USAA Car Insurance PIP Coverage Class Action Lawsuit Settlement

UPDATE:

• The Court granted this USAA settlement final approval on May 17, 2021.

Certain USAA car insurance policyholders and health care providers in Washington may be able to benefit from a class action lawsuit settlement.

The settlement agreement establishes two Subclasses: the Insured Subclass and the Provider Subclass.

The Insured Subclass will consist of anyone who was insured under the personal injury protection (PIP) coverage of a Washington automobile insurance policy issued by any of the USAA Entities — defendants United Services Automobile Association (USAA) and USAA Casualty Insurance Co., and USAA General Indemnity Co., and Garrison Property and Casualty Insurance Co. — received medical, health care, or rehabilitation services, or medication or equipment, from one or more members of the Provider Subclass, and who made a claim under the PIP coverage of that policy, submitted (or whose health care provider submitted) to the USAA entities a bill for such services or products, and who had that bill reduced by a reason code stating that the billed amount exceeded the reasonable amount for the service provided from May 30, 2015, through Jan. 22, 2021.

Members of the Class certified by the federal court in Krista Peoples v. United Services Automobile Association, et al., Case No. 2:18-cv-01173- RSL in the U.S. District Court for the Western District of Washington, also are members of the Insured Subclass.

The Provider Subclass consists of all Washington health care providers who provided medical, health care, or rehabilitation services, or medication or equipment, to a person who was insured under the PIP coverage of a Washington automobile insurance policy issued by one of the USAA entities, and who submitted to the USAA entities bills for such services or products pursuant to the PIP coverage of that insurance policy, who received from the USAA entities as payment less than the full amount of the charges billed, and whose bill was reduced by a reason code stating that the billed amount exceeded the reasonable amount for the service provided May 30, 2015, through Jan. 22, 2021.

Two class action lawsuits had challenged the RF reductions made to health care bills submitted for payment in Washington under USAA car insurance PIP coverage.

The challenged reductions allegedly were based on the use of USAA’s use of a computerized bill review process that determines how reasonable health care fees are based on provider charges for the same treatments in the same geographic areas.

The amount of each Class Member’s payment has not yet been determined.

Payments for Class Members will be calculated as follows:

• 140 percent of the RF Reduction on each charge submitted on non-exhausted claims
• 100 percent of the RF Reduction on each charge submitted on exhausted claims

“Non-exhausted claims” are those for which PIP coverage remained for the applicable claim as of the date of the explanation of reimbursement (EOR), according to the settlement agreement. 

“Exhausted claims” are those for which PIP coverage did not remain for the applicable claim as of the date of the EOR.

The claims must not have been previously settled or resolved, and only one payment will be made per RF reduction. If more than one Class Member submits a claim for the same reduction, a process is in place to resolve the situation.

In addition to monetary relief, the company also has agreed to stop using the challenged methodology for adjusting USAA car insurance PIP coverage claims in Washington for a period of two years after July 21, 2020.

An approval hearing in the USAA car insurance PIP coverage settlement is scheduled for May 13, 2021.

Objections and requests for exclusion must be filed by April 23, 2021.

Claim forms must be submitted by Aug. 11, 2021.

Who’s Eligible

The settlement agreement establishes two Subclasses: the Insured Subclass and the Provider Subclass.

• The Insured Subclass will consist of anyone who was insured under the personal injury protection (PIP) coverage of a Washington automobile insurance policy issued by any of the USAA Entities — defendants United Services Automobile Association (USAA) and USAA Casualty Insurance Co., and USAA General Indemnity Co., and Garrison Property and Casualty Insurance Co. — received medical, health care, or rehabilitation services, or medication or equipment, from one or more members of the Provider Subclass, and who made a claim under the PIP coverage of that policy, submitted (or whose health care provider submitted) to the USAA entities a bill for such services or products, and who had that bill reduced by a reason code stating that the billed amount exceeded the reasonable amount for the service provided from May 30, 2015, through Jan. 22, 2021. Members of the Class certified by the federal court in Krista Peoples v. United Services Automobile Association, et al., Case No. 2:18-cv-01173- RSL in the U.S. District Court for the Western District of Washington, also are members of the Insured Subclass.
• The Provider Subclass consists of all Washington health care providers who provided medical, health care, or rehabilitation services, or medication or equipment, to a person who was insured under the PIP coverage of a Washington automobile insurance policy issued by one of the USAA entities, and who submitted to the USAA entities bills for such services or products pursuant to the PIP coverage of that insurance policy, who received from the USAA entities as payment less than the full amount of the charges billed, and whose bill was reduced by a reason code stating that the billed amount exceeded the reasonable amount for the service provided May 30, 2015, through Jan. 22, 2021.

Potential Award

Varies.

• The amount of each Class Member’s payment has not yet been determined.
• Payments for Class Members will be calculated as follows:
• • 140 percent of the RF Reduction on each charge submitted on non-exhausted claims
  • 100 percent of the RF Reduction on each charge submitted on exhausted claims

Proof of Purchase

N/A

Claim Form

CLICK HERE TO FILE A CLAIM »

NOTE: If you do not qualify for this settlement do NOT file a claim.

Remember: you are submitting your claim under penalty of perjury. You are also harming other eligible Class Members by submitting a fraudulent claim. If you’re unsure if you qualify, please read the FAQ section of the Settlement Administrator’s website to ensure you meet all standards (Top Class Actions is not a Settlement Administrator). If you don’t qualify for this settlement, check out our database of other open class action settlements you may be eligible for.

Claim Form Deadline

08/11/2021

Case Name

Eastside Physical Therapy Inc., et al. v. United Services Automobile Association, et al., Case No. 17-2-26885-2 SEA in the Superior Court of the State of Washington in and for the County of King

Final Hearing

05/13/2021

Settlement Website

EastsideSettlement.com

Claims Administrator

Eastside v. USAA Claims Administrator – 7179
P.O. Box 44
Minneapolis, MN 55440-0044
1-877-878-6878
info@EastsideSettlement.com

Class Counsel

Brendan Donckers
David E. Breskin
BRESKIN JOHNSON & TOWNSEND PLLC

Young-Ji Ham
Jenna M. Labourr
WASHINGTON INJURY LAWYERS PLLC

Defense Counsel

Jay Williams
SCHIFF HARDIN LLP

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