United States District Court, W.D. Kentucky, Louisville Division
MARGARET WILSON, individually and on behalf of a Class of persons similarly situated, Plaintiffs
ANTHEM HEALTH PLANS OF KENTUCKY, INC. Defendant
MEMORANDUM OPINION AND ORDER
REBECCA GRADY JENNINGS, DISTRICT JUDGE UNITED STATES DISTRICT
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
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.
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.
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
January, 2017, the Court certified the class requested by
Wilson and named Robert R. Sparks and Strauss Troy Co.,
L.P.A., as class counsel. [DE 47 at 3157].
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
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].
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