Goidel v. Aetna Life Insurance Company

Background

Emma Goidel, Ilana Lee, Madeline Lee, and Lesley Brown brought this class action on behalf of LGBTQ individuals insured by Aetna who want to have children but cannot conceive through sexual intercourse with their partners and may need fertility treatment, including intrauterine insemination or in vitro fertilization.

Plaintiffs alleged that Aetna's health-benefit policies required LGBTQ insured individuals to pay out of pocket for several rounds of fertility treatment before coverage became available. They alleged that non-LGBTQ insured individuals could obtain coverage immediately after representing that they had been unable to conceive naturally for a year. Plaintiffs claimed that this difference violated Section 1557 of the Patient Protection and Affordable Care Act, the New York State Human Rights Law, and the New York City Human Rights Law. The opinion addresses settlement approval and does not decide whether Aetna violated those laws.

Proposed Settlement

The parties proposed two settlement classes. The Injunctive Settlement Class includes individuals in an eligible LGBTQ relationship who are currently covered by an Aetna-provided or Aetna-administered health plan in New York and who currently or in the future want coverage for intrauterine insemination or in vitro fertilization. The proposed injunctive relief would require Aetna to change its policy so that those individuals would not need to pay out of pocket for the treatments.

The Damages Settlement Class includes individuals in an eligible LGBTQ relationship whose Aetna plan covered infertility treatments during the class period, September 1, 2017, through May 31, 2024, but who paid out of pocket because of Aetna's definition of infertility. The agreement divides this class into three categories based on whether eligibility and out-of-pocket expenses have already been identified. Class members would receive at least $2,300 for prior out-of-pocket fertility-treatment payments, plus a pro rata share of approximately $10,000 in additional damages. The proposed agreement also provides $15,000 service awards to each of the four named plaintiffs and anticipates a separate application for $1,625,000 in attorneys' fees, subject to final approval.

Court's Analysis

The court applied Federal Rule of Civil Procedure 23, which requires judicial approval of class settlements. At the preliminary stage, the court evaluated whether it would likely be able to approve the settlement as fair, reasonable, and adequate and certify the settlement classes for purposes of judgment.

The court found that the proposed representatives' interests were not antagonistic to those of absent class members and that plaintiffs' attorneys were qualified and experienced. The court also found that the settlement resulted from good-faith, arm's-length negotiations after extensive discovery, including review of more than 77,000 documents and assistance from a privately retained mediator.

The court found the proposed relief adequate in light of the litigation risks, including the novelty of plaintiffs' legal theory, the complex regulatory setting, the fact-intensive damages issues, and uncertainty about whether Aetna could be liable under the Affordable Care Act for its role as administrator of self-funded plans. The court also found that the claims process and notice plan were reasonable. Atticus Administration would mail direct notice, maintain a settlement website, and process electronic claims and supporting documentation.

The court determined that the proposed distribution treated class members equitably because each member would receive at least $2,300 for out-of-pocket costs and a pro rata share of the additional-damages fund. It also found the proposed service awards reasonable at the preliminary stage. The court stated that the proposed attorneys' fee request appeared reasonable, but expressly made that assessment subject to final approval.

The court conditionally certified the settlement classes. It found that the estimated 116-member class satisfied the requirements for numerosity, common questions, typical claims, and adequate representation. It also found that common issues predominated and that a class action was the superior method of resolving the dispute. Because certification was sought only for settlement, the court did not need to address whether the case would be manageable at trial.

Disposition

Judge Vernon S. Broderick granted plaintiffs' unopposed motion for preliminary approval of the settlement on the terms stated in the accompanying order. The court approved the preliminary settlement process, conditional settlement-class certification, proposed notice procedures, and appointment of the settlement administrator. It scheduled a final fairness hearing for October 10, 2025, at 2:00 p.m. at the Thurgood Marshall U.S. Courthouse in New York City.

Pending the final approval hearing, the court stayed all deadlines except those specified in the opinion and preliminary-approval order for carrying out the settlement. The court retained jurisdiction over matters arising from or connected with the settlement agreement and directed the clerk to close the motion at docket entry 92.