Chitkin v. Lincoln National Insurance

879 F. Supp. 841, 1995 U.S. Dist. LEXIS 2848, 1995 WL 103175
CourtDistrict Court, S.D. California
DecidedMarch 2, 1995
DocketCiv. 90-1287-R (AJB)
StatusPublished
Cited by7 cases

This text of 879 F. Supp. 841 (Chitkin v. Lincoln National Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Chitkin v. Lincoln National Insurance, 879 F. Supp. 841, 1995 U.S. Dist. LEXIS 2848, 1995 WL 103175 (S.D. Cal. 1995).

Opinion

AMENDED ORDER GRANTING LINCOLN NATIONAL’S MOTION FOR SUMMARY JUDGMENT ON ITS COUNTERCLAIM

RHOADES, District Judge.

This matter comes before the Court on Defendant and Counterclaimant Lincoln National Insurance Company’s (“Lincoln National’s”) Motion for Summary Judgment on its counterclaim. 1 For the reasons given be *845 low, Lincoln National’s Motion for Summary Judgment is granted. 2

I. Background

On June 8, 1987, twenty-month-old Danielle Chitkin nearly drowned in a duck pond. Danielle wandered out of an open sliding glass door at the home of Ed and Judy Way while Nancy Chitkin visited with Judy Way. Danielle then made her way across the backyard, through an unlocked, unauthorized gate, and toward the duck pond, before falling into the pond. Danielle suffered severe brain damage as a result of the incident.

Lincoln National provided medical benefits to Danielle Chitkin because her father, John Chitkin, participated in a the Jerome’s Furniture Warehouse Health VEBA Plan (the “Plan”). Lincoln National issued a group policy of insurance to the Plan. Lincoln National has paid claims totalling $701,048.66 under the Plan for medical treatment for Danielle.

The Plan includes a section entitled “Return of Over Payment.” That section states in full:

Payment made for charges must be returned to Lincoln National if:
1. it is found that such charges were paid in error, or
2. a third party is determined to be liable for such charges.
If an individual insured under the policy has
a. medical or dental charges; or
b. loss of earnings;
as a result of the negligence or intentional act of a third party, and makes a claim to Lincoln National for benefits under the policy for such charges or such lost earnings, the insured individual (or legal representative of minor or incompetent) must agree in writing to repay Lincoln National from any amount of money received by the insured individual from the third party, or its insurer. The repayment will be to the extent of the benefits paid by Lincoln National, but will not exceed the amount of the payment received by the individual from the third party, or its insurer. However, the reasonable expenses, such as lawyers’ fees and court costs, incurred in effecting the third party payment reimbursed to Lincoln National may be deducted from the repayment to Lincoln National.
The repayment agreement will be binding upon the insured individual (or legal representative of a minor or incompetent) whether:
a. the payment received from the third party, or its insurer, is the result of:
1) a legal judgment; or
2) an arbitration award; or
3) a compromise settlement; or
4) any other arrangement; or
b. the third party, or its insurer, has admitted liability for the payment; or
c. the medical or dental charges or loss of earnings are itemized in the third party payment.

On August 20, 1987, the Chitkins entered into a settlement agreement with Ed and Judy Way for $100,000, the maximum benefits available under the Ways’ homeowners insurance policy.

*846 Beginning in late 1987, Lincoln National began to take steps to control its expenditures on behalf of Danielle Chitkin. In October 1987, for example, Lincoln National endeavored to reduce Danielle’s nursing care from twenty-four to sixteen hours per day. According to the Chitkins, Lincoln National’s efforts included its misrepresentation to Danielle’s doctor that the Chitkins wanted to reduce Danielle’s nursing care, when, in fact, the Chitkins wanted no such thing. Later, in November 1987, Lincoln National took the position that Danielle’s care could be characterized as custodial only. Such a characterization again would save Lincoln National a substantial sum. Lincoln National did not retreat from its “custodial care” position until January 1989. In October 1988, an attorney for Lincoln National asked the Chitkins to consider a voluntary reduction in nursing care in order to prolong Danielle’s entitlement to benefits because Lincoln National’s expenditures on behalf of Danielle were approaching the lifetime maximum coverage limits set out in the Plan.

In December 1987, Lincoln National announced that it planned to raise medical rates substantially for employees of Jerome’s Furniture because Jerome’s was “a group where it has been difficult to proactively manage an ongoing claim.” The Chitkins argue that the “ongoing claim” was Danielle’s claim. Lincoln National does not dispute the Chitkin’s interpretation. The Chitkins argue that this rate hike was the first significant step in Lincoln National’s effort to terminate the Plan. According to the Chitkins, Lincoln National raised rates in an effort to force most employees out of the Plan. Once Plan membership fell below a certain level, Lincoln National could exercise its right under the Plan to terminate coverage. In December 1988, Lincoln National announced that it would raise rates again in February 1989 to a level almost three times the rate charged during 1987. John Chitkin was the only Jerome’s employee who did not leave the Plan after the second rate increase. Lincoln National cancelled the Jerome’s Furniture Policy on March 31, 1989.

Following Lincoln National’s cancellation of the Plan, the Chitkins were able to obtain coverage through PacifiCare. Lincoln National, however, still retained some obligations toward Danielle under the terms of the Plan because Danielle was completely disabled at the time of the cancellation. Lincoln National’s coverage was secondary to PacifiCare’s coverage. PacifiCare’s coverage of Danielle’s physical therapy contained a limit of sixty days of therapy. Danielle soon exhausted these sixty days and turned to Lincoln National for payment for additional treatment under Lincoln National’s secondary coverage, because the Jerome’s Plan contained no limit on therapy benefits. Despite numerous inquiries by the Chitkins, their attorney, and Danielle’s therapy provider, Lincoln National refused to assure the Chit-kins or Danielle’s therapy provider that it would pay any amount for Danielle’s therapy.

On August 15, 1988, the Chitkins filed suit in San Diego Superior Court against a number of defendants, including Le Chateau Homeowners Association and the designer and builder of the Chitkins’ subdivision, W. Wolf Industries, Inc.

On January 24, 1990, the Chitkins’ counsel sent Lincoln National’s counsel, Vicki Lai, a letter asking Lai to make someone available to participate in a mediation between the Chitkins and various tortfeasors. The mediation, however, did not take place as scheduled.

The Chitkins settled their disputes with W.

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Cite This Page — Counsel Stack

Bluebook (online)
879 F. Supp. 841, 1995 U.S. Dist. LEXIS 2848, 1995 WL 103175, Counsel Stack Legal Research, https://law.counselstack.com/opinion/chitkin-v-lincoln-national-insurance-casd-1995.