June 26, 2019

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Anthem Settles Mental Health Parity Litigation Involving Autism Treatment

A federal district court in Indiana recently granted preliminary approval of a settlement between Anthem and a class seeking coverage of Applied Behavior Analysis (“ABA”) treatment for autism disorders. The three-year old litigation involved claims that Anthem violated the federal Mental Health Parity and Addiction Equity Act (“MHPAEA”) by limiting the hours of ABA therapy that would be covered for children ages seven and older. As part of the settlement, Anthem will pay $1.625 million to a common fund for the benefit of approximately 200 class members; the amount per person will vary based on individual claims for ABA therapy that were denied. Anthem also agreed to stop using guidelines that limited ABA coverage based solely on an individual’s age. Anthem will further require employees who review treatment plans to participate in periodic external continuing education relating to autism and/or ABA therapy.

As we have discussed previously, MHPAEA claims related to ABA treatment have become more common, but courts have yet to issue many substantive decisions on the lawfulness of plans’ ABA restrictions. Plan sponsors and fiduciaries should expect scrutiny of ABA restrictions to continue.

The case is W.P. v. Anthem Ins. Cos., No. 1:15-cv-00562 (S.D. Indiana).

© 2019 Proskauer Rose LLP.

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About this Author

Russell L Hirschhorn ERISA Litigation, employee benefits attorney, Proskauer
Senior Counsel

Russell Hirschhorn is a Senior Counsel in the Labor & Employment Law Department, where he focuses on complex ERISA litigation and advises employers, fiduciaries and trustees on ERISA benefit and fiduciary issues. 

Russell represents employers, plan sponsors, plans, trustees, directed trustees and fiduciaries in all phases of litigation, arbitration and mediation involving employee benefits, including class action and individual claims relating to ERISA’s fiduciary duty and prohibited transaction provisions, denials of claims for benefits, severance plans, ERISA Section 510,...

212.969.3286
Stacey Cerrone, Labor and Employment Attorney, Proskauer Rose Law FIrm
Senior Counsel

Stacey C.S. Cerrone is a senior counsel in the Labor & Employment Law Department, where she focuses her practice on ERISA litigation and labor and employment law.

Stacey represents plan sponsors, plans, directed trustees, and fiduciaries in all phases of litigation and mediation involving all aspects of ERISA, including: class actions and individual claims relating to ERISA's fiduciary duty and prohibited transaction provisions; denials of claims for benefits; church plans, severance plans; ERISA Section 510; retiree benefits; ERISA preemption of state law claims; and plan investment losses.

Stacey’s work also includes wage and hour law, handling numerous wage and hour class and collective actions. She also does employment law work including employment discrimination, sex harassment, gender discrimination, race discrimination, national origin discrimination and ADA claims. She also handles traditional labor law matters, including collective bargaining and defending unfair labor practice charges. Stacey is the author of numerous speeches and articles. She is co-editor of the Employee Benefits & Executive Compensation blog and co-chair of and contributor to the “ERISA Preemption and Effect on Other Laws” chapter of the ABA Labor & Employment Section's Employee Benefits Law book and the author of the “When is Preliminary Relief Available” chapter in BNA’s ERISA Litigation book.

504.310.4086