Judge Refuses Class Action in Prosthetics Suit

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On September 14, a California federal judge ruled that a proposed class action suit accusing UnitedHealth Group and two subsidiaries of improperly denying coverage for prosthetic devices in violation of federal benefits law can't be heard as a group. The proposed group, including lead plaintiffs David Trujillo and Deana Harden, numbered about 1,900 UnitedHealth beneficiaries. The judge ruled that the definition of the proposed class was too broad, but that the beneficiaries can file an amended complaint, as well as a renewed motion for class certification.

In the complaint, according to Law 360, the beneficiaries had limited the proposed class to UnitedHealth customers whose requests for prosthetic arms and legs were denied on the basis that the devices didn't meet the minimum specifications of the person's needs. But in the motion for certification of the class action in August, the group sought to include UnitedHealth customers whose requests were denied for any reason. In the ruling, U.S. District Judge John F. Walter wrote that both definitions were too broad because they could include many unrelated denials.

In the original complaint filed in December 2017, Trujillo and Harden accused UnitedHealth and its subsidiaries of violating the Employee Retirement Income Security Act by not using appropriate procedures for assessing claims for prosthetic devices. Trujillo's request for a HiFi Socket was denied by UnitedHealth because the claim did not sufficiently explain why the socket was necessary. Harden's 13-year-old son's claim for a powered arm and hand prosthesis was denied after UnitedHealth said the providers did not use the correct billing codes for the various parts of the device.

In March, UnitedHealth asked the court to dismiss it from the case, arguing that the plaintiffs didn't show that as a parent company, it had control over the claims denial process. The judge denied that motion in April, after UnitedHealth failed to submit a proposed statement of decision within two days of the deadline for filing a reply as mandated by the judge's standing order.