Collins v. Anthem Health Plans, Inc.

865 A.2d 1247, 49 Conn. Supp. 81, 2004 Conn. Super. LEXIS 2383
CourtConnecticut Superior Court
DecidedJune 16, 2004
DocketFile No. X01-CV-99-0156198S
StatusPublished

This text of 865 A.2d 1247 (Collins v. Anthem Health Plans, Inc.) is published on Counsel Stack Legal Research, covering Connecticut Superior Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Collins v. Anthem Health Plans, Inc., 865 A.2d 1247, 49 Conn. Supp. 81, 2004 Conn. Super. LEXIS 2383 (Colo. Ct. App. 2004).

Opinion

SHEEDY, J.

The present case is before this court on remand from our state’s Supreme Court, which reversed the order of the trial court, Hodgson, J., granting partial class certification with regard to three of sixteen sub-paragraphs of the plaintiffs’ second amended complaint.1 Four causes of action sounding in breach of contract, tortious interference with business expectations, breach of the implied covenant of good faith and fair dealing and violation of the Connecticut Unfair Trade Practices Act (CUTPA), General Statutes § 42-110a et seq., are there alleged. The plaintiffs named in the second amended complaint (complaint) are orthopedic physicians or groups thereof, who allege that they each had a written agreement with Anthem Health Plans, Inc., the defendant, which breached the agreement in several ways. The class of unnamed plaintiffs consists of all physicians who, from 1993 to the present, signed one of several agreements to provide medical services to the defendant’s insureds. Subparagraph (b) of paragraph twenty of the first count and paragraph twenty-three of the second, third and fourth counts of the complaint assert the same factual allegation as the basis for each count; specifically, the defendant’s failure to provide the plaintiffs named in the complaint and other similarly situated physicians with a consistent medical utilization-quality management and administration of covered services by paying financial incentive and performance bonuses to providers and Anthem Blue Cross and Blue Shield staff members [83]*83involved in making utilization management decisions. Subparagraph (g) of paragraph twenty of the first count and paragraph twenty-three of the second, third and fourth counts allege that the defendant failed to maintain accurate books and records, which resulted in improper payments based on claims submitted. Subparagraph (m) of paragraph twenty of the first count and paragraph twenty-three of the second, third and fourth counts assert the defendant’s failure to provide senior personnel to work with the plaintiffs or other similarly situated physicians. As to these three subparagraphs, the Supreme Court found that the trial court failed to make specific findings to support the conclusion that predominance was established as required by Practice Book § 9-8. The Supreme Court’s directive provides in pertinent part: “On remand, the trial court is directed to determine whether the plaintiffs have established that the predominance requirement of Practice Book § 9-8 is satisfied with respect to paragraphs 20 (b), (g) and (m) of the complaint. To the extent that the predominance requirement is met with respect to paragraphs 20 (b), (g) and (m), the trial court is directed to reinstate the partial class certification order.” Collins v. Anthem Health Plans, Inc., 266 Conn. 12, 67-68, 836 A.2d 1124 (2003).

Paragraph 20 (j) of the first count of the complaint asserts that the defendant made “payments for services dependent on profiling, a practice whereby treatment and/or payment for covered services for the patient is permitted/disallowed in whole or part by the use of statistical averages for the treating physician.” Paragraph 23 0) of the second, third and fourth counts alleges that the same practice constitutes the causes of action there pleaded. As to these paragraphs, the trial court concluded that the commonality and typicality requirements of Practice Book § 9-7 were not satisfied. Our Supreme Court, however, identified the “harm” [84]*84that the representative plaintiff's were alleged to share with the class members was not nonpayment for services or termination from participation in the agreements but was, instead, “the practice itself, which looms as a threat of potential termination or underpayment for services.” Collins v. Anthem Health Plans, Inc., supra, 266 Conn. 67. It found that the typicality requirement was satisfied and its directive to this court pertinent to that allegation was: “With respect to paragraph 20 (j) of the complaint, if the requirements of Practice Book § 9-7, other than typicality, and the requirements of Practice Book § 9-8 are met, the trial court is directed to grant partial class certification with respect to the issues raised in that paragraph.” Collins v. Anthem Health Plans, Inc., supra, 68.

I

PREDOMINANCE

Practice Book § 9-8 provides that an action may be maintained as a class action if the prerequisites of Practice Book § 9-7 are satisfied and the court finds that “the questions of law or fact common to the members of the class predominate over any questions affecting only individual members . . . .” Our Supreme Court, while recognizing that the “predominance criterion is far more demanding than the requirement of commonality”; (internal quotation marks omitted) Collins v. Anthem Health Plans, Inc., supra, 266 Conn. 48; has provided guidance to the trial court in narrowing the focus of the necessary inquiry. “The predominance inquiry tests whether [the] proposed classes are sufficiently cohesive to warrant adjudication by representation. . . . Class-wide issues predominate if resolution of some of the legal or factual questions that qualify each class member’s case as a genuine controversy can be achieved through generalized proof, and if these particular issues are more substantial than the issues subject only to individualized proof.” (Internal quotation marks omitted.) Id. Pertinent to this assessment, [85]*85the court noted that rule 23 (b) (3) of the Federal Rules of Civil Procedure “suggests consideration of the following four factors: (A) the interest of members of the class in individually controlling the prosecution or defense of separate actions; (B) the extent and nature of any litigation concerning the controversy already commenced by or against members of the class; (C) the desirability or undesirability of concentrating the litigation of the claims in the particular forum; [and] (D) the difficulties likely to be encountered in the management of a class action.” (Internal quotation marks omitted.) Id., 48-49. The court counseled a balancing of the economic benefits of proceeding with a class action against any procedural unfairness that might result from class certification. Id., 49-50, citing Amchem Products, Inc. v. Windsor, 521 U.S. 591, 117 S. Ct. 2231, 138 L. Ed. 2d 689 (1997). There, the United States Supreme Court stated: “In adding ‘predominance’ and ‘superiority’ to the qualification-for-certification list, the Advisory Committee [on the Federal Rules of Civil Procedure] sought to cover cases ‘in which a class action would achieve economies of time, effort, and expense, and promote . . . uniformity of decision as to persons similarly situated, without sacrificing procedural fairness or bringing about other undesirable results.’ ” Id., 615.

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Bluebook (online)
865 A.2d 1247, 49 Conn. Supp. 81, 2004 Conn. Super. LEXIS 2383, Counsel Stack Legal Research, https://law.counselstack.com/opinion/collins-v-anthem-health-plans-inc-connsuperct-2004.