Judge Wants More Info|on Autism Settlement


SEATTLE (CN) – A federal judge has granted class certification but did not approve a settlement agreement for parents of autistic children who sued T-Mobile and its insurer for denying coverage for applied behavior analysis therapy.
     Two parents sued T-Mobile using pseudonyms last year for denying autism therapy for their son. They also sued the T-Mobile Employee Benefit Plan and United Healthcare Services, under the 2008 Mental Health Parity and Addiction Equity Act.
     T-Mobile agreed in February to spend $676,000 for a fund to cover applied behavior analysis therapy for the plaintiffs’ son and the other class members.
     Before that, the company agreed to expand their benefits to include the therapy through their United Healthcare plans.
     Applied behavior analysis is considered a relatively effective treatment for children and teens with autism spectrum disorders to develop communication skills.
     U.S. District Judge Richard Jones on Monday granted the plaintiffs’ unopposed motion to certify the class, but denied the motion to approve the settlement agreement, expressing skepticism about the plaintiffs’ calculations for the class fund.
     “The court has no way of knowing how much each claim costs, the approximate number of claims per claimant, or even the number of claimants, aside from it being in the hundreds,” Jones wrote in a 12-page order.
     Jones wrote that the released claims in the settlement “are phrased too broadly” and recommended that the parties limit that part of the claim to those related to T-Mobile’s denial of coverage for applied behavior analysis therapy.
     Under the settlement the parties submitted, remaining funds from the settlement would be reverted back to T-Mobile.
     “Courts are generally wary of settlement agreements that permit unrewarded fees to revert back to defendants rather than be added to the class fund,” Jones wrote.
     “It appears that in this case, the parties agree that any funds left over after all payments have been made will revert to T-Mobile. The Court is satisfied that this provision is not the product of collusion because any unrewarded attorneys’ fees will remain in the fund to pay for class members’ claims.”
     Jones noted that the parties reached a settlement without extensive, years-long litigation and that the attorneys fees and expenses were significantly lower than in similar cases.
     He allowed the plaintiffs to file a renewed motion by July 30 with a new settlement deadline, and other deadlines related to the class members.
     Companies’ denials of applied behavior analysis therapy have been the subject of a number of lawsuits under the Mental Health Parity law.
     Boeing’s health care plan was sued for similar claims in 2014, and that year Regence Blue Shield agreed to create a $6 million fund in Washington to reimburse its policyholders for autism treatments it had denied.
     Aetna paid $4.5 million in 2015 for failing to cover applied behavior analysis in Missouri, and agreed to be barred from the state for a year if it violates the settlement agreement.
     Premera Blue Cross paid $3.5 million in 2014 in a similar agreement in Seattle.

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