Blue Cross to Pay $125,000 in Ground-Breaking Settlement for Autism Care

DETROIT, June 2, 2010 /PRNewswire/ -- Blue Cross Blue Shield of Michigan has again been compelled by a lawsuit to pay claims for autism spectrum disorder treatment known as Applied Behavior Analysis, or "ABA."

In the case of Matthews v. Blue Cross, Case No. 09-018750-CK , Wayne County Circuit Court, Blue Cross accepted a case evaluation award of $125,000 in favor of the plaintiff, Cheryl Matthews, an Oakland County Circuit Court judge.  Matthews alleged in her lawsuit that Blue Cross wrongfully refused to pay $38,000 in insurance claims stemming from the ABA treatment provided to her autistic son.

Earlier this year, Blue Cross paid over $1,000,000 to settle a class action lawsuit, Johns v. Blue Cross, No. 08-12272 (E.D. Mich) which also alleged that the insurer had engaged in a pattern and practice of wrongfully denying claims for ABA therapy.  Both the Matthews case and the Johns case were handled by Gerard Mantese and John Conway, who devote a large part of their practice to making ABA therapy available to children with autism spectrum disorder.

Blue Cross took the position that Matthews' claim should be denied because ABA therapy was not an approved medical treatment under her insurance policy.  Blue Cross filed three separate motions for summary disposition, seeking to dismiss the case, but Judge Prentis Edwards denied all three motions, forcing Blue Cross to either settle the claims or go to trial.

The $125,000 amount which Blue Cross must pay to Matthews represents three times the cost of therapy and recognized Matthews' argument that her inability to access additional therapy from Blue Cross for her son will result in increased life care costs for her son. Many other States mandate that insurers pay for ABA therapy for autistic children, but the Michigan legislature has not yet passed a law to this effect.

Gerard Mantese, counsel for Cheryl Matthews, stated: "We believe that this is the first settlement in the United States to recognize the link between the inability of children with autism spectrum disorder to access needed ABA therapy and increased life care costs in the future because of the reduced functioning of children with ASD."

John Conway, co-counsel for Matthews, stated, "We will continue to bring these suits until all insurers stop making baseless excuses for insuring this needed therapy."

SOURCE Mantese Honigman Rossman and Williamson, P.C.