A California federal judge has certified a class of more than 1,000 UnitedHealth Group beneficiaries accusing the insurer of denying benefits for prosthetic limbs in violation of federal benefits law. Two previous certification bids failed.
According to Law 360, U.S. District Judge John F. Walter ruled that the beneficiaries have shown there are “significant questions of fact and law” that are common to the entire class involving allegations that United didn’t offer alternative devices that met the customers’ needs in its notices of benefit denial and that if United determined that any of the components in a claim were not covered, the insurer denied coverage for the entire claim.
“The court concludes that proceeding as a class action has the capacity to generate common answers to common questions apt to drive the resolution of the litigation, including whether United’s practices violate the terms of the plans, or the [Employee Retirement Income Security Act]’s claim procedures and notice requirements,” according to the order.
The February 4 ruling follows a decision in September 2018 in which the judge ruled that the proposed class action suit accusing UnitedHealth Group and two subsidiaries of improperly denying coverage prosthetic limbs couldn’t be heard as a group.
In the original complaint filed in December 2017, David Trujillo and Deana Harden accused UnitedHealth Group and its subsidiaries, United HealthCare Services and UnitedHealthcare Insurance Co., of violating the Employee Retirement Income Security Act (ERISA) by not using appropriate procedures for assessing the claims for prosthetic arm and leg devices.
The beneficiaries filed their second renewed bid for class certification in December 2018, when the judge ruled that the proposed class definition was too broad, and again in November, when the judge said that the beneficiaries failed to submit the evidence they relied on in their October brief asking him to certify the class.
The judge said on February 4 that Trujillo’s and Harden’s claims are sufficiently typical of the class claims, finding that there is no dispute that United denied their requests on the basis that the devices did not meet the minimum specifications for their needs and did not present an alternative device that would meet their functional needs, according to Law 360.
In March 2018, UnitedHealth Group asked the court to dismiss it from the case, arguing that the beneficiaries didn’t show that it, as a parent company, had control over the claims denial process. The judge denied the motion in April 2018 based on the company’s failure to submit a proposed statement of decision within two days of the deadline for filing a reply.
The newly certified class includes people covered under United plans, governed by ERISA, self-funded or fully insured, whose requests for prosthetic arm and leg devices had been denied from January 2015 through May 2018 on the basis that the devices didn’t meet the minimum specifications of the person’s needs. It does not include people whose requests for prosthetic devices have been denied for other reasons.
