ERISA Class Action Review – 2025

2024), the plaintiffs brought a putative class action against their health insurer for refusing to cover speech therapy for their child with autism. Id. at 986. The employer-sponsored plan only covered treatments that were “evidence-based,” and so Group Health Cooperative deemed these therapies ineligible for coverage. Id. The district court granted summary judgment to the defendant, and on appeal, the Seventh Circuit affirmed. The plaintiffs alleged that Group Health Cooperative violated the Parity Act by applying the “evidence-based” requirement more stringently to mental health benefits for autism than it did to physical benefits for chiropractic care, arguing that chiropractic treatment also lacks “scientific support.” Id. However, the Seventh Circuit emphasized that the relevant statutory provision requires treatment limitations applicable to mental health benefits be no more restrictive than treatment limitations “applied to substantially all medical and surgical benefits covered by the plan.” Id. at 987. The Seventh Circuit reasoned that a showing that an insurer limits one mental health benefit more than it does one medical benefit is not equivalent to a showing that the insurer limits a mental health benefit more than it does substantially all medical benefits. Id. at 988. Midthun-Hensen suggests that the plaintiffs may not be able to prevail on a Parity Act claim simply by showing that one mental health benefit is more restricted than another medical benefit covered by the plan. Rather, they must show that the plan limits a mental health benefit more than it limits substantially all medical and surgical benefits. In Collins, et al. v. Anthem, Inc. , 2024 U.S. Dist. LEXIS 48569 (E.D.N.Y. Mar. 19, 2024), the plaintiffs filed suit alleging that their insurer unreasonably denied requests for coverage for residential behavioral health treatment services in violation of the Parity Act. Id. at *3. In opposing the plaintiffs’ motion for class certification, the defendants focused mainly on standing and commonality. The court rejected the defendants’ arguments and granted the plaintiffs’ motion for class certification. With respect to standing, the defendants did not challenge the standing of the plaintiffs or the proposed class as to declaratory relief, but rather argued that certain class members lacked standing to seek injunctive relief, making class certification inappropriate. Id. at *23. The injunctive relief sought was for the defendants to stop using certain challenged guidelines to deny coverage for behavioral health services, but at the time of the suit, many putative class members’ plans were no longer administered by the defendants. Id. at *23-24. However, the court noted that the injunctive relief requested would remand the class members’ denied claims to the defendants for reprocessing, and that a remand for reprocessing is available injunctive relief when a court determines that a plan administrator’s finding was arbitrary and capricious. Id. at *25. Accordingly, the court concluded that the plaintiffs and class members had standing for this form of injunctive relief. With respect to commonality, the court emphasized that it was not necessary for each putative class member to demonstrate that a particular guideline was applied to their claim in an identical way in order to establish commonality. Id. at *32. The court reasoned that it is sufficient that each denial resulted from a unitary course of conduct, i.e., the application of the challenged guidelines. Id. In general, benefits denial cases are far less common than breach of fiduciary duty claims involving the management of retirement funds. However, when a common practice, such as denying coverage for autism treatments, impacts a large number of healthcare plan participants, these cases can be quite lucrative. Accordingly, litigators on the defense side should continue to expect a steady stream of these cases in 2025 and beyond. 5. Cases Involving the Application Of Time Bars Defendants in ERISA suits must carefully consider all defenses, including time bar defenses. In the ERISA context, this question is somewhat complicated because the statute of limitations can vary based on the nature of the claim. Section 113(2) of the Act states that plaintiffs have either six years or three years to bring a claim for breach of fiduciary duties. See 29 U.S.C. § 1113. The shorter timeline applies when a defendant can establish that the plaintiff had “actual knowledge” of the breach; the longer timeline applies when there was no actual knowledge. Id. However, this period can be extended when there is evidence of fraud or concealment. Id. With respect to other statutory claims, the limitations period can be murkier still. The Act itself does not prescribe

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