Michigan Ass'n of Chiropractors v. Blue Cross Blue Shield
300 Mich. App. 551
| Mich. Ct. App. | 2013Background
- MAC represents about 1,400 Michigan chiropractors; Dr. Mitchell is a MAC member and BCBSM affiliated provider.
- BCBSM insures health care and 70% of MAC members are in BCBSM’s chiropractic network; some MAC members were former BCBSM providers.
- Providers sign Traditional Participation and TRUST agreements; a 1999 settlement governs administration/interpretation of these agreements.
- Plaintiffs allege BCBSM underpays chiropractic services while reimbursing non-chiropractic providers for the same services.
- Plaintiffs move to certify a class of MAC members with BCBSM contracts denied reimbursement; Counts I–III seek various forms of relief.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Is the class definition suitable for certification? | Definition is workable for declaratory relief on Counts I–II. | Definition is too broad; requires individualized inquiries (Tinman risk). | Class definition upheld for Counts I–II; Count III requires individual proof; bifurcate declaratory relief. |
| Did the court properly assess numerosity? | Numerous MAC members with/without contracts; class clearly large. | Evidence only shows providers under contract; size uncertain; numerosity not shown. | Numerosity not established; remand to quantify third-element of class; no decertification solely on this issue. |
| Do common questions predominate for the proposed class? | Counts I–II involve common policy questions; Count III requires more individualized inquiry. | Damages/common questions are not sufficiently generalized; many individualized determinations. | Counts I–II present common issues; Count III requires individual proofs; class cert limited accordingly. |
| Is the class representative adequate for all counts? | Mitchell represents class adequately for Counts I–II. | Mitchell lacks evidence of timely, denied, covered claims; not adequate for Count III. | Adequacy met for Counts I–II; Count III not adequate; justify bifurcation and limitation. |
Key Cases Cited
- Tinman v Blue Cross & Blue Shield of Mich, 264 Mich App 546 (2004) (stresses individualized proofs can defeat class certification)
- Henry v Dow Chemical Co, 484 Mich 483 (2009) (requires independent determination of prerequisites and not mere pleadings)
- Zine v Chrysler Corp, 236 Mich App 261 (1999) (numerosity requires evidence or reasonable estimate)
- Wal-Mart Stores, Inc. v. Dukes, 564 U.S. _ (2011) (class-wide answers must drive resolution; commonality must prevail)
- Gen. Tel. Co. of the Southwest v. Falcon, 457 U.S. 147 (1982) (typicality and adequacy guided by class-action considerations)