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Case Briefs

By ALM Staff | Law Journal Newsletters |
June 29, 2006

Pennsylvania Court Addresses Related Claims Exclusion

In Aetna, Inc. v. Lexington Insurance Co. et al, case number 03076 (May 3, 2006), the Pennsylvania Court of Common Pleas of Philadelphia County addressed the definition of a 'claim' as related to several lawsuits alleging similar causes of action but in different jurisdictions filed multiple years apart.

In the Aetna case, Aetna sought insurance coverage for losses and defense costs related to the settlement of consolidated class actions first brought in 1999. The class actions generally alleged that Aetna had embarked on a course of conduct to squeeze health care providers ('HCPs') economically. According to the class plaintiffs, Aetna had denied coverage and refused to pay HCPs based upon economic grounds, rather than medical necessity; had delayed payments for significant periods; had reduced amounts otherwise to be reimbursed; had blacklisted certain HCPs; had refused to negotiate unilateral change to contract terms; had actuarially manipulated the system through various means; and had concealed the foregoing.

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