Anthem will settle a proposed class action lawsuit alleging violations of the Employment Retirement Income Security Act (ERISA) and mental health parity laws at a cost of about $12.9 million. The case is Marissa Collins et al. v. Anthem Inc. et al., case number 2:20-cv-01969, in the U.S. District Court for the Eastern District of New York.
The participants in employer-provided health plans administered by Anthem recently filed a motion for preliminary approval of the settlement, as well as a supporting memorandum and a signed settlement agreement. Anthem and the participants first announced a settlement in April.
Participants in Anthem's employee health plan originally filed suit in April 2020, claiming that Anthem applied overly restrictive criteria to claims for residential inpatient behavioral health treatment. The participants alleged that the criteria both violated the terms of their plan and violated ERISA. Furthermore, the participants alleged that Anthem's denial of coverage violated the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The MHPAEA requires that health plan restrictions as applied to mental health treatment can be no more restrictive than those applied to medical and surgical treatment.
Anthem filed a motion to dismiss the case, but the court denied it in February 2022. Accordingly, in March 2024, the court certified a broad class of individuals enrolled in ERISA-governed health benefit plans administered by Anthem. The class includes those who were denied mental health coverage due to a lack of medical necessity, based on guidelines that violated the terms of their plan. The court also issued a retroactive injunction forcing the insurance giant to reprocess claims for mental health treatment and grant declaratory relief.
The terms of the settlement agreement provide that Anthem will make a lump sum payment of about $12.9 million. The lump sum, less administrative costs, attorney fees, case contribution awards for the lead plaintiffs, and other expenses, will go into a settlement account. Members of the class will receive a nominal payment of $100 or a pro rata reimbursement based on their individual claims, up to a certain maximum amount.
HBL has experience in all areas of benefits and employment law, offering a comprehensive solution to all your business benefits and HR/employment needs. We help ensure you are in compliance with the complex requirements of ERISA and the IRS code, as well as those laws that impact you and your employees. Together, we reduce your exposure to potential legal or financial penalties. Learn more by calling 470-571-1007.
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