Estate of Gene B. Lokken v UnitedHealth Group

Case Information

Case name	Estate of Gene B. Lokken, et al. v. UnitedHealth Group, Inc., et al.
Court	U.S. District Court for the District of Minnesota.
Docket	0:23-cv-03514 (JRT/SGE).
Filed	November 14, 2023.
Judge(s)	District Judge John R. Tunheim; Magistrate Judge Shannon G. Elkins.
Plaintiffs	Estate of Gene B. Lokken and other Medicare Advantage beneficiaries or their representatives; proposed class representatives.
Defendants	UnitedHealth Group, Inc.; UnitedHealthcare, Inc.; naviHealth, Inc.; and pleaded Doe defendants.
Case type	Proposed class action concerning Medicare Advantage post-acute-care benefit decisions.
Claims / issues	Contract and implied-covenant claims; Medicare administrative exhaustion and federal preemption; alleged use of nH Predict.
Status	September 4, 2026: defendants filed a second amended answer following leave granted September 1. Contract and implied-covenant claims survived the February 2025 dismissal ruling.

Estate of Gene B. Lokken v. UnitedHealth Group is a proposed class action in the District of Minnesota challenging alleged use of naviHealth's nH Predict tool to terminate Medicare Advantage coverage for post-acute care. The original complaint was filed on November 14, 2023. Plaintiffs contend that algorithmic predictions displaced individualized medical judgment and caused premature coverage denials.

The court allowed contract and implied-covenant claims to proceed in February 2025 and addressed discovery in March 2026. Defendants filed a second amended answer on September 4, 2026, denying liability. This article's procedural account is verified through that filing.

Allegations and AI connection

The original plaintiffs were the estates of Gene B. Lokken and Dale Henry Tetzloff. Their complaint alleged that nH Predict projected the duration of post-acute care and that defendants used its outputs to override treating physicians' recommendations. Plaintiffs sought damages and injunctive relief for allegedly wrongful coverage terminations.

The complaint characterized the model as having a 90% error rate, relying on alleged reversals of appealed denials. That figure is the plaintiffs' allegation about challenged decisions, rather than an adjudicated measurement of all model outputs. Defendants' September 2026 answer disputes the allegations and denies liability.

Contract terms and February 2025 ruling

On February 13, 2025, Judge John R. Tunheim waived administrative exhaustion in the circumstances pleaded and granted the motion to dismiss in part. The claims for breach of contract and breach of the implied covenant of good faith and fair dealing survived; five other counts were dismissed with prejudice as preempted.

The surviving theory concerns promises in the plans' Evidence of Coverage documents that clinical staff and physicians would make claim decisions. The court distinguished enforcement of those contractual commitments from state-law duties that would impose additional standards on Medicare Advantage plans. This ruling determined which claims could proceed at the pleading stage.

March 2026 discovery order

On March 9, 2026, Magistrate Judge Shannon G. Elkins granted in part and denied in part a motion to compel. The order required relevant records concerning nH Predict's development and use, employee practices, and oversight. It permitted inquiry into whether the tool was designed to replace physician decision-making.

The order also imposed limits: defendants did not have to produce the model's underlying data, rules, source code or medical guidelines under the disputed request. The court treated whether nH Predict actually made coverage determinations as a merits question for later resolution. Required production was due within 21 days of the order.

September 2026 proceedings

At a September 1 hearing, Magistrate Judge Elkins granted defendants leave to amend their answer and directed filing within seven days. The minute entry also extended plaintiffs' expert-disclosure deadline to October 14, 2026 and requested a joint proposal concerning other scheduling deadlines.

Defendants filed their second amended answer on September 4. They denied the substantive wrongdoing allegations and liability, and disputed the suitability of class treatment.

Related articles

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• Protecting Patients from Automated Denials Act (119th Congress)
• Cases

References