Folweiler Chiropractic, PS v. American Family Insurance Company
American Family Class Action PIP Settlement
Case No. 16-2-16112-0 SEA

Frequently Asked Questions

 

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  • A court authorized the notice because you have a right to know about a settlement in the lawsuit known as Folweiler v. American Family Insurance Company, et al., Case No. 16-2-16112-0 SEA in the Superior Court of King County, Washington.  

    On July 8, 2016, Dr. David Folweiler filed a putative class action against American Family Insurance Company on behalf of his business and a putative class of Washington providers alleging that American Family improperly reduced provider charges submitted under the terms of an insured’s PIP or MedPay coverage.  Plaintiff challenged Defendants’ use of a medical charge database compiled and maintained by FAIR Health to evaluate the reasonableness of a provider’s charges.  Where a provider’s charges exceeded the 85th percentile of charges contained in a medical charge database they were reduced to the 85th percentile.  Defendants identified these reductions on the explanation of remittance as Explanation Code P0041 (“Reason Code 41”).  Plaintiff claims that the Reason Code 41 reductions violated the Washington Consumer Protection Act and the Washington Insurance Code.  The complaint sought damages and certification of a statewide class of medical providers.

    Defendants moved to dismiss the lawsuit.  Plaintiff filed a motion for summary judgment and to certify a putative class, and the parties engaged in discovery.  On February 14, 2017, the lawsuit was dismissed but in 2018 an appellate court reversed the dismissal and reinstated the case.  In September 2019, the parties engaged in two days of mediation with Stewart Cogan, a mediator in Seattle, and ultimately reached the settlement described in the notice.

    Defendants have vigorously denied and continue to deny any wrongdoing and any liability, but elected to settle to avoid the continued burden and expense of litigation.

  • The Defendants in the lawsuit are American Family Insurance Company and American Family Mutual Insurance Company.

  • In a class action, one or more people called the “Class Representative” (in this case, Dr. David Folweiler’s business, Folweiler Chiropractic, PS,) sue on behalf of people who have similar claims.  All these people are “Class Members” in a “Class.”  One court resolves the issues for all Class Members, except for those who exclude themselves from the Class.

  • Defendants vigorously denied, and continue to deny, all of the allegations of wrongdoing.  The settlement is not an admission by Defendants of any fault, wrongdoing, or liability whatsoever.  Defendants instead agreed to the settlement to eliminate the substantial burden, expenses and uncertainties of further litigation.

  • To see if you are eligible for benefits from this settlement, you first have to determine if you are a Class Member.

  • You may be a Class Member if you were a Washington healthcare provider who from July 8, 2012 through December 23, 2019 had your PIP or MedPay claims for reimbursement of medical expenses reduced by Defendants based on an explanation code P0041 as set out in the Explanation of Remittance form sent to the provider.  If you are not sure whether you are included in the Class, you may call the Settlement Administrator, toll free at 1-855-961-0955.

  • Defendants have agreed to pay up to a total of $6 million to settle this action. That amount includes all attorneys’ fees and expenses and case contribution fees awarded by the court as well as the costs for administering the settlement (“Settlement Costs”). It also includes the payments to Class Members who submits a timely and valid claims. Each Class Member who submits a valid and timely claim can recover an amount equal to the sum of Reason Code 41 reductions that Defendants took on each provider’s bill(s) plus a multiplier. The multiplier is calculated by taking the difference between $6 million and the Settlement Costs and dividing it by the total amount of Reason Code 41 reductions taken by Defendants (approximately $2.9 million).

    Class Counsel asked the court for an award of attorneys’ fees and expenses. Any amount awarded as fees or expenses by the court shall be paid by the Defendants. Defendants have agreed not to oppose any application that does not exceed two million dollars ($2,000,000).

    On behalf of the Class Representative, Class Counsel also sought a case contribution fee not to exceed $10,000. Defendants have agreed not to oppose Class Counsel’s request for the case contribution fee up to that amount and will pay any fee awarded by the court.

    The Court approved the request for attorneys’ fees and expenses, the Class Representative payment, and granted final approval of the Settlement on February 19, 2020.

  • The deadline to file a claim passed on May 20, 2020.

  • In connection with medical bills paid by Defendants pursuant to PIP or MedPay coverage, you can recover the amount of Reason Code 41 reductions taken since July 8, 2012.  An additional amount, currently estimated to be approximately 30-40% of your Reason Code 41 reductions, will be added to your refund.  By way of example, if Defendants reduced a provider’s medical bills covered by the settlement by a total of $100 and that provider submitted a timely and valid claim, she could recover $100 plus an estimated $30-$40 for a total of $130-$140.

  • Payments were mailed on May 19, 2020 to eligible Class Members who send in timely and valid claim forms.

  • Unless you excluded yourself from the settlement, you cannot sue, continue to sue, or be part of any other lawsuit against the Defendants regarding any of the legal issues involved in the Folweiler litigation or that are included within the Released Claims.  If you remained a Class Member, you gave a “release” to the Defendants (the “Released Claims”) described in greater detail in FAQ 11.  In addition, if you remained a Class Member, all of the court’s orders will apply to you and legally bind you.

    The Settlement Agreement, available on the Important Documents page, describes the exact legal claims that you gave up if you did not exclude yourself from the settlement.

  • As part of the Settlement Agreement, the Class Representative and all Class Members who did not exclude themselves from the Settlement agreed to release the Defendants and all of their affiliates and other related persons and entities, from any claims, rights, demands, actions, causes of action, suits, Unknown Claims (as defined in paragraph 1.27 of the Settlement Agreement), debts, liens, contracts, liabilities, agreements, interest, costs, expenses, losses, or damages (whether actual, consequential, treble, statutory and/or punitive or exemplary or other), whether arising in law or equity, for or arising out of or related to (i) the allegations that were or could have been asserted by Plaintiff or the Settlement Class in this Lawsuit which relate in any way to the subject matter of the Lawsuit, which was Defendants’ use of and the validity, reliability, and lawfulness of the FAIR Health medical charge database to assess whether a provider’s bill exceeded the 80th and/or 85th percentile; or (ii) Defendants’ review, handling, payment, adjustment or denial, in whole or in part, of claims for PIP or MedPay benefits through Defendants’ use of the 80th or 85th percentile of the FAIR Health database.

  • If you did not want a payment from this settlement, but you wanted to keep the right to individually sue the Defendants about the issues in this case, then you must have taken steps to exclude yourself from the settlement. This is called “opting out” of the Settlement Class. The deadline for opting out has passed.

     
  • The deadline to exclude yourself from this Settlement passed on February 10, 2020.

  • No.  Unless you excluded yourself, you gave up any right to individually sue the Defendants for the claims that this settlement resolves.  You must have excluded yourself from this class to individually sue the Defendants over the claims resolved by this settlement.  The deadline to exclude yourself from the Settlement passed on February 10, 2020.

  • No.  If you excluded yourself, you will not get a payment and you did not need to submit a claim form.

  • The deadline to object to the Settlement passed on February 10, 2020.

  • Objecting is simply telling the court that you do not like something about the settlement.  You could have objected only if you remained a Class Member.  You will still be bound by the result if you objected because the court approved the settlement anyway. Excluding yourself is telling the court that you do not want to be a Class Member.  If you excluded yourself, you could not have objected because the case no longer would have affected you.

     
  • The court has appointed David Breskin and Brendan Donckers of Breskin, Johnson & Townsend, PLLC as Class Counsel.  You do not have to pay Class Counsel. If you wanted to be represented by your own lawyer, and have that lawyer appear in court for you in this lawsuit, you could have hired one at your own expense.

  • Class Counsel submitted a fee and expense application, seeking an award based on the value of the settlement and the work performed in an amount not to exceed two million dollars ($2,000,000). Defendants have agreed not to oppose Class Counsel’s fee and expense application up to this amount. The request for fees and expenses will be available on the Important Documents page, after it has been filed. The court approved the motion at the final approval hearing on February 19, 2020.

  • The court held a final approval hearing on February 19, 2020, in Courtroom 847 at 516 3rd Avenue, Seattle, Washington 98104. At this hearing, the court considered whether the settlement was fair, reasonable, and adequate. The court also considered Class Counsel’s fee and expense application and the Class Representative case contribution fee. The Court granted final approval of the Settlement on February 19, 2020.

  • No. The hearing took place on February 19, 2020.

  • If you did nothing, you will not receive a payment from the settlement.  But, unless you excluded yourself, you will still be bound by the settlement and you will not be able to individually sue the Defendants for the claims resolved in the settlement.  You will also be legally bound by all of the orders the court issues and judgments the court makes concerning the lawsuit.

  • These FAQs summarize the settlement.  For more information, including copies of the Settlement Agreement and other legal documents, visit the Important Documents page, call the Settlement Administrator at 1-855-961-0955, or write to:

    Folweiler v. American Family Insurance
    c/o JND Legal Administration
    PO Box 91209
    Seattle, WA 98111

     

    Please Do Not Contact The Court

     

For More Information

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Mail

Folweiler v. American Family Insurance
c/o JND Legal Administration
PO Box 91209
Seattle, WA 98111