CareFirst Will Pay $3.6M To Settle Lactation Support Class Action

A $3.6 million CareFirst class action settlement has been reached to resolve claims that the insurer violated the Affordable Care Act by denying lactation benefits.

The settlement will compensate Class Members for any costs they were forced to pay out-of-pocket when their claims were denied. CareFirst will also pay administrative costs, attorneys’ fees, and service awards.

“With respect to the settlement’s benefits, plaintiffs highlight that there is no limit on the total dollar amount of the cash settlement payments that CareFirst may make to class members for authorized claims,” the CareFirst lactation benefits class action settlement notes.

In their motion requesting preliminary approval, the plaintiffs estimate that around $400,000 will be automatically paid on more than 10,000 claims. A remaining estimated $3.2 million will be paid to around 90,000 other claims after Class Members complete a simple affirmation.

Settlement Class Members eligible for payment include participants or beneficiaries of nonexempt CareFirst plans who were not covered or reimbursed for comprehensive breastfeeding and lactation support and counseling services claims between August 2012 and August 2018.

The CareFirst class action was originally filed by plaintiffs in October 2016, alleging that the insurance company did not comply with the Affordable Care Act (ACA) and the Employee Retirement Income Security Act (ERISA) when it denied claims for comprehensive breastfeeding and lactation support.

The insurance company allegedly forced women to pay for these services out-of-pocket by not including trained professionals in their coverage network.

This meant that women had to turn to out of network providers for which CareFirst would completely deny or only partially pay claims.

The settlement’s prospective relief would rectify the lack of options by adding trained professionals into the CareFirst network to provide comprehensive breastfeeding and lactation support, and counseling services.

The settlement will not only provide cash payments to affected consumers, it will also provide payment for attorneys’ fees. Class Counsel can ask for up to $3 million in attorneys’ fees under the settlement.

Additionally, each plaintiff will receive $2,500 as a service award for their efforts as Class representatives.

Plaintiff attorney Nicholas E. Chimicles told Law360 that they viewed the class action as a “seminal case” and that the settlement was an “excellent result” for the plaintiffs and Class Members.

Chimicles also spoke to Law360 on lactation benefits under ACA. When the provisions regarding lactation benefits took effect, they were not interpreted uniformly by all insurance companies. This resulted in some insurance companies taking a proactive stance on lactation benefits while others were less forthcoming.

“That’s why CareFirst was one of the insurance carriers that we felt was an appropriate target to, in essence, rectify the shortcomings over the last half dozen years,” Chimicles told Law360.

Top Class Actions will post updates to this class action settlement as they become available. For the latest updates, keep checking TopClassActions.com or sign up for our free newsletter. You can also receive notifications when this article is updated by using your free Top Class Actions account and clicking the “Follow Article” button at the top of the post.

The proposed Class is represented by Nicholas E. Chimicles, Kimberly Donaldson Smith and Stephanie E. Saunders of Chimicles & Tikellis LLP; and Jonathan W. Cuneo, Pamela B. Gilbert, Monica E. Miller, and Katherine Van Dyck of Cuneo Gilbert & LaDuca LLP.

The CareFirst Lactation Support Insurance Coverage Class Action Lawsuit is Ferrer, et al. v. CareFirst Inc., et al., Case No. 1:16­-cv-­02162, in the U.S. District Court for the District of Columbia.

UPDATE: February 2019, the CareFirst lactation support class action settlement is now open. Click here to file a claim.