Court Sides With Spine Arthroplasty Patients in Aetna Lawsuit

The United States District Court for the Central District of California has breathed life back into a lawsuit against Aetna Life Insurance Company by granting class certification.

The plaintiffs in this matter include two individuals who were insured by Aetna. They allegedly consulted with surgeons who recommended lumbar artificial disc replacement surgery. According to the allegations, Aetna denied their requests claiming the procedure was “experimental or investigational.”

Plaintiffs are claiming Aetna’s denial policy harmed them. They are “primarily seeking an injunction requiring Aetna to retract its policy that Lumbar ADR [artificial disc replacement] is ‘experimental or investigational.’”

The plaintiffs sought class certification for those individuals covered under Aetna plans governed by Employee Retirement Income Security Act (ERISA). Specifically, those whose requests for lumbar artificial disc replacement surgery Aetna denied because the procedure is “experimental or investigational.” Plaintiffs presented evidence of 239 insureds.

The court granted in substantial part the motion for class certification. It certified the following class: “All persons covered under Aetna Plans, governed by ERISA, self-funded or fully insured, whose requests for lumbar artificial disc replacement surgery were denied at any time within the applicable statute of limitations, or whose requests for that surgery will be denied in the future, on the ground that lumbar artificial disc replacement surgery is experimental or investigational, and whose denials will be subject to abuse of discretion review by the district court.”

Aetna has already filed an appeal. Just two weeks after the order granting class status, Aetna filed an appeal arguing that “[t]he ruling is manifestly erroneous in three ways.”

Aetna claims that the order violates Aetna’s “right to raise contractual defenses to the claims of the individual absent class members.” Next, Aetna argues that the order violates “precedent requiring that ERISA plans be strictly enforced as written.” Finally, Aetna asserts that the court oversimplifies “their class certification analysis.”