In a significant victory for parents of children with autism, a federal judge has certified a class action suit against Cigna Corp. for the insurer’s refusing to cover two types of behavioral treatments on the grounds that they are “investigative or experimental.” U.S. District Court Judge Juan R. Sanchez ruled, in certifying a class, that the class must be limited to parents who actually filed claims for the treatment and were denied. Judge Sanchez refused to expand the class to include those who may have considered it futile to file a claim because of Cigna’s alleged blanket policy against such coverage. The Plaintiffs contended in the suit that the two treatments — applied behavior analysis (ABA) and early intensive behavioral treatment (EIBT) — have become “widely accepted” as the most effective treatments for autism.
Judge Sanchez also rejected Cigna’s argument that the class was in conflict with the U.S. Supreme Court’s recent decision in Wal-Mart Stores Inc. v. Dukes. The Dukes ruling was “inapposite,” Judge Sanchez found, because it centered on the Justices’ concern that the women suing Wal-Mart could not point to a single, uniform employment practice, but instead were challenging thousands of individual decisions made by local supervisors. The judge found that in the case, “in contrast, Cigna indisputably has a national policy of denying coverage for ABA.”
This ruling is viewed as “a huge victory for the autism community.” Hopefully, the case sends the message that “insurance companies need to stand up and do the right thing by acknowledging the body of evidence that supports the validity of ABA therapy.” The lawyers who represented the Plaintiffs, Gregory B. Heller of Young Ricchiuti Caldwell & Heller in Philadelphia and Gerard V. Mantese of Mantese Honigman Rossman & Williamson in Troy, Mich., have done a tremendous job in this most important case.
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