Farmers Insurance Medpay - Class Certified
An Illinois circuit court has certified a class action case against Illinois Farmers Insurance Company, Farmers Insurance Exchange, Farmers Group, Incorporated, and Zurich Services Corporation by insureds in Alabama, California, Illinois, Indiana, Louisiana, Nebraska, Nevada, North Carolina, Tennessee, Virginia and Wisconsin (and their medical providers by assignment) who accuse the company of questionable practices to reduce medical bills from 2001 into 2006.
The case concerns medical providers and policyholders who accuse the companies of implementing a third-party, biased computer auditing program to reduce payouts under the medical payments coverage of property and casualty insurance. The case is pending in the Twentieth Judicial Circuit, St. Clair County, Illinois.
The trial court certified the following class: All persons insured by Farmers property and casualty insurance companies in the states of Alabama, California, Illinois, Indiana, Louisiana, Nebraska, Nevada , North Carolina, Tennessee, Virginia, and Wisconsin (and their assignee medical providers), who (a) during the period from January 1, 2001 through March 2006, submitted one or more claims for payment of medical expenses pursuant to an automobile policy's medical payments coverage; (b) had their claim(s) submitted for automated review by Farmers through Zurich using Medata bill review data; (c) received or were tendered payment in an amount less than the submitted medical expenses based on RC40 (or substantially similar codes), pursuant to computer review.
Excluded from the class are persons in any state whose reductions were based on a bill review percentile over 90 percent, and any persons whose claims were referred to Farmers' Special Investigative Unit and were found fraudulent. Also excluded from the Class claims are: (1) claims based on reductions pursuant to state-mandated fee schedules; (2) statutory fraud claims by persons who reside outside Illinois; (3) civil conspiracy claims by persons who reside outside Illinois; (4) members of the Illinois state judiciary; (5) claims where Defendants conducted an override of the computer-based reduction; (6) claims regarding insureds whose policy limits were exhausted; and (7) Farmers and any entity in which it has a controlling interest, including officers and directors and the members of their immediate families. The statutory fraud and civil conspiracy class is limited to Illinois class members only.
The Court appointed Patrick B. Komeshak, D.C. and Komeshak Chiropractic Clinic as class representatives and LakinChapman, LLC, as lead class counsel. The certification of a class is an important step in moving a class action case forward.
LakinChapman, LLC regularly represents medical providers and consumers in class action litigation. Those seeking more information may contact the firm at medicalbillreview@lakinchapman.com (medical providers) or classaction@lakinchapman.com (consumers), or call (800) 851-5523.
