The Selfie Coup: How to Tell If Your Government Is Plotting to Overthrow Itself

DEAN FALVY

Dean Falvy, a lecturer at the University of Washington School of Law in Seattle, describes how to tell whether a government is plotting to overthrow itself—a phenomenon he calles a “Selfie Coup.” Falvy explains the difference between a Selfie Coup and creeping authoritarianism by providing examples of both and argues that the more aware civil society is of the possibility of a Selfie Coup, the more likely it can prepare its defenses in time to prevent it.

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M. v. Premera Blue Cross

Docket: 18-4098

Opinion Date: July 24, 2020

Judge: Robert Edwin Bacharach

Areas of Law: ERISA, Health Law, Insurance Law

The parents of a teenage girl (L.M.) sued Premera Blue Cross under the Employee Retirement Income Security Act (ERISA), claiming improper denial of medical benefits. L.M. experienced mental illness since she was a young girl. L.M. was eventually placed in Eva Carlston Academy, where she obtained long-term psychiatric residential treatment. For this treatment, the parents submitted a claim to Premera under the ERISA plan’s coverage for psychiatric residential treatment. Premera denied the claim ten days into L.M.’s stay. But Premera agreed to cover the first eleven days of L.M.’s treatment, explaining the temporary coverage as a "courtesy." The parents appealed the denial of subsequent coverage, and Premera affirmed the denial based on a physician's medical opinion. The parents filed a claim for reimbursement of over $80,000 in out-of-pocket expenses for L.M.’s residential treatment at the Academy. Both parties moved for summary judgment, and the district court granted summary judgment to Premera based on two conclusions: (1) Premera’s decision was subject to the arbitrary-and- capricious standard of review; and (2) Premera had not acted arbitrarily or capriciously in determining that L.M.’s residential treatment was medically unnecessary. The district court granted summary judgment to Premera, and the parents appealed. After review, the Tenth Circuit concluded the district court erred by applying the arbitrary-and-capricious standard and in concluding Premera had properly applied its criteria for medical necessity. Given these conclusions, the Court reversed and remanded the matter back to the district court for de novo reevaluation of the parents’ claim.