFE & ACCIDENT INSURANCE CO., Administrator and/or Trustee on Behalf of American General Life & Accident Insurance Co. Employee Benefit Plan; BENEFIT TRUST LIFE, Administrator and/or Trustee on Behalf of Lagrange Country Club, Inc. Employee Benefit Plan, Wood Tech, Inc. Employee Benefit Plan; BLUE CROSS OF ALASKA; BLUE CROSS OF WASHINGTON; SPECIALTY MEDICAL CLINIC EMPLOYEE BENEFIT PLAN, BELL ATLANTIC CORPORATION; C & P TELEPHONE; TUTHILL CORPORATION; FKW, INC.; BLUE CROSS/BLUE SHIELD OF MINNESOTA; BLUE CROSS/ BLUE SHIELD OF MAINE; BANKERS LIFE AND CASUALTY COMPANY; NATIONAL ASSOCIATION OF HEALTH UNDERWRITERS; CITY OF LEWISTON SCHOOL DEPARTMENT; RELIASTAR LIFE INSURANCE COMPANY; PPG INDUSTRIES, INC.; VENTURA INSURANCE ADMINISTRATORS, INC.; VENTURA COUNTY FOUNDATION FOR MEDICAL CARE, INC.; A & P GROCERY STORE, INC., A & P GROCERY STORE, INC. EMPLOYEE BENEFIT PLAN; CRAWFORD INSURANCE COMPANY; SECURITY BENEFIT TRUST FUND, ROOFERS LOCAL 149 SECURITY BENEFIT TRUST FUND; ROOFERS LOCAL 149 EMPLOYEE BENEFIT PLAN; ITT HARTFORD GROUP, INC., ITT HARTFORD GROUP, INC., As Administrator and/or Trustee; GENERAL AMERICAN LIFE INSURANCE COMPANY; GENEL CO; PAN-AMERICAN LIFE INSURANCE COMPANY; NATIONAL INSURANCE SERVICES; DAVID KOPPE; WILLIAM MCGUIRE M.D.; METRA HEALTH CARE MANAGEMENT CORPORATION; UNITED HEALTHCARE CORPORATION; UNITED HEALTHCARE CORPORATION EMPLOYEE BENEFIT PLAN; UNITED HEALTHCARE SERVICES, INC.; UNITED BEHAVIORAL SYSTEMS, INC.; OPERATING ENGINEERS LOCAL 37 HEALTH AND WELFARE FUND; CAPP CARE, INC., MICHAEL HENRY; HEALTH INTERNATIONAL, INC., erroneously served and sued as HEALTH INTERNATIONAL CORP.; STANISLAUS FOUNDATION FOR MEDICAL CARE; EXECUTIVE RISK; BENEFIT PANEL SERVICES; GREAT-WEST LIFE ASSURANCE COMPANY; ROCKY MOUNTAIN MEDICAL SERVICES, dba BLUE CROSS AND BLUE SHIELD OF COLORADO; CARPENTERS HEALTH AND WELFARE TRUST FOR SOUTHERN CALIFORNIA; CARPENTERS PENSION TRUST FOR SOUTHERN CALIFORNIA; CARPENTERS SOUTHERN CALIFORNIA ADMINISTRATIVE CORPORATION; MILLWRIGHTS LOCAL UNION NO. 1607; CARPENTERS LOCAL UNION NO. 1506; CHICAGO DISTRICT COUNCIL OF CARPENTERS WELFARE FUND; CHICAGO DISTRICT COUNCIL OF CARPENTERS PENSION FUND; RETAIL CLERKS EMPLOYERS BENEFIT PLANS OF NORTHERN CALIFORNIA AND VALLEY CLERKS TRUST FUND; CT CORPORATION, CSC THE UNITED STATES CORPORATION; BLUE CROSS/ BLUE SHIELD OF CALIFORNIA; METROPOLITAN LIFE INSURANCE COMPANY, Administrators and/or Trustee on Behalf of: Sears, Roebuck & Co. Group Medical Plan, Chemical Bank, Inc. Employee Benefit Plan, New York State Freeway Authority Employee Benefit Plan, New York State Department Civic Employee Benefit Division, Tenneco/J.I. Case Co. Employee Benefit Plan, Sun Chemical Corporation Employee Benefit Plan, Dunn & Bradstreet Employee Benefit Plan, Rockwell International, Inc. Employee Benefit Plan, ZEP Manufacturing Company Employee Benefit Plan, National Services Industries, Inc. Employee Benefit Plan, F.W. Woolworth Company Employee Benefit Plan, Nordstrom's Inc. Employee Benefit Plan, Town of New Paltz Employee Benefit Plan, Trustees of the American Engineers Council Insurance Trust Fund, Felker Benefit Services, Pepsico, Inc. Employee Benefit Plan, Ukiah Unified School District Employee Benefit Plan, Louisiana-Pacific, Inc. Employee Benefit Plan, General Electric Company Employee Benefit Plan,

Proctor & Gamble Corporation Employee Benefit Plan, City of Culver Employee Benefit Plan, California Conservation Corp Employee Benefit Plan, Allcare Plan, Transport International Tools, Inc. Employee Benefit Plan, Wood Company Employee Benefit Plan, Montgomery Ward, Inc. Employee Benefit Plan, R.H. Macy's, Inc. Employee Benefit Plan, McDonough Capperton, Inc. Employee Benefit Plan, Toys R Us, Inc. Employee Benefit Plan, J.I. Case Power & Equipment, Inc. Employee Benefit Plan; METRA HEALTH, WILLIAM W. MCGUIRE, M.D.; DAVID KOPPE; UNIFIED BEHAVIORAL SYSTEMS, INC.; NATIONAL ASSOCIATION OF LIFE UNDERWRITERS; SOUTHWESTERN BELL EMPLOYEE BENEFIT PLAN; UNIVERSAL CITY STUDIOS, INC., UNIVERSAL STUDIOS EMPLOYEE BENEFIT PLAN; MUTUAL OF OMAHA; HEALTHCARE COMPARE CORPORATION; HEALTH RISK MANAGEMENT, INC.; BENEFIT ADMINISTRATORS, INC.; CARE AMERICA, INC.; UNIFORMED SERVICE BENEFIT PLAN, INC., U.S. POSTAL SERVICE; YUMA PROVING GROUND; U.S. ARMY; U.S. MARINE CORPS; U.S. NAVY; U.S. AIR FORCE; U.S. COAST GUARD; UNITED STATES OF AMERICA; FIRST HEALTH, INC.; GREAT WEST LIFE ASSURANCE COMPANY; BLUE CROSS/BLUE SHIELD OF ALABAMA; SERVICE MASTER, INC. EMPLOYEE BENEFIT PLAN; GARY METHODIST HOSPITAL, INC., GARY METHODIST HOSPITAL, INC. EMPLOYEE BENEFIT PLAN; LEWISTON SCHOOL; MAINE STATE CORRECTIONAL INSTITUTION EMPLOYEE BENEFIT PLAN; BLUE CROSS/BLUE SHIELD OF OREGON, INC., Administrator and/or Trustee on Behalf of: Safeway Stores, Inc. Employee Benefit Plan, Painters Local 10 Employee Benefit Plan, John Q. Hammonds Hotels, Inc. Employee Benefit Plan; ADVENTIST HEALTH SYSTEM OF LOMA LINDA, Administrator and/or Trustee on Behalf of Loma Linda School of Medicine Health Assistance and Medical Personnel Services Plan; LOMA LINDA SCHOOL OF MEDICINE HEALTH ASSISTANCE AND MEDICAL PERSONNEL SERVICES PLAN; UNITED CHAMBERS INSURED PLANS; AMERICAN GENERAL LIFE & ACCIDENT INSURANCE CO., Administrator and/or Trustee on Behalf of American General Life & Accident Insurance Co. Employee Benefit Plan; AMERICAN COMMUNITY MUTUAL INSURANCE CO.; AMERICAN TRUST ADMINISTRATORS; AUTOMOTIVE INDUSTRIES WELFARE FUND MEDICAL PLAN, BROWN GROUP INSURANCE CO., Administrators and/or Trustee on Behalf of Brown Group Insurance Co. Healthcare Plan; BANKERS LIFE & CASUALTY COMPANY, Administrator and/or Trustee on Behalf of City of Chicago Employee Benefit Plan; THE VOLLRATH COMPANY, INC., THE VOLLRATH COMPANY, INC. EMPLOYEE BENEFIT PLAN; CHUBB LIFE AMERICA; COMPARITIVE INS. SERV.; MCDONNELL DOUGLAS CORP./DOUGLAS AIRCRAFT COMPANY; SCREEN ACTORS GUILD PRODUCERS PENSION PLAN; SWIN CHEM PRODUCTS, INC., GREAT LAKES CHEMICAL, INC.; BL NETWORK, INC. EMPLOYEE BENEFIT PLAN; GROUP RESOURCES, INC.; HARCOURT BRACE JOVANOVICH, INC.; HEALTH ECONOMICS CORPORATION; CITY/COUNTY OF SAN FRANCISCO; INSURNATIONAL INSURANCE ADMINISTRATORS, INC.; INSURNATIONAL, INC.; INTERMOUNTAIN ADMINISTRATORS, INC.; LABORERS HEALTH & WELFARE TRUST FOR SOUTHERN CALIFORNIA; MCDOWELL AGENCY, INC.; MUTUAL ASSURANCE; SAN FRANCISCO PRINT INDUSTRY WELFARE FUND, and Newspaper & Periodical Driver's & Helper's Union Local 921 Publishers' Welfare Trust; PAVERS AND ROAD BUILDERS DISTRICT COUNCIL WELFARE FUND; JACK WICKWARE; IBEWNECA SOUTHWESTERN HEALTH AND BENEFIT FUND; WAL-MART, INC.; WAL-MART, INC. ASSOCIATES GROUP

HEALTH PLAN; STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY; GROUP HEALTH INCORPORATED; FEDERATED MUTUAL INSURANCE COMPANY; EUROPEAN CAR PARTS, INC.; EMPLOYEE BENEFIT PLAN; F.W. WOOLWORTH COMPANY EMPLOYEE BENEFIT PLAN; F.W. WOOLWORTH CO.; PAULA ASSURANCE CO.; PAN AMERICAN UNDERWRITERS, INC.; GALLEGHER BASSETT SERVICES, INC.; EMPLOYEE BENEFITS ADMINISTRATION AND MANAGEMENT CORPORATION; MILK & ICE CREAM EMPLOYEES WELFARE PLAN; BLUE CROSS BLUE SHIELD OF DELAWARE, Blue Cross Blue Shield of Indiana; Blue Cross Blue Shield of Kentucky; Blue Cross Blue Shield of New Jersey; Blue Cross Blue Shield of Connecticut; UNITED INSURANCE COMPANY OF AMERICA; NALC HEALTH BENEFIT PLAN; INDIANA CHILD PROTECTIVE SERVICES; NORTHERN INDIANA STATE DEVELOPMENTAL CENTER; COLUMBIA HCA HEALTHCARE CORPORATION, Defendants-Appellants.

No. 98-55905

UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT

Submitted February 11, 2000¹

Filed March 17, 2000

NOTE: SEE ORDER AT 234 F.3d 428.

[Copyrighted Material Omitted] COUNSEL: Stephen Simon, in Propria Persona, Inverness, Florida, for the plaintiff-appellant.

Bruce A. Beckman, Jeffrey P. Smith, Brian F. Rowe, Beckman, Davis, Smith & Ruddy, Los Angeles, California, for defendants-appellees Value Behavioral Health, Inc., Value Health, Inc., Preferred Health Care, Ltd., American Psychmanagement, Inc., Robert Patricelli, The Prudential Insurance Company of America, The Guardian Life Insurance Company of America, Pacific Mutual Life Insurance Company, PM Group Life Insurance Company, Blue Cross/Blue Shield of Ohio, Mutual Health Service Co., Humana, Inc., McDonough Capperton, Inc., McDonough Capperton, Inc. Employee Benefit Plan and Health Management Strategies International, Inc.

Robert S. Hark, Hark &...