A federal court in Philadelphia yesterday granted class action status to a lawsuit brought by the parents of an autistic child against CIGNA Corporation and related CIGNA entities for their policy of denying insurance coverage for an autism treatment known as Applied Behavior Analysis (ABA) therapy. In their lawsuit, the plaintiff, Kristopher Churchill and Luis Rolando, allege that the CIGNA companies have a nationwide policy of classifying ABA as experimental, and therefore they do not provide insurance coverage for this therapy. The plaintiffs claim that the classification of ABA as experimental and the denial of insurance coverage for ABA violates federal laws governing insurance plans. The court's order today means that the case will proceed as a nationwide class action on behalf of all families having children with autism who were denied coverage by CIGNA for ABA therapy.Judge Juan Sanchez's memorandum is here:
On September 2, 2011, after a brief discovery period, Churchill filed a Second Amended Complaint adding Luis Rolando as a named Plaintiff.4 Rolando is a current member of an employer health plan sponsored by NetApp and administered by CIGNA. Rolando's son, a beneficiary of Rolando's NetApp Group Welfare Plan, suffers from ASD and received ABA therapy, which was specifically covered under the NetApp Plan. In the Second Amended Complaint, Plaintiffs allege CIGNA improperly denied insurance benefits to cover their sons' ABA treatment in violation of § 502(a)(1)(B) and (a)(3) of the Employee Retirement Security Act (ERISA), 29 U.S.C. § 1132(a)(1)(B) and (a)(3). Rolando seeks benefits due pursuant to § 1132(a)(1)(B) and equitable relief pursuant to § 1132(a)(3) [emphasis added]The case bears watching because ERISA plans are not subject to state insurance mandates.