Oksana B., et al. v. Premera Blue Cross, et al.

UNITED STATES DISTRICT COURT WESTERN DISTRICT OF WASHINGTON AT SEATTLE 10 OKSANA B., et al., CASE NO. C22-1517 MJP 11 Plaintiffs, ORDER GRANTING MOTION FOR ATTORNEYS’ FEES 12 v. 13 PREMERA BLUE CROSS, et al., 14 Defendants.

16 This matter comes before the Court on Plaintiffs’ Motion for Attorneys’ Fees. (Dkt. No. 53.) Having reviewed the Motion, the Response (Dkt. No. 58), the Reply (Dkt. No. 59), and all supporting materials, the Court GRANTS the Motion.

19 BACKGROUND 20 Plaintiffs A.B. and his parents, Oksana and Alexander, brought suit against Defendants Premera Blue Cross, The Tableau Software, Inc. Employee Benefit Plan, and Salesforce.com Health and Welfare Plan (“Defendants”) for denying claims for A.B.’s stay at two mental health care facilities: (1) Second Nature, and (2) Catalyst. The Court granted summary judgment in Plaintiffs’ favor, finding that Premera had wrongly denied plan benefits for A.B.’s both facilities.

2 (Order on Cross Motions (Dkt. No. 37).) The Court found that Premera abused its discretion by failing to provide reasoned decisions and improperly construing and applying the Plan’s terms.

4 (Id. at 14-24.) And while the Court denied Plaintiffs’ Parity Act claim, it did so because their success on the other claims mooted the Parity Act claims. In other words, Plaintiffs achieved a high degree of success. The Court then awarded attorneys’ fees to Plaintiffs, finding that they were properly awarded under ERISA, 29 U.S.C. § 1132(g)(1). (Order Granting Motion for Attorneys’ Fees (Dkt. No. 49) (“Fee Order”).) In total, the Court awarded $49,552.50 in fees and $400 in costs. (Id.) 10 The Ninth Circuit reversed the grant of summary judgment and award of fees and costs.

11 (Ninth Cir. Mem. (Dkt. No. 52).) First, the Ninth Circuit held that the Plan did not cover the Second Nature stay. (Id. at 2-3.) Second, though the Ninth Circuit agreed with this Court’s analysis and conclusion that Premera violated ERISA in denying the Catalyst claim and that Plaintiffs had made a strong showing of an entitlement of coverage, it ordered the determination be remanded to Premera for further assessment. (Id. at 3-7.) The Ninth Circuit also vacated the award of fees so that this Court could “conduct that analysis anew” in light of its decision. (Id. at 7.)

18 Plaintiffs have filed a renewed motion for attorneys’ fees, asking for an award of $41,827.50 in fees, and $400 in costs. (Reply at 7 (Dkt. No. 59).) The Court previously found the fees were appropriately awarded under the applicable law, because Plaintiffs had prevailed on their claims and the relevant factors supported an award. In its prior order, the Court found that all of the time requested was reasonable, and that the hourly rates were also reasonable.

23 Specifically, the Court found reasonable: (1) 54.7 hours spent by Brian King, the principal attorney, (2) 58.5 hours spent by Andrew Sommers, a law clerk and attorney, and (3) 5.9 hours spent by local counsel, John Wood. (Fee Order at 8.) And the Court approved King’s $600/hour rate, Sommer’s rate $225-$250/hour, and Wood’s $500/hr. (Id.) Plaintiffs asks for approval of these same rates, but have reduced their fee request by $7,725, to reflect the exclusion of time entries that counsel has identified as being solely related to the Second Nature claim. (Reply at 6 n.23.) They ask for a total award of $41,827.50. (Id. at 7.)

7 ANALYSIS A. Plaintiffs Entitled to Fees 9 Premera argues that Plaintiffs should not be awarded any attorneys’ fees or costs because they only obtained remand of their Catalyst-related claim to Premera, and otherwise lost their claim concerning the Second Nature stay. The Court disagrees.

12 Under Supreme Court authority, “a fees claimant must show some degree of success on the merits before a court may award attorney’s fees under § 1132(g)(1).” Hardt v. Reliance Standard Life Ins. Co., 560 U.S. 242, 255 (2010) (citation and quotation omitted). “A claimant does not satisfy that requirement by achieving trivial success on the merits; or a purely procedural victor[y], but does satisfy it if the court can fairly call the outcome of the litigation some success on the merits without conducting a lengthy inquir[y] into the question whether a particular party’s success was substantial or occurred on a central issue.” Id. (citation and quotation omitted). As the Ninth Circuit has explained, a remand order “even without a positive signal on the plaintiff’s eligibility for benefits or a subsequent award of benefits, can constitute some success ‘on the merits’ under Hardt.” Woolsey v. Aetna Life Ins. Co., No. 20-16885, 2022 22 WL 1598964, at *2 (9th Cir. May 20, 2022). The court explained: “What is critical in this context is that the court determined the administrative process was significantly deficient, and that the plaintiff obtained a renewed opportunity to secure benefits.” Id. The Ninth Circuit reached a similar conclusion in another unpublished decision, finding an entitlement to fees where the plaintiff “obtain[ed] an initial remand for further consideration of her ERISA claim . . .

4 even [though] the district court did not ultimately agree that she was entitled to benefits.”

5 Gorbacheva v. Abbott Lab'ys Extended Disability Plan, 794 F. App'x 590, 594 (9th Cir. 2019).

6 Applying Hardt and considering the two unpublished Ninth Circuit decisions noted above, the Court finds that Plaintiffs here are entitled to fees under ERISA. Although Plaintiffs lost their claim that Premera wrongly denied coverage for the Second Nature stay, Plaintiffs succeeded before both this Court and the Ninth Circuit in demonstrating that Premera abused its discretion in denying the Catalyst claim. And both courts have agreed that Plaintiffs made a strong showing that they are entitled to coverage. (Ninth Cir. Mem. at 7; Order on Cross Motions at 18-24.) Thus, the remand is not merely a “purely procedural victory” that falls short of satisfying § 1132(g)(1). See Hardt, 560 U.S. at 255. Instead, Plaintiffs succeeded in obtaining a meaningful opportunity to obtain benefits. This supports an award.

15 B. The Hummell Factors Remain Satisfied 16 ERISA provides the District Court with discretion to award attorneys’ fees and costs to either party of an action brought by a plan participant. 29 U.S.C. § 1132(g)(1); Hardt v. Reliance Standard Life Ins. Co., 560 U.S. 242, 256 (2010). In making this discretionary determination, a district court “should” consider the following, non-exclusive five factors: 20 (1) the degree of the opposing parties' culpability or bad faith; (2) the ability of the opposing parties to satisfy an award of fees; (3) whether an award of fees against the 21 opposing parties would deter others from acting under similar circumstances; (4) whether the parties requesting fees sought to benefit all participants and beneficiaries of an 22 ERISA plan or to resolve a significant legal question regarding ERISA; and (5) the relative merits of the parties’ positions.

1 Hummell v. S. E. Rykoff & Co., 634 F.2d 446, 453 (9th Cir. 1980). The Court refers to these as the “Hummell factors.” The Court’s analysis also acknowledges the “general rule, [that] the prevailing party on an ERISA claim is entitled to attorney’s fees, ‘unless special circumstances would render such an award unjust.’” United Steelworkers of Am. v. Ret. Income Plan For Hourly-Rated Emps. of ASARCO, Inc., 512 F.3d 555, 564 (9th Cir. 2008) (quoting Hensley v. Eckerhart, 461 U.S. 424, 429 (1983)). And when applying the Hummell factors, courts “must keep at the forefront ERISA’s remedial purposes that should be liberally construed in favor of protecting participants in employee benefit plans.” McElwaine v. US W., Inc., 176 F.3d 1167, 1172 (9th Cir. 1999) (internal quotation and citation omitted).

10 Consistent with its previous Order, the Court again finds that all of these factors support an award. (See Fee Order at 3-7.) First, as the Court previously found, Premera failed to explain how it made its medical-necessity determination and how A.B. had recovered sufficiently to warrant treatment at a lower level and that this showed bad faith and culpability. (Id. at 4.)

14 Although that determination is now remanded, the Court’s finding concerning Premera’s culpability stands and supports the award of fees. Second, there remains no dispute that Premera can satisfy the award. Third, there remains a deterrent effect in the award, as doing so would help convince Premera that providing a reasoned and thoughtful decision in the first place will avoid litigation and wrongful denials of coverage. Fourth, other Plan beneficiaries may yet gain some benefit from the outcome here, though this remains largely neutral. Fifth, even with the Ninth Circuit’s reversal, Plaintiffs continue to have a strong position with regard to the Catalyst claim.

21 So while Premera vindicated its position with regard to the Second Nature claim, it lacks any solid footing with regard to the Catalyst claim. The Court again finds this favors Plaintiffs. On balance, these factors all support an award of fees. And Premera has not identified any new analysis based on the Ninth Circuit’s reversal that would make the Hummell factors cut against an award of fees. The Court therefore finds that the Hummell factors again favor an award of fees, and that an award is appropriate and proper on the record before it.

4 C. Reduced Fees Appropriate 5 The Court agrees with Defendants, in part, that a haircut to the reduced fee request is proper to account for time spent solely on the Second Nature claim.

7 As the Court previously explained, in deciding the number of hours “reasonably expended,” the Court considers whether the time on matter that was “excessive, redundant, or otherwise unnecessary.” Hensley v. Eckerhart, 461 U.S. 424, 434 (1983); (See Fee Order at 8).

10 And the requesting attorney must provide reasonable documentation of the work performed to enable this determination. See Hensley, 461 U.S. at 433.

12 Although Plaintiffs have proposed a reduction of $7,725 from their initial fee request, the Court finds that a further reduction is proper to exclude time spent on the Second Nature Claim.

14 Defendants argue that counsel should have segregated the time spent solely on the Second Nature claims, and given their failure to do so, the Court should reduce the fee request by 50%.

16 (Defs. Opp. at 7-9.) The Court agrees with Defendants that additional time spent briefing matters specific to Second Nature should be excluded, and that the $7,725 reduction is not quite adequate. But the Court rejects the request for a 50% reduction. Although Plaintiffs’ counsel expended time solely to the facts and law concerning Second Nature, almost all of the legal analysis and core briefing on summary judgment benefitted both claims. And the Second Nature claim was factually less complex than the Catalyst claim, while involving the same law and general legal framework. For this reason, the Court does not find that 50% of counsel’s time reasonably reflects time spent solely on the Second Nature claim. Considering that counsel has already reduced the award by over 15%, and based on the Court’s review of the billing entries, it Court finds that a total reduction of 20% of the billed time reasonably reflects the exclusion of time spent exclusively on the Second Nature Claim. Applying the 20% reduction to the total time billed, the Court awards $39,642 (which is 80% of $49,552.50).

5 The Court again awards $400 in costs for the filing fee.

6 CONCLUSION 7 The Court finds that Plaintiffs are entitled to attorneys’ fees and costs and that an award of $39,642 reasonably reflects the time expended on Plaintiffs’ successful claim. The Court thus GRANTS the Motion and AWARDS Plaintiffs $39,642 in attorneys’ fees and $400 in costs.

10 The clerk is ordered to provide copies of this order to all counsel.

11 Dated October 15, 2025.

A 13 Marsha J. Pechman United States Senior District Judge