1. Case Name: Gordon v. New W. Health Servs., U.S. District Court for the District of Montana, Great Falls Division
2. Type of Treatment Services Denied: Inpatient detoxification for unspecified disorder
- Plaintiff: Daniel Patrick Buckley, Buckley Law Office; Lawrence A. Anderson, Anderson Law Office
- Defendant: Ian McIntosh, Kelsey E. Bunkers, Crowley Fleck
4. Format: Opinion and order on Class Certification
- ERISA Claim? Yes
- Class Action/or Individual Action: Order addresses proposed class certification (denied)
- Defendant: Insurer
- Type of Insurance Plan: Employer plan (unclear whether large or small group)
- Type of Coverage Denial: Medical necessity
6. Legal Pointer: The Plaintiff seeks class certification for alleged violations of MHPAEA, Montana State Parity laws, etc. and request Defendant reimburse the members of the class for money that Defendant should have paid for claims, and ask for an injunction prohibiting unlawful conduct. The Defendant argues that they no longer provide claims administration which has rendered the Plaintiff’s claims moot. Additionally, Defendant argues that the individualized monetary damages are improper for class certification.
7. Legal Issues and Causes of Action: Plaintiff argues that Defendant systematically denies mental health treatment in violation of MHPAEA and Montana state parity laws. Further, Plaintiff argues that Defendant employed impermissible criteria for treating addiction cases. They request an injunction and reimbursement for benefits that were not paid.
Ruling: Plaintiff’s motion for class certification is denied, Defendant’s motion to deny class certification is granted.
8. Narrative Case Description: Plaintiff’s son received inpatient detoxification treatment at the behest of his physicians. Plaintiff argued a systematic violation of MHPAEA and requested class certification. The Defendant no longer provides any claims administration and does not administer any commercial health plans, thus rendering moot the Plaintiff’s claims. Additionally, Defendant argues that the individualized monetary damages are the only remedy that Plaintiffs seek and that this is improper for the Court to address in a class certification.
The Court agrees with Defendant’s argument that the Plaintiff has not identified any ongoing conduct that the Court may enjoin, since the Defendant no longer administers the plan.
The Court does agree with Plaintiffs that the numerosity, commonality, typicality, adequate representation and class ascertainability requirements of class actions have been met.
9. Additional Comments: None
11. Practical Implications and Lessons Learned: None.
12. All Legal Theories Presented in Case: Violations of MHPAEA, Montana State Parity laws, class certification
13. Successful Legal Theories in Case: None.