Liberty Mutual points to appellate decision as it seeks summary judgment in PPO class

Amelia Flood May 25, 2011, 12:52am


Liberty Mutual Insurance Company and Liberty Mutual Fire Insurance Company are pointing to a May 9 decision by the Fifth District Appellate Court in their quest for summary judgment in a 2004 class action over Preferred Provider Organization (PPO) discounts.

The insurer filed a letter and copy of the decision May 13 as Madison County Circuit Judge Dennis Ruth continues to consider dueling summary judgments filed by Liberty Mutual and plaintiff Thomas Kaltenbronn.

Ruth heard arguments on the moves in February.

The case, a 2004 class action filed on behalf of a class of Illinois healthcare providers, rests on claims that Liberty Mutual took discounts from workers' compensation claims that it was not entitled to.

The suit is one of a number of PPO class actions filed in the early part of the past decade by the former Lakin Law Firm of Wood River and its partners Freed & Weiss of Chicago.

That partnership fell apart in 2007.

Overlap between several of the suits has surfaced in several of the PPO class actions that remain pending.

Ruth heard arguments from both sides on the summary judgment issue in February during a hearing that lasted over five hours on Feb. 4.

The suit is currently set for a case management conference Thursday at 9 a.m.

According to the letter sent to Ruth with the May 13 filing, Liberty Mutual is citing the May 9 decision in Coy Chiropractic Health Center vs. Travelers Cas. & Sur. Co. to bolster
arguments Liberty Mutual made in February that it was not obligated to "direct" clients to providers in the PPO because Illinois workers' compensation law does not allow an insurer to dictate where a worker seeks treatment.

The meaning of the word "direct" under the state's workers' compensation law and the laws governing PPOs in the state was discussed at length in February.

Liberty Mutual argues in the letter that the Fifth District's opinion in Traveler's "squarely rejects" the plaintiffs' arguments about the failure to steer and Illinois' PPO regulations.

In the attached Traveler's opinion, the Fifth District judges find that there was not a provision in the PPO agreement that separated workers' compensation claims from the discounted claims providers agreed to when entering the PPO.

"The only promises Travelers makes in the payor agreement are to distribute materials to customers, educate employers on how to access the network, and direct claimants to contract providers to the extent permitted under applicable law," the opinion reads.

The court went on to reverse the Travelers class certification and to remand it to Madison County.

The Travelers' suit is based on similar claims to those found in the Liberty Mutual case.
That suit is helmed by chiropractors Richard Coy and Frank Bemis.

Robert Schmieder II is class counsel in the Liberty Mutual case.

Thomas Keefe Jr. and Carol Rutter are among those who represent Liberty Mutual in the suit.

The Liberty Mutual class action is Madison case number 04-L-1416.

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