Landmark $8.75M AGG Class Action Settlement Against UnitedHealthcare Receives Final Approval

Key Takeaways

• Court approves landmark settlement expanding access to proton beam radiation therapy (PBRT). Final approval of an $8.75 million ERISA class action settlement requires UnitedHealthcare to revise its PBRT coverage policy and provide payments of up to $75,000 to eligible class members denied coverage.
• Settlement delivers immediate relief and lasting policy change. UnitedHealthcare must remove restrictive PBRT exclusions and adopt revised medical necessity criteria that expand coverage for certain cancer diagnoses based on evolving clinical evidence.
• Patients and providers denied PBRT coverage may have recourse. Individuals or healthcare providers who were denied PBRT coverage or reimbursement should consider contacting AGG’s Healthcare Litigation team to evaluate potential claims or recovery options.

Overview

On December 12, 2025, Judge Allison D. Burroughs of the U.S. District Court for the District of Massachusetts granted final approval of the class action settlement in the consolidated ERISA litigation challenging UnitedHealthcare’s denials of proton beam radiation therapy (“PBRT”) coverage, certified a settlement class, and entered final judgment. Most importantly, the final settlement requires United to pay up to $75,000 to class members who were denied access to PBRT and requires United to amend and revise its PBRT coverage policy, expanding access to PBRT.

The court also approved attorneys’ fees and costs of $2 million to class counsel and service awards of $25,000 for each of the three class representatives, to be paid by UnitedHealthcare separately from class member payments. No class member objected or opted out.

Case Background

The litigation began in 2019 and was later consolidated, with named plaintiffs Kate Weissman, Zachary Rizzuto, and Richard Cole challenging denials of PBRT for individuals diagnosed with cervical/gynecological, primary central nervous system, and prostate cancers under ERISA-governed plans issued or administered by UnitedHealthcare. In May 2025, the court granted preliminary approval to a proposed settlement valued that also contemplated important medical policy changes to expand PBRT access and potential payments up to $75,000 per qualifying member who paid out of pocket. Following notice to the class, the court conducted the Final Fairness Hearing on December 12, 2025.

The Final Approval Order

In its Final Approval Order issue December 12, 2025, the court granted final approval of the settlement under Rule 23(e). The court certified, for settlement purposes, a Rule 23(b)(1) and (b)(2) class comprising persons who, while covered by an ERISA-governed plan issued or administered by UnitedHealthcare:

• were diagnosed with one of the three cancers at issue;
• obtained PBRT and had their claim denied for clinical reasons between March 26, 2016, and August 28, 2023; and
• whose PBRT treatment was not paid by another payor.

The court made the requisite Rule 23(a) and Rule 23(g) findings and appointed Kate Weissman, Richard Cole, and Zachary Rizzuto as class representatives.

Attorneys’ Fees, Costs, and Service Awards

By separate order entered the same day, the court awarded class counsel $2 million in attorneys’ fees and expenses, and approved service awards of $25,000 each for the three class representatives, all to be paid by UnitedHealthcare separate and apart from class payments.

Significance and Next Steps

The final approval cements a settlement that both provides monetary relief to eligible class members and prospective relief through revisions to United’s PBRT policy. The settlement provides policy revisions intended to expand access to PBRT and transparency for members with certain cancers, and provided payments up to $75,000 per qualifying member, underscoring the settlement’s practical impact for affected patients.

Pursuant to the settlement agreement, changes to United’s PBRT medical policy include removal of a list of 13 different cancer sites for which United deemed PBRT “unproven and not medically necessary due to insufficient evidence of efficacy for treating all other indications.” Because of the settlement, individuals may access coverage for PBRT for these cancer sites if there is (1) documentation supporting that surrounding tissue cannot be spared with standard radiation; and (2) an evaluation and comparison of treatment plans for PBRT, intensity-modulated radiation therapy (“IMRT”), and stereotactic body radiation therapy (“SBRT”) for the specific member. The revisions to the policy reflect developments and studies supporting the use of PBRT, including the American Society of Radiation Oncology’s Model PBRT Policy.

This outcome could not have been achieved without the efforts of the class representatives and class counsel, who prevailed after years of litigation.

If you are an individual or healthcare provider who has been denied PBRT coverage or reimbursement by an insurer, please contact AGG Healthcare Litigation attorneys Rich Collins or Landen Benson.