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Denial of ABA Therapy For Autism - National Class Action Sought Against CIGNA

Author: Mantese Honigman Rossman and Williamson, P.C.

Published: 2011-07-08 : (Rev. 2011-09-30)

Synopsis and Key Points:

A federal court in Philadelphia is reviewing a motion for class action in a lawsuit against CIGNA Insurance over denying insurance coverage for Applied Behavior Analysis therapy.

Main Digest

National Class Action Status Sought Against CIGNA in Philadelphia Over Denial of ABA Therapy For Autism.

A federal court in Philadelphia is reviewing a motion for class action in a lawsuit brought by the father of an autistic child against CIGNA Insurance over its policy of denying insurance coverage for Applied Behavior Analysis (ABA) therapy.

In his lawsuit, the plaintiff, Kristopher Churchill, alleges that CIGNA has a nationwide policy of classifying ABA as experimental, and therefore not providing insurance coverage for this therapy.

The plaintiff claims that the classification of ABA therapy as experimental violates federal laws governing insurance plans. Earlier in the case, the Court denied CIGNA's Motion to Dismiss the case on legal grounds. The case is before Judge Juan R. Sanchez.

According to the lawsuit, ABA is a well recognized and scientifically valid form of autism treatment for children.

Numerous authorities and organizations have supported using ABA to treat autism, including the U.S. Surgeon General and the National Institute of Mental Health. Also, the American Academy of Pediatrics states that the effectiveness of ABA "has been well documented through 5 decades of research." Moreover, 26 states, including Pennsylvania, mandate insurance coverage for ABA-type autism treatments.

Churchill is represented by Gerard Mantese and John Conway of Michigan, and Greg Heller of Pennsylvania. Mantese and Conway are counsel in several cases seeking insurance coverage for ABA therapy.

In 2010, they obtained final approval of a class action against Blue Cross Blue Shield of Michigan requiring payment of approximately $1 million in claims for ABA. Mantese and Conway, and former Michigan State Senator, David Honigman, are also representing thousands of military beneficiaries seeking coverage of ABA therapy from the Department of Defense and its insurer, TRICARE.

In March 2011, a federal court in Washington D.C. granted class action status to the military beneficiaries in that case, Berge v Department of Defense, et al.

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