1. Case Name: C.S., et al. v. The Boeing Company Master Welfare Plan, et al.
2. Type of Treatment Services Denied: Applied Behavior Analysis (ABA) therapy for Autism Spectrum Disorder (ASD)
- Plaintiff: Eleanor Hamburger, Richard E Spoonemore, Sirianni Youtz, Spoonemoore, & Hamberger
- Defendant: Laurence A. Shapero, Riddell Williams, P.S.
4. Format: Order Granting Final Settlement Order and Approving and Directing Disbursements from Qualified Settlement Trust Fund
- ERISA Claim: Yes
- Class Action/or Individual Action: Class Action
- Defendant: Health Plan and Health Plan administrator
- Type of Insurance Plan: Employee welfare benefit plan
- Type of Coverage Denial: Medically necessary
6. Legal Pointer: The Court agreed that the terms of the settlement proposal were fair and reasonable.
7. Legal Issues and Causes of Action: Plaintiffs sought to end Boeing’s allegedly discriminatory practice of excluding all coverage under the Plan for treatment of ABA therapy to treat ASD.
Ruling: This case settled. The agreed-upon removal of the exclusion from coverage for the treatment from the terms of the plan, the absence of caps or visit limits, and a $900,000 fund established to pay for retrospective claims, attorney fees, and costs were found to be fair, reasonable, and adequate.
8. Narrative Case Description: Plaintiffs were diagnosed with ASD. Boeing excluded all coverage of ABA therapy through the application of blanket, hidden exclusions and limitations. As a result, Plaintiffs paid for ABA therapy treatment out of their own pockets.
9. Additional Comments: This case settled. Boeing agreed to provide coverage of ABA therapy without age or treatment limitations for an unimpeded “path to coverage” which conforms to a “best practices” model for such treatment as informed by experts affiliated with Washington autism treatment clinics. Additionally, Boeing agreed to create a $900,000 fund to compensate class members’ claims for ABA therapy incurred during the class period, in addition to attorney fees, costs, and incentive awards. An additional $150,000 will be paid to cover notice costs and claims administration. In return, the class members agreed to release Boeing from any and all claims vis-à-vis ABA therapy coverage.
The federal district court agreed that the agreement was fair, reasonable, and adequate, and that all procedural requirements had been satisfied. Moreover, the fair and reasonable request for $225,000 in attorney fees, $9737.45 in litigation costs, and $20,000 in incentive awards to the two class representatives was approved.
11. Practical Implications and Lessons Learned: The class contended that the applicable case law factors supported approval of the agreement. First, the settlement agreement provided complete relief to all class members, both prospectively and retrospectively. Second, the class members had a strong case, and the agreed-upon reimbursement and prospective relief likely exceeded what they could have obtained at trial. Third, not one class member objected to the settlement. Fourth, other cases filed against other insurers were heavily litigated. Fifth, Boeing worked in good faith to resolve this case and the matter was resolved without extensive discovery. Finally, class counsel strongly supported the agreement.
12. All Legal Theories Presented in Case: Breach of fiduciary duties, violation of Parity Act, ERISA violation
13. Successful Legal Theories in Case: This case settled.