A recent certification of a class against CIGNA in the Eastern District of Pennsylvania is a good example of the type of issue on which insurers may continue to have significant class action exposure following the Supreme Court’s decision in Wal-Mart (see my blog post on Wal-Mart).  This decision has received fairly extensive coverage in the media and blogs, including on Insurance Networking News and Insurance Dispatch

In Churchill v. CIGNA Corp., 2011 U.S. Dist. LEXIS 90716 (E.D. Pa. Aug. 12, 2011), the plaintiff alleged that CIGNA improperly denied claims seeking certain types of treatment for autism known as Applied Behavior Analysis and Early Intensive Behavioral Treatment (collectively “ABA”).  The claims were denied under an exclusion for “experimental or investigative” treatment, and CIGNA apparently had a policy of universally denying all such claims on this basis.  Id. at *2.

The court found that the new commonality requirement articulated in Wal-Mart was satisfied because, in contrast to the discretion that Wal-Mart gave store managers over employment decisions, “Cigna indisputably has a national policy of denying coverage for ABA to treat ASD” and “the central question here is whether Cigna’s denial of medical coverage for ABA as a treatment for ASD on the basis that such treatment is investigative or experimental was proper, and the answer to this question will resolve each class member’s individual claim.”  Id. at *12-13.  The court also found that predominance was satisfied because there was no evidence that the policy of denying these claims was any different for any of the ERISA plans managed by CIGNA.  Rather, “Cigna made a class-wide determination that ABA was experimental in all cases.  The propriety of this determination – specifically, whether it violates ERISA – can easily be litigated in a single forum.”  Id. at *22.  The court did not really address some of the individual issues I could see arising in this kind of case, such as whether, assuming the treatment was not “experimental or investigative,” it would be appropriate for particular children based on their condition.

Notably, the court distinguished a Tennessee federal court decision, Graddy v. Blue Cross blue Shield of Tenn., 2010 WL 670081 (E.D. Tenn. Feb. 19, 2010), in which the court found that individualized assessments as to the appropriateness of treatment would be required, and the insurer apparently did not have any across-the-board, universal policy.

The key takeaway I see here is that when an insurer adopts a bright-line rule requiring denial of all claims of a particular type, without any exceptions and without any individualized assessment, while that might in some instances make business sense, that type of policy or practice can in some cases increase the insurer’s class action exposure.  Where some discretion is given to front-line personnel and individual, fact-based determinations are made, there is less chance a class action being certified.

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Photo of Wystan Ackerman Wystan Ackerman

I am a partner at the law firm of Robinson+Cole in Hartford, Connecticut, USA.  My contact information is on the contact page of my blog.  I really enjoy receiving questions, comments, suggestions and even criticism from readers.  So please e-mail me if you…

I am a partner at the law firm of Robinson+Cole in Hartford, Connecticut, USA.  My contact information is on the contact page of my blog.  I really enjoy receiving questions, comments, suggestions and even criticism from readers.  So please e-mail me if you have something to say.  For those looking for my detailed law firm bio, click here.  If you want a more light-hearted and hopefully more interesting summary, read on:

People often ask about my unusual first name, Wystan.  It’s pronounced WISS-ten.  It’s not Winston.  There is no “n” in the middle.  It comes from my father’s favorite poet, W.H. (Wystan Hugh) Auden.  I’ve grown to like the fact that because my name is unusual people tend to remember it better, even if they don’t pronounce it right (and there is no need for anyone to use my last name because I’m always the only Wystan).

I grew up in Deep River, Connecticut, a small town on the west side of the Connecticut River in the south central part of the state.  I’ve always had strong interests in history, politics and baseball.  My heroes growing up were Abraham Lincoln and Wade Boggs (at that time the third baseman for the Boston Red Sox).  I think it was my early fascination with Lincoln that drove me to practice law.  I went to high school at The Williams School in New London, Connecticut, where I edited the school newspaper, played baseball, and was primarily responsible for the installation of a flag pole near the school entrance (it seemed like every other school had one but until my class raised the money and bought one at my urging, Williams had no flag pole).  As a high school senior, my interest in history and politics led me to score high enough on a test of those subjects to be chosen as one of Connecticut’s two delegates to the U.S. Senate Youth Program, which further solidified my interest in law and government.  One of my mentors at Williams was of the view that there were far too many lawyers and I should find something more useful to do, but if I really had to be a lawyer there was always room for one more.  I eventually decided to be that “one more.”  I went on to Bowdoin College, where I wrote for the Bowdoin Orient and majored in government, but took a lot of math classes because I found college math interesting and challenging.  I then went to Columbia Law School, where I was lucky enough to be selected as one of the minions who spent their time fastidiously cite-checking and Blue booking hundred-plus-page articles in the Columbia Law Review.  I also interned in the chambers of then-Judge Sonia Sotomayor when she was a relatively new judge on the Second Circuit, my only connection to someone who now has one-ninth of the last word on what constitutes the law of our land.  I graduated from Columbia in 2001, then worked at Skadden Arps in Boston before returning to Connecticut and joining Robinson+Cole, one of the largest Connecticut-based law firms.  At the end of 2008, I was elected a partner at Robinson+Cole.

I’ve worked on class actions since the start of my career at Skadden.  Being in the insurance capital of Hartford, we have a national insurance litigation practice and I was fortunate to have the opportunity to work on some prominent class actions arising from the 2004 hurricanes in Florida and later Hurricane Katrina, including cases involving the applicability of the flood exclusion, statutes known as valued policy laws, and various other issues.  My interest and experience in class actions gradually led me to focus on that area.

In Connecticut courts I’ve defended various kinds of class actions that go beyond insurance, including cases involving products liability, securities, financial services and consumer contracts.

My insurance class action practice usually takes me outside of Connecticut.  I’ve had the pleasure of working on cases in various federal and state courts and collaborating with great lawyers across the country.  While class actions are an increasingly large part of my practice, I don’t do exclusively class action work.  The rest of my practice involves litigating insurance coverage cases, often at the appellate level.  That also frequently takes me outside of Connecticut.  A highlight of my career thus far was working on Standard Fire Ins. Co. v. Knowles, the U.S. Supreme Court’s first Class Action Fairness Act case.  I was Counsel of Record for Standard Fire on the cert petition, and had the pleasure of working with Ted Boutrous on the merits briefing and oral argument.

I started this blog because writing is one of my favorite things to do and I enjoy following developments in class action law, writing about them and engaging in discussion with others who have an in interest in this area.  It’s a welcome break from day-to-day practice, keeps me current, broadens my network and results in some new business.

When I’m not at my desk or flying around the country trying to save insurance companies from the plaintiffs’ bar, or attending a conference on class actions or insurance litigation (for more on those, see the Seminars/Programs page of this blog), I often can be found playing or reading with my young daughter, helping my wife with her real estate and mortgage businesses, reading a book about history or politics, or watching the Boston Red Sox (I managed to find bleacher seats for Game 2 of the 2004 World Series when Curt Schilling pitched with the bloody sock).  When the weather is good I also love to take the ferry to Block Island, Rhode Island and ride a bike or walk the trails there. If you go, I highly recommend the Clay Head Trail.