Microsoft Must Face ‘Wilderness Program’ Exclusion Class Action Lawsuit

Microsoft can’t avoid a health care class action after a federal judge determined that exclusions for “wilderness programs” do not discredit a 16-year-old’s claims that the company unfairly denied him coverage for mental health treatment.

U.S. District Judge John C. Coughenour recently denied part of Microsoft’s motion to dismiss class action claims against them brought by a 16-year-old “A.H.”

Judge Coughenour found that A.H. sufficiently demonstrated that the program he participated in was not exempt from health care coverage.

Microsoft claimed that the program was classified as a wilderness program, which is not covered by the health plan, but the court found differently based on the services provided.

“For example, wilderness programs that offer services that are primarily educational or recreational would clearly be excluded; whereas, wilderness programs that are state-licensed and offer medically necessary mental health or substance abuse treatment may be covered,” Judge Coughenour said in his motion. “Moreover, the plan’s definition of ‘eligible provider,’ could encompass a state-licensed wilderness program offering medically necessary mental health or substance abuse treatment.”

A.H. says he suffers from a mental illness and substance abuse disorder. A.H. is covered under a health plan based on his mother’s employment at Microsoft. In February 2016, A.H. sought treatment from a wilderness therapy program after conventional methods had failed.

A.H. filed the Microsoft ERISA class action under claims that the company violated the Employee Retirement Income Security Act (ERISA) by denying coverage for his wilderness based mental health and substance abuse program. In April, Microsoft motioned to dismiss the youth’s claims and A.H. defended his claims in May.

Although the court did not dismiss all claims, Judge Coughenour did dismiss the fiduciary duty claims without prejudice, the Affordable Care Act claims, and the Parity Act claims.

A.H. brought fiduciary duty claims under ERISA, but the court found that he did not sufficiently allege injury under the Act. Due to this, the claims were tossed. However, A.H. does have the opportunity to amend the claims.

The Microsoft ERISA class action also brought allegations that the company’s actions violated the Federal Mental Health Parity and Addiction Equity Act and the Affordable Care Act. The court found that the language in the Affordable Care Act’s anti-discrimination clause did not support A.H.’s interpretation and subsequent claims.

Judge Coughenour also found that A.H. failed to sufficiently allege that the wilderness program exclusion in Microsoft’s health plan created an unfair limitation on mental health treatment in violation of the Parity Act. The court stated that the A.H. did not show how limitations on wilderness programs were “stricter” than limitations on medical or surgical care.

“Plaintiff has not plausibly alleged facts that demonstrate the exclusion at issue represents a treatment limitation on mental health or substance use disorder benefits that is more restrictive than medical/surgical benefits,” the court’s motion states.

Plaintiffs are represented by Richard E. Spoonemore and Elanor Hamburger of Sirianni Youtz Spoonemore Hamburger; and Jordan M. Lewis of Jordan Lewis PA.

The Microsoft ERISA Class Action Lawsuit is A.H., et al. v. Microsoft Corp. Welfare Plan, Case No. 2:17­-cv-­01889, in the U.S. District Court for the Western District of Washington at Seattle.