Cheslow v. Continental Casualty Company

CourtDistrict Court, N.D. Illinois
DecidedMay 24, 2022
Docket1:21-cv-04010
StatusUnknown

This text of Cheslow v. Continental Casualty Company (Cheslow v. Continental Casualty Company) is published on Counsel Stack Legal Research, covering District Court, N.D. Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cheslow v. Continental Casualty Company, (N.D. Ill. 2022).

Opinion

THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF ILLINOIS EASTERN DIVISION LINDA CHESLOW, ) ) Plaintiff, ) No. 21 C 4010 v. ) ) Judge Virginia M. Kendall CONTINENTAL CASUALTY COMPANY, ) ) Defendants. )

MEMORANDUM OPINION AND ORDER Plaintiff Linda Cheslow brought claims against Defendant Continental Casualty Company (“Continental”) alleging breach of contract and fraud claims. (Dkt. 1). Cheslow purchased long- term care insurance from Continental through her employer’s group policy. Continental raised nationwide premiums at different rates and times based on varying state regulatory regimes. Cheslow argues the raising of premiums at different rates violated the terms of the contract and amounted to fraud due to Continental’s statement that a change in premiums would only occur if “premiums for all other Insureds in the same premium class” rose and that premiums could not be changed due to “age or health.” Id. For the reasons discussed below, Defendant’s Motion to Dismiss [16] is granted in part and dismissed in part. BACKGROUND On a motion to dismiss under Rule 12(b)(6), the Court accepts the complaint’s well- pleaded factual allegations, with all reasonable inferences drawn in the non-moving party’s favor, but not its legal conclusions. See Smoke Shop, LLC v. United States, 761 F.3d 779, 785 (7th Cir. 2014). Unless otherwise noted, the following factual allegations are taken from Plaintiff’s Complaint [1] and are assumed true for purposes of this motion. W. Bend Mut. Ins. Co. v. Schumacher, 844 F.3d 670, 675 (7th Cir. 2016). Linda Cheslow, a citizen and resident of the State of California, purchased a certificate for long-term care insurance provided by Continental Casualty Company (“Continental”) through her employer, Hoffman-LaRoche, Inc.’s long-term care group policy, effective June 1, 2008. (Dkt. 1 ¶¶ 1, 4, 8, 18). Long-term care insurance policies provide for the costs of assistance required due

to disability or old age. (Id.). Unique from long-term disability insurance, which provides income protection in the event an individual becomes disabled, long-term care insurance provides for a range of services individuals may require if they are unable to care for themselves. (Id. at ¶ 12). For example, long-term care insurance may include coverage for assistance in a home or an assisted living facility, among other available services. (Id.). Individuals may purchase long-term care at a younger age to “secure a more favorable premium than they could otherwise obtain over the coming years.” (Id.). Continental issued long-term care insurance policies across the nation, including a group long-term care policy number 0010177TQ (“the Policy”) offered to Hoffman-LaRoche, Cheslow’s employer, with an effective date of November 2, 2002. (Id. at ¶ 15–16). The Policy Cheslow

enrolled in provided her with a daily nursing home benefit of $250, a daily Alternate Care Facility benefit of $250, and a daily Community Based Care benefit of $150. (Id. at ¶ 20). Under the heading for “PREMIUM”, the Policy certificate specifies: We cannot change the Insured’s premiums because of age or health. We can, however, change the Insured’s premiums based on his or her premium class, but only if We change the premiums for all other Insureds in the same premium class. A change may be made, as provided in the following paragraph, on any Premium Due Date after the end of the Premium Rate Guarantee Period. The Premium Rate Guarantee Period starts on the Participating Employer’s Effective Date. The length of this period is stated in the Schedule of the Master Application.

(Id. at ¶ 21). The Policy certificate does not include any additional definition of “premium class.” (Id. at ¶ 24). The rate schedules for the Policy included rates ranging based on only age and benefit level. (Id.). The master policy includes tables of monthly and biweekly premium rates nationwide, without indicating differences based on state of residency. (Id. at ¶ 27). In contrast to the Policy Cheslow obtained, Continental also offered individual long-term care insurance coverage policies, one of which stated expressly, “We may change the premium rates. Any change will apply to all

policies in the same class as Yours in the state where the policy was issued.” (Id. at ¶ 37). At the outset, Cheslow’s Policy certificate included a monthly premium of $206.71 or an annual premium of $2,478.12. (Id. at ¶ 28). On September 13, 2016, Continental issued a letter to Cheslow indicating her premium would increase by 95.5% in two phases. (Id. at ¶ 29). The first phase would be a 70% increase on November 1, 2016, followed by a 15% increase on November 1, 2017. (Id.). After the first phase of a 70% increase, Cheslow was informed her new monthly premium payment would be an additional $72.71 each month at $279.42. (Id.). In response to the premium increase, Cheslow could react in one of three ways, according to the letter. (Id. at ¶ 30). First, she could continue her coverage by paying the new premium of $279.42 each month. (Id.). Second, she could reduce her level of coverage to “minimize the effect” of the

increase. (Id.). Or third, she could execute a non-forfeiture benefit and discontinue premium payments, accepting “a drastically reduced maximum benefit under the certificate.” (Id.). Cheslow was unable to pay the increased monthly premium and chose to take the second option, reducing her benefit in order to reduce her premium. (Id.). The letter Continental sent in September 2016 also informed Cheslow that the premium rate increase would not be effective for everyone: “Continental . . . must comply with the laws and regulations of the states in which certificates were issued, which vary by state. It is likely that the size and timing of the rate increases may vary by state.” (Id. at ¶ 31). The rates did in fact vary by states. For example, in Washington D.C., Continental sought a 10% increase to take effect September 1, 2016, for insured individuals in Cheslow’s premium class. (Id. at ¶ 32). Cheslow is seeking to raise claims as a class action representing “[a]ll individuals who purchased or are insured under a Continental Casualty Company group policy for long-term care

coverage delivered in New Jersey, whose group policy either states or was marketed using material that states that premiums will not increase unless they also increase for all other insureds or all other insureds in a premium class, age, category, or other specified category.” (Id. at ¶¶ 38–39). Plaintiff raises five claims for relief. The first count is breach of contract due to Continental’s increasing premiums in a manner that was not uniform for all other insured individuals in the same premium class by raising premiums under the Policy at different rates and different times in different states. (Id. at ¶¶ 47–53). The second cause is breach of the implied covenant of good faith and fair dealing on the same basis. (Id. at ¶¶ 54–60). Third, Cheslow brings a cause of action for violation of the New Jersey Consumer Fraud Act, N.J.S.A. 56: 8-1 et seq. (“NJCFA”), “through its unfair and deceptive practices in marketing and selling long-term care

policies . . ., including concealing its intent to raise premiums on a state-by-state basis at the time the coverage was sold.” (Id. at ¶¶ 61–70). The fourth cause of action is fraudulent concealment based on Continental’s “failure to disclose . . . its intention to seek premium increases that varied in timing and amount from state to state . . ..” (Id. at ¶¶ 71–76). Finally, Cheslow raises a cause of action for declaratory and injunctive relief. (Id. at ¶¶ 77–81). LEGAL STANDARD “To survive a motion to dismiss under 12(b)(6), a complaint must ‘state a claim to relief that is plausible on its face.’” Adams v. City of Indianapolis, 742 F.3d 720, 728 (7th Cir. 2014) (quoting Bell Atl. Corp. v.

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Cheslow v. Continental Casualty Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cheslow-v-continental-casualty-company-ilnd-2022.