F. ovo Aetna

Filing 83

ORDER for Supplemental Briefing re 45 MOTION to Certify Class . Signed by Judge Samuel Conti on 9/10/2013. (sclc1S, COURT STAFF) (Filed on 9/10/2013)

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IN THE UNITED STATES DISTRICT COURT

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FOR THE NORTHERN DISTRICT OF CALIFORNIA

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For the Northern District of California

United States District Court

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DENNIS F., CAROL F., GRACE F.,
MARK P., KESTREL P., MAURA T.,
EDWARD T., EMILY T., ED L., and
MINDY L.,

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Plaintiffs,
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v.
AETNA LIFE INSURANCE,

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Defendant.

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Case No. 12-cv-02819-SC
ORDER FOR SUPPLEMENTAL
BRIEFING RE: CLASS
CERTIFICATION

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Now before the Court is Plaintiffs' motion for class

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certification.

The motion is essentially predicated on the

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allegation that Defendant adopted an erroneous policy of tabulating

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patients' LOCAT scores.

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the way in which Defendant tabulated the total LOCAT Scores for

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Dimension III and Dimension V.

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Defendant assigned a score of either "0" or "1," depending on

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whether a patient had a score of "3" or greater in any sub-

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dimension.

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III should be equivalent to the highest sub-dimension score in that

Specifically, Plaintiffs take issue with

For each of these dimensions,

Plaintiffs assert that the total score for Dimension

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dimension.

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should be tabulated in the same way.

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assert that Defendant should have scored Dimension V by taking the

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sum of the scores of Dimension V's three sub-dimensions.

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of the class is Defendant's alleged failure to correctly tabulate

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LOCAT scores, not Defendant's alleged errors in evaluating medical

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records.

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reserved the right to argue that Defendant improperly evaluated

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their conditions.

United States District Court

Alternatively, Plaintiffs

The focus

However, if the class is not certified, Plaintiffs have

While the Court is not prepared to render a judgment on the

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For the Northern District of California

Plaintiffs assert that the total score for Dimension V

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merits of Plaintiffs' class claims at this time, the Court is

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concerned with Plaintiffs' interpretation of the LOCAT Scoring

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Form.

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that "24" is the highest LOCAT score a patient can possibly

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receive.

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inpatient care if that patient receives a score of "11-24").

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Defendant's interpretation of the LOCAT Scoring Form also yields a

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possible high score of "24" -- a patient could receive high scores

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of "20," "1," "1," "1," and "1" for Dimensions I through V,

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respectively.

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score of "42" -- a patient could receive high scores of "20," "1,"

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"5," "1," and "15" for Dimensions I through V, respectively.1

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Thus, Plaintiffs' interpretation of the LOCAT Scoring Form could

The LOCAT Scoring Forms submitted by Plaintiffs indicate

See Mot. Ex. 7 (indicating that a patient may qualify for

However, Plaintiff's interpretation yields a high

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A patient could receive a total Dimension V score of "15" (and
thus a total LOCAT score of "42") if the sub-dimensions scores for
Dimension V are added together. Alternatively, if the total score
for Dimension V is equivalent to the highest sub-dimension score,
with "5" being the highest possible sub-dimension score, a patient
could receive a total LOCAT score as high as "32."

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yield a LOCAT score which is almost double the highest possible

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score identified by the form itself.

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Given this inconsistency, it is unclear if Plaintiffs can

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prevail on class claims predicated on their interpretation of the

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LOCAT Scoring Form.

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rule on the merits of Plaintiffs' class claims, determination of a

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motion for class certificate "generally involves considerations

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that are enmeshed in the factual and legal issues comprising the

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plaintiff's cause of action."

While neither party has asked the Court to

Wal-Mart Stores, Inc. v. Dukes, 131

United States District Court

For the Northern District of California

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S. Ct. 2541, 2552 (2011).

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the possibility of certifying a class that has little chance of

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succeeding on the merits, especially since Plaintiffs might have a

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better chance of success if they merely challenged Defendant's

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individual decisions concerning the medical necessity of RTC care,

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claims which Plaintiffs have waived by proceeding as a class

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action.

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Moreover, the Court is concerned about

Accordingly, the Court requests supplemental briefing on (i)

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whether the LOCAT Scoring Forms or any of the other evidence before

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the Court support Plaintiffs' interpretation of the LOCAT Scoring

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Forms, (ii) and how the concerns expressed above might affect

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Plaintiffs' motion for class certification.

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requests supplemental briefing on whether any Aetna members have

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been granted coverage for RTC care despite having a LOCAT Score

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that, according to the LOCAT Scoring Form, was too low to justify

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that level of care.

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provide a more exact definition of their proposed class that

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includes, time limitations, e.g., "Subclass 1 is comprised of those

The Court also

Finally, the Court requests that Plaintiffs

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Aetna participants and beneficiaries who submitted claims any time

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after January 1, 2008 . . . ."

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The parties shall submit their supplemental briefs within

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seven (7) days of the signature date of this Order.

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The

supplemental briefs shall not exceed ten (10) pages.

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IT IS SO ORDERED.

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Dated: September 10, 2013

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UNITED STATES DISTRICT JUDGE

United States District Court

For the Northern District of California

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The Court notes that Exhibits 4 through 7 to Plaintiff's motion,
the LOCAT Scoring Forms for Emily, Grace, and Mariah, are blurry
and practically illegible. The Court requests that Plaintiffs
submit legible copies of these exhibits, along with a legible copy
of the LOCAT Scoring Form for Kestrel. These exhibits may be filed
under seal.

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