Pennsylvania Chiropractic Ass'n v. Blue Cross Blue Shield Ass'n
2012 U.S. Dist. LEXIS 146955
N.D. Ill.2012Background
- Plaintiffs are healthcare providers and associations who treated BCBS insureds and allege wrongful recoupment of payments plus deficient ERISA notice and appeal procedures.
- Defendants are Blue Cross and Blue Shield entities led by BCBSA, with various regional BCBS plans administering insureds and handling claims.
- Plaintiffs claim initial reimbursements were followed by improper adverse determinations that sought repayment, sometimes offset by withholding other payments.
- Plaintiffs allege lack of ERISA notice/appeal details, or no appeal at all, and seek ERISA remedies for unpaid benefits and injunctions for proper process.
- Plaintiffs amended multiple times; Hopkins’s ERISA claim was dismissed; class certification motions have been repeatedly denied or deferred.
- Plaintiffs seek certification of multiple provider, BlueCard, and Florida discrimination classes, including a Florida chiropractor discrimination class.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether provider classes meet Rule 23(b)(3) predominance | Common issues exist on adverse determinations and notice/appeal failures. | Predominance is defeated by numerous individual issues (assignment, provider agreements, notice forms). | Not satisfied; predominance not shown. |
| Whether provider classes fit Rule 23(b)(1)(A) for inconsistent adjudications | Some uniform requirements could bind defendants; subgroups could share policy. | Extensive individualized issues prevent uniform standards across defendants. | Not appropriate; 23(b)(1)(A) not met. |
| Whether provider classes satisfy Rule 23(b)(2) | Declaratory/injunctive relief plus remand for ERISA notice could be shared relief. | Relief would be individualized and monetary; not cohesive or indivisible. | Not appropriate; 23(b)(2) not met. |
| Whether the Florida discrimination class can be certified | Uniform Florida statute claim against BCBSF for discriminatory limits on chiropractic care. | Damages; predominance/predominance analysis not satisfied; other procedural issues. | Not certified. |
Key Cases Cited
- Amchem Prods., Inc. v. Windsor, 521 U.S. 591 (U.S. 1997) (predominance higher standard; class cohesion required)
- Wal-Mart Stores, Inc. v. Dukes, 131 S. Ct. 2541 (U.S. 2011) (commonality and predominance; class action limits)
- Kennedy v. Conn. Gen. Life Ins. Co., 924 F.2d 698 (7th Cir.1991) (standing and assignees; colorable claim to benefits)
- Halpin v. W.W. Grainger, Inc., 962 F.2d 685 (7th Cir.1992) (substantial compliance standard for ERISA procedures)
- Ponsetti v. GE Pension Plan, 614 F.3d 684 (7th Cir.2010) (substantial compliance; fact-intensive inquiry)
- In re Allstate Ins. Co., 400 F.3d 505 (7th Cir.2005) (ERISA class certification; choice of Rule 23(b)(2) vs (b)(3))
- Spano v. Boeing Co., 633 F.3d 574 (7th Cir.2011) (inconsistent adjudications and class reformation considerations)
- Pipefitters Local 636 Ins. Fund v. Blue Cross Blue Shield, 654 F.3d 618 (6th Cir.2011) (inconsistent or evolving class treatment under ERISA)
- McReynolds v. Merrill Lynch, Pierce, Fenner & Smith, Inc., 672 F.3d 482 (7th Cir.2012) (foundational common issue analysis in ERISA contexts)
- Pella Corp. v. Saltzman, 606 F.3d 391 (7th Cir.2010) (common issues and design/disparate damages considerations)
- Kartman v. State Farm Mut. Auto. Ins. Co., 634 F.3d 883 (7th Cir.2011) (cohesiveness and individualized questions in Rule 23(b)(2) contexts)
- Gates v. Rohm & Haas Co., 655 F.3d 255 (3d Cir.2011) (cohesiveness in Rule 23(b)(2) analysis)