The United States District Court of the Central District of California
has certified a class of plaintiffs in a Gianelli & Morris lawsuit
alleging that UnitedHealthcare Insurance Company categorically denies
coverage for artificial lumbar disc surgery as “unproven”
despite the fact that the surgery is safe and effective.
Hill v. UnitedHealthcare Insurance Company, Case No. SA CV 15-0526-DOC. Gianelli & Morris previously won class
certification in a similar case against Blue Shield of California,
Escalante v. Blue Shield, Case No. 2:14-CV-3021 DDP-PJWx.
In its March 21, 2017 decision, the court in
Hill granted class certification of a class of ERISA beneficiaries subject to a
de novo standard of review. Plaintiff alleges in this case that UnitedHealthcare
refuses to cover artificial lumbar disc surgery regardless of the insured’s
need for this surgery. This is so despite the fact that the United States
Food and Drug Administration has approved several artificial lumbar disc
devices and found them safe and effective for the treatment of degenerative
The court determined that determined that ERISA members covered under UnitedHealthcare
policies shared a common issue because the company “has stated that
its standard practice is to deny lumbar ADR as unproven—meaning
that it appears that when lumbar ADR is denied as unproven it is denied
under standard policy.” Thus, the court granted class certification
and appointed Gianelli & Morris as class counsel.
“Insurers like UnitedHealthcare and Blue Shield have adopted positions
on cutting-edge treatments like artificial lumbar disc surgery that are
out of date and unsupported scientifically,” said Gianelli &
Morris partner Rob Gianelli. “When the FDA and the majority of medical
specialists practicing in a field find new treatments to be safe and effective,
insurers should not be allowed to block their use.”
Gianelli & Morris has successfully prosecuted a number of class actions
against health plans that refused to provide needed treatments. These include:
Gallimore v. Kaiser Foundation Health Plan, Inc. (reconstructive surgery benefits);
Kaiser Foundation Health Plan, Inc. (applied behavioral analysis and speech therapy for autistic children);
Bath v. Blue Shield of California (improper rescissions of health policies).