Med Mal News

A federal judge in Detroit has certified a class in a case brought on behalf of children with autism. The named plaintiffs, two fathers of autistic children, allege that Blue Cross Blue Shield of Michigan should not have denied the children access to a type of therapy known as applied behavior analysis (ABA). They contend that, contrary to the insurer's assertions, the therapy is not merely experimental and unproven, and it should have been covered by their families' medical insurer. In certifying two subclasses in the case ' those who were denied coverage and those who did not apply for it because they knew they would be denied ' Judge Stephen J. Murphy III stated, “With respect to predominance, the common issues here ' whether ABA is experimental and whether [Blue Cross Blue Shield] provided the class members with the opportunity for a full and fair review ' predominate over any individualized issues.” Excluded from the class are plaintiffs who settled with the defendant in an earlier, similar action, Johns v. Blue Cross Blue Shield of Michigan. Under the terms of settlement in that case, the approximate 100 plaintiff families were paid; however, the insurer continues to deny payments for ABA therapy to new applicants who seek it. Co-lead counsel for the plaintiffs, Gerard Mantese, a partner at Mantese Honigman Rossman and Williamson of Troy, MI, says that that outcome is what necessitates a classwide ruling now. Without it, Blue Cross Blue Shield of Michigan will continue to deny new claims for ABA therapy, putting children at risk. “Time is of the essence,” Mantese said. “Studies show unless they get [ABA therapy] at a young age, they will forever lose the window of opportunity they have to achieve their greatest potential.”