Madison County Circuit Judge Daniel Stack has certified a class action complaint against Hartford Insurance Company alleging the insurer engaged in a scheme to reduce payouts under medical payments coverage in property and casualty insurance policies by using biased third party software programs to adjust claims.
Stack entered his order July 7.
Represented by the Lakin Law Firm, Winnie Madison filed suit against Hartford in 2000, alleging Hartford systematically reduced its payments by "pre-pricing" bills submitted by medical providers in violation of the insurance policies.
Stack appointed the Lakin Law Firm of Wood River, Freed and Weiss of Chicago and Timothy Campbell of Godfrey as class counsel.
He certified the following class: "All insured persons, or licensed medical providers by assignment, who from August 8, 1990 to the date of this order: (a)submitted a first-party claim for payment of a medical bill to an Affiliated Hartford Company; (b) had their claim submitted to computer review by Hartford Fire; (c) received or were tendered an amount less that the submitted medical expenses by Hartford Fire; and (d) received or were tendered an amount less than the stated policy limits."
Stack excluded anyone from Delaware, Florida, Hawaii, Kansas, Kentucky, Massachusetts, Michigan, Minnesota, New Jersey, New York, North Dakota, Oregon, Pennsylvania and Utah.
He also excluded anyone whose claims were referred to Hartford's special investigative unit and found to be fraudulent and anyone who had a claim denied because of a duplicate bill.
Stack held that through discovery it was established that Hartford Fire handled all medical payment claims regardless of which Hartford company actually handled the papers; Hartford Fire employed the claim handlers and entered into the vendor contracts and Hartford Fire selected the percentile used by the software and established the claims procedures and paid claims for their account.
Hartford had told Stack that claims for medpay easily exceed 100,000 people during the class period.
"Based upon the number of class members, the geographical dispersement of class members, and the ability and likelihood that class members would bring a suit on their own behalf, the Court finds that the proposed class action is so numerous that joinder of all members would be impracticable," Stack wrote.