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Associated Medical Networks3/31/2005
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As an alternative to this claimed common question of fact, however, the Providers assert that predominance under the rule is satisfied by the existence of questions of law common to members of the plaintiff class: (a) whether a physician can sue a health insurer based on a patient's assignment, and (b) whether Anthem's non-assignment clauses bar recovery in such claims. The first is not a disputed question, however. Anthem acknowledges its network policy of paying the claims from all non-network providers directly to their patients. In addition, Anthem does not challenge the legal viability of the Providers' assignment of benefits theory. Among the issues Anthem identifies as elements at trial, it asserts no general claim that a physician's suit cannot be based on an assignment from a patient. To the extent that this first issue presents any question, its resolution will not substantially advance the class members' claims nor achieve any economy of time, effort, or expense. More importantly, this first claimed question of law was not identified by the trial court as an issue of law upon which it found predominance satisfied. The first claimed question does not satisfy predominance.
As to the legal question regarding Anthem's non-assignment clauses, Anthem contends in part that it is not a common issue because "only some of Anthem's health plans contain non-assignment provisions." Appellant's Reply Br. at 15. The trial court made no finding as to whether this is a question of law "common to the members of the class" as required by T.R. 23(B)(3). In fact, the non-assignment clause question was not the basis for the trial court's determination that predominance was satisfied. The only finding made by the trial court to support its conclusion of predominance was Anthem's "common course of conduct in paying patients of non-Network health care providers directly," which the trial court found to be both a "factual and legal issue." Appellants' Appendix at 15. The trial court did not find predominance based upon any question regarding the enforceability of Anthem's non-assignment clauses.
We conclude that the class certification in this case fails as a matter of law to comply with the dominance requirement of T.R. 23(B)(3), which is not satisfied by the trial court's finding of Anthem's common course of conduct in directly paying patients of non-Network providers.
Superiority
A class certification based upon T.R. 23(B)(3) requires compliance with both the predominance and the superiority requirements. Because we conclude that the Providers failed to satisfy the predominance requirement, the class certification fails, and we need not separately address whether the superiority requirement was satisfied.
Conclusion
The trial court's Order Certifying Plaintiff Class is reversed, and this cause is remanded for further proceedings.
Shepard, C.J., and Sullivan and Rucker, JJ., concur. Boehm, J., not participating.
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