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Wilson v. Anthem Health Plans of Kentucky, Inc.

United States District Court, W.D. Kentucky, Louisville Division

September 3, 2019

MARGARET WILSON, individually and on behalf of a Class of persons similarly situated, Plaintiffs
v.
ANTHEM HEALTH PLANS OF KENTUCKY, INC. Defendant

          MEMORANDUM OPINION AND ORDER

          REBECCA GRADY JENNINGS, DISTRICT JUDGE UNITED STATES DISTRICT COURT

         Plaintiff Margaret Wilson (“Wilson”) brings this action against Defendant Anthem Health Plans of Kentucky (“Anthem”) seeking relief for alleged violations of Employee Retirement Income Security Act of 1974, 29 U.S.C. §§1001, et seq. (“ERISA”) and the Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C.A. § 300gg-26 (“MHPAEA”). [DE 1 at 1]. Before the Court is Wilson's unopposed Motion for Preliminary Approval of Class Settlement, Approval of Notice to the Class, and Scheduling Final Fairness Hearing (“Motion”). [DE 76]. The matter is ripe. For the reasons below, the Court GRANTS LEAVE TO SUPPLEMENT THE MOTION.

         I. BACKGROUND

         Wilson is the mother and legal guardian of M.W., a minor child with Autism Spectrum Disorder (“ASD”). [DE 1 at 2]. According to Wilson's complaint, “Autism cannot be cured, but it can be treated” and Applied Behavior Analysis (“ABA”) is the “most common and recognized method” of treatment. Id. at 3. Wilson and her son are insured by Anthem. Id. at 2.

         M.W. enrolled in the Highlands Center for Autism to receive ABA treatment. Id. at 10. Wilson submitted claims to Anthem “seeking coverage for the cost” of M.W.'s treatment. Id. at 11. Anthem “paid small amounts of some claims” but, because of coverage limitations, did not reimburse most of the treatment costs. Wilson has continued to seek treatment for M.W.'s ASD but claims that “Anthem has continued to impose coverage limitations on it.” Id. at 11. Wilson has spent “tens of thousands of dollars in unreimbursed expenses for the medically necessary care” of M.W. Id.

         In 2014, Wilson filed a Class Action Complaint, arguing that Anthem violated ERISA and MHPAEA by “routinely impos[ing] caps and limits on benefits under its health insurance policies for insureds seeking treatment for Autism Spectrum Disorders.” Id. at 1. Because of Anthem's allegedly unlawful practices, Wilson sought relief for herself and on behalf of a class of similarly situated individuals.

         In January, 2017, the Court certified the class[1] requested by Wilson and named Robert R. Sparks and Strauss Troy Co., L.P.A., as class counsel. [DE 47 at 3157].

         In August, 2018, the parties, negotiated a Class Action Settlement Agreement (the “Settlement”) with the assistance of Magistrate Judge King. The compensatory terms of the Settlement are as follows:

On behalf of the class members involved in this action, Anthem has agreed to create a fund totaling $300, 000. No. part of this fund reverts to Anthem. The settlement fund is to be used to provide settlement to Class Members and pay attorney fees, costs, and incentive awards approved by the Court.
The Net Settlement Fund will be distributed to Class Members. That fund is expected to total $175, 000. Class Members who had claims denied by Anthem using the denial reason description “Benefit Maximum Met” or “Units exceed a utilization management authorization” shall receive a pro rata share of the Net Settlement Fund or a minimum payment of $250.00, whichever is greater. All other Class Members shall receive $250.00.
Margaret Wilson, the Class Representative, will seek an award of $10, 000. Class Counsel has agreed to apply to the Court for approval of attorneys (sic) fees and costs, which will not exceed $115, 000.00. Anthem has agreed not to oppose a fee application which is in accord with the above referenced procedure. The comprehensive settlement agreement is attached and incorporated herein as Exhibit “A”.
Any funds remaining from uncashed settlement checks after 120 days following payments to Class Members shall be disbursed as a cy pres award to Families for the Effective Treatment of Autism (FEAT) of Louisville.

[DE 76-1 at 3266].

         On March 13, 2019, Wilson filed her Motion [DE 76], attaching a Settlement Agreement [DE 76-2], a Notice of Class Action Settlement (the “Notice”) [DE 76-2], and an Order Preliminarily Approving the Class Action Settlement Agreement, ...


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