If You Are a Washington Health Care Provider or a Washington PIP Insured of a USAA Company, and Your Health Care Bills Were Reduced Based on a “Reasonable Fee” Code, You May Be Entitled to Payment from a USAA Class Action Settlement.
United Services Automobile Association (“USAA”), USAA Casualty Insurance Company (“USAA CIC”), USAA General Indemnity Company (“USAA GIC”), and Garrison Property and Casualty Insurance Company (“Garrison”) (collectively USAA) have reportedly agreed to a class action settlement of two lawsuits filed against them in King County, Washington Superior Court, styled Eastside Physical Therapy, Inc., P.S. and Krista Peoples v. United Services Automobile Association, et al., Class Action Case No. 17-2-26885-2 SEA (the “Eastside Case”) and Krista Peoples v. United Services Automobile Association, et al. Class Action Case No. 18-2-16812-1 SEA (the “Peoples Case”), alleging, among other things, that USAA failed to pay the full amount of health care bills submitted to them for payment under the Personal Injury Protection (or “PIP”) coverages of their Washington auto insurance policies because of reductions based on USAAs’ use of a computerized bill review process to determine the reasonableness of health care fees based on provider charges for the same treatment in the same geographic area. USAA reportedly denied that they did anything wrong and maintained that they have complied with and exceeded their insurance policies and their obligations under Washington law.
Who Is Included In The Washington USAA Personal Injury Protection PIP Reasonable Fee Reduction Class Action Settlement?
The Washington USAA Personal Injury Protection PIP Reasonable Fee Reduction class action settlement reportedly includes, unless otherwise excluded, the following settlement classes:
The Insured Subclass shall consist of all persons (1) who were insured under the Personal Injury Protection (“PIP”) coverage of a Washington automobile insurance policy issued by any of the USAA Entities; (2) who received medical, health care, or rehabilitation services, or medication or equipment, from one or more members of the Provider Subclass; (3) who made a claim under the PIP coverage of that policy; (4) who submitted (or whose health care provider submitted) to the USAA Entities a bill for such services or products; and (5) who had that bill reduced by a reason code stating that the billed amount exceeded the reasonable amount for the service provided (“RF Reductions”) from May 30, 2015 through January 22, 2021 (the “Insured Class Members”).
The Provider Subclass shall consist of all Washington health care providers (1) who provided medical, health care, or rehabilitation services, or medication or equipment, to a person who was insured under the Personal Injury Protection (“PIP”) coverage of a Washington automobile insurance policy issued by one of the USAA Entities; (2) who submitted to the USAA Entities bills for such services or products pursuant to the PIP coverage of that insurance policy; (3) who received from the USAA Entities as payment less than the full amount of the charges billed; and (4) whose bill was reduced by a reason code stating that the billed amount exceeded the reasonable
amount for the service provided (“RF Reductions”) from May 30, 2015 through January 22, 2021 (the “Provider Class Members”)
The “RF Reductions” at issue in the lawsuits reportedly include those with Reason Codes with an RF-prefix, CR104, NR260, and NR263 that appear under the “Reason” or “Reason Code” section of the “Explanation of Reimbursement” or “EOR” form sent to providers and insureds.
What Settlement Benefits Does The USAA Personal Injury Protection PIP Reasonable Fee Reduction Class Action Lawsuit Settlement Provide?
The USAA Personal Injury Protection PIP Reasonable Fee Reduction class action lawsuit settlement reportedly provides for monetary payments to eligible Class Members, an Attorneys’ Fees and Expense Award to Class Counsel, and possible Incentive Awards to the Class Representatives.
In order to get paid under the USAA settlement, class members must file claim forms. Provider Class Members must fill out a “Provider Claim Form” and Insured Class Members must fill out an “Insured Claim Form.” Claims must be submitted/postmarked by August 11, 2021.
USAA settlement claims will reportedly be calculated as follows:
- 140% of the RF Reduction on each charge submitted on non-exhausted claims, and 100% of the RF Reduction on each charge submitted on non-exhausted claims.
- “Non-exhausted claims” are those for which there was PIP coverage remaining for the applicable claim as of the date of the Explanation of Reimbursement (EOR). “Exhausted claims” are those for which there was no PIP coverage remaining for the applicable claim as of the date of the EO
- There shall be no Claims Payment on claims that were settled or resolved, through a signed release, accord, mediation, or arbitration, before preliminary approval; and
- There shall be only one Claims Payment per RF Reduction.
In addition, the Settlement provides that the USAA companies will, for a period of two years after July 21, 2020 cease use of their RF Methodology in the adjustment of Washington PIP claims.
Where Can You Obtain More Information About The USAA Personal Injury Protection Class Action Settlement?
For more information about the Washington USAA Personal Injury Protection PIP Reasonable Fee Reduction class action lawsuit settlement, write to Eastside v. USAA Claims Administrator – 7179 P.O. Box 44, Minneapolis, MN 55440-0044, call 1-877-878-6878, email info@EastsideSettlement.com or visit the USAA class action settlement website at https://eastsidesettlement.com/
I had a car accident and I had very bad back pain.