Justia Insurance Law Opinion Summaries

Two members of a program advertised as providing healthcare discounts to consumers sued, seeking to represent a class of 30,850. They claimed violations of the Ohio Consumer Sales Practices Act as well as Ohio’s common law prohibition against unjust enrichment in that healthcare providers listed in the discount network that had never heard of the program, and that newspaper advertisements, designed to look like news stories were deceptive. The district court exercised jurisdiction under the Class Action Fairness Act of 2005, 28 U.S.C. 1332(d), which grants jurisdiction over class actions in which the amount in controversy exceeds $5 million and the parties are minimally diverse. The district court dismissed. The Sixth Circuit affirmed. The consumer-protection laws of many states, not just of Ohio, govern the claims and there are many factual variations among the claims, making a class action neither efficient nor workable nor above all consistent with the requirements of Rule 23 of the Federal Rules of Civil Procedure.

The class certification issue presented in this case arose from a dispute concerning the payment of medical bills under the Colorado Automobile Accident Reparations Act (No-Fault Act). Plaintiffs Pauline Reyher and Dr. Wallace Brucker filed suit against State Farm Mutual Automobile Insurance Company (State Farm) alleging that it failed to pay full, reasonable amounts in medical expenses in violation of the No-Fault Act and its own contracts. Plaintiffs subsequently moved to certify two classes that included all insureds and providers, respectively, who submitted medical bills to State Farm and were reimbursed for less than the full amounts. The trial court denied the motion for certification on grounds that Plaintiffs failed (among other things) to establish the "predominance" requirement. The appellate court reversed and remanded the case to enter an order certifying the class. State Farm appealed, arguing that the appellate court's finding of "predominance" was made in error. Upon review, the Supreme Court affirmed the trial court's decision and reversed the appellate court.

Plaintiffs appealed from a decision granting defendants' motion to dismiss plaintiffs' complaints for failure to state a claim upon which relief could be granted. Plaintiffs, participants in two retirement plans offered by defendants, brought suit alleging breach of fiduciary duty under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq. Plaintiff alleged that defendants acted imprudently by including employer stock as an investment option in the retirement plans and that defendants failed to provide adequate and truthful information to participants regarding the status of employer stock. The court held that the facts alleged by plaintiffs were, even if proven, insufficient to establish that defendants abused their discretion by continuing to offer plan participants the opportunity to invest in McGraw-Hill stock. The court also held that plaintiffs have not alleged facts sufficient to prove that defendants made any statements, while acting in a fiduciary capacity, that they knew to be false. Accordingly, the judgment was affirmed.

Plaintiffs, participants in retirement plans offered by defendants and covered by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., appealed from a judgment dismissing their ERISA class action complaint. Plan documents required that a stock fund consisting primarily of Citigroup common stock be offered among the plan's investment options. Plaintiffs argued that because Citigroup stock became an imprudent investment, defendants should have limited plan participants' ability to invest in it. The court held that plan fiduciaries' decision to continue offering participants the opportunity to invest in Citigroup stock should be reviewed for an abuse of discretion and the court found that they did not abuse their discretion here. The court also held that defendants did not have an affirmative duty to disclose to plan participants nonpublic information regarding the expected performance of Citigroup stock and that the complaint did not sufficiently allege that defendants, in their fiduciary capacities, made any knowing misstatements regarding Citigroup stock. Accordingly, the court affirmed the judgment.

The class action alleges that the company committed fraud by charging for uninsured or underinsured motorist coverage that is worthless in light of policy restrictions. The district court remanded to state court based on the representative plaintiff's argument that the amount in controversy was less than $5,000,000. The Seventh Circuit reversed, calculating the cost if the company were to stop charging a premium or change the terms so that policyholders receive indemnity more frequently, and the availability of punitive damages in Illinois, and concluding that it is not "legally impossible" that policyholders would recover the jurisdictional amount.

Plaintiff brought a class action in Louisiana state court on behalf of a class of Louisiana medical providers against three Louisiana defendants, alleging that defendants failed to comply with the preferred provider organization (PPO) notice provisions of Louisiana law. Homeland Insurance Company subsequently appealed the district court's class action to Louisiana state court. Because it concluded that the local controversy exception to the Class Action Fairness Act applied, 28 U.S.C. 1332(d)(4), the court affirmed the judgment of the district court.

Plaintiff sued three defendants in Louisiana state court, alleging that there was an enterprise between all three defendants to misappropriate funds using a Texas bill review company's under-calculation of recommended payments to hospitals. Defendants subsequently appealed the judgment of the district court holding that the local controversy exception to federal court jurisdiction under the Class Action Fairness Act (CAFA), 28 U.S.C. 1332(d), applied to this class action suit filed by plaintiffs and remanding this case to Louisiana state court. The court held that, based on its conclusion that plaintiff failed in its burden to establish that the sole local defendant formed a significant basis of the claims of the potential class, the court vacated the remand order and directed that the case be reinstated on the district court's docket.

Plaintiffs (Insured) filed a class action claiming violations of the Texas Insurance Code, alleging insurance discrimination in the non-standard insurance market, which served lower income individuals and those drivers with less than ideal driving records. Defendants (Insurance Companies) each moved to dismiss the case based on the "local controversy" and "home state" mandatory abstention provisions of the Class Action Fairness Act (CAFA), 28 U.S.C. 1332(d). The court concluded that the underlying case presented questions of Texas state law regarding insurance policies issued for automobiles in the state of Texas by Texas County Mutuals to Texas citizens. The Insured's case did not appear to be national litigation, so the spirit and intent of CAFA were not fulfilled. Therefore, the court held that the district court properly applied the "local controversy" and "home state" mandatory abstention provisions of CAFA diversity jurisdiction.

Timothy Hop's automobile was damaged in an accident with a driver insured by Safeco Insurance Company. In addition to the costs of repair, Hop sought "residual diminished value" (RDV) for his vehicle. When Safeco failed to pay RDV, Hop filed a class action complaint for declaratory relief in the district court, seeking a declaration that Safeco was required to investigate and pay class members, people whose vehicles were damaged by a Safeco insured and who were not paid RDV by Safeco, for RDV of their vehicle. The district court granted Hop's motion for class certification. The Supreme Court reversed, holding that the district court abused its discretion in certifying a class action before Hop had satisfied the statutory requirements to bring an individual third party action against Safeco. Remanded with instructions to dismiss Hop's class action without prejudice.

The district court certified a class action and a proposed class in an action under the Employee Retirement Income Security Act, 29 U.S.C. 1001. The suit claimed that Blue Cross breached its fiduciary duty by imposing and failing to disclose an other-than-group subsidy and that the OTG subsidy violated Mich. Comp. Laws 550.1211(2). The state insurance commissioner took the position that state law allows the assessment and that revenue it generates funds Medigap coverage. The Sixth Circuit reversed, holding that the class action is not the superior method of adjudication (Federal Rule of Civil Procedure 23(b)(3)) and prosecuting separate actions does not present the risk of inconsistent adjudications (FRCP 23(b)(1)(A)). ERISA fiduciary status is a crucial threshold factual issue specific to every class member, requiring the court to make individualized determinations. Resolution of the legality of the subsidy before that determination would also mitigate the state's concerns about stopping collection of the fee. Potential awards at stake would not preclude individual class members from seeking relief and there was no evidence that individual litigation would create a risk of inconsistent adjudications that would establish incompatible standards of conduct for the defendant.