May 22, 2020

Judge Rules Class Action Suit for Prosthetic Device Coverage Can Proceed

A federal judge in California has certified a class action suit accusing Anthem of improperly denying coverage for microprocessor-controlled foot-ankle prosthetic devices.  Plaintiffs allege that Anthem used erroneous criteria to deny coverage on the basis that the devices were experimental, and its blanket denials were a violation of its fiduciary duty under ERISA.  Plaintiffs seek changes to Anthem’s practice of denying claims, and that Anthem gives up any profits that resulted from the improper claim denials. The judge reasoned the case may proceed as a class action because of the number of individuals impacted, a common question of law applies to all the potential class members, the harm suffered is common to all the class members, and there is no reason to doubt that the plaintiffs will fairly and adequately protect the interests of the class in prosecuting the case.