Citizens Communications Co. v. Trustmark Insurance

303 F. Supp. 2d 197, 2004 U.S. Dist. LEXIS 2423, 2004 WL 322348
CourtDistrict Court, D. Connecticut
DecidedFebruary 18, 2004
Docket3:01CV948 (MRK)
StatusPublished
Cited by2 cases

This text of 303 F. Supp. 2d 197 (Citizens Communications Co. v. Trustmark Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Connecticut primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Citizens Communications Co. v. Trustmark Insurance, 303 F. Supp. 2d 197, 2004 U.S. Dist. LEXIS 2423, 2004 WL 322348 (D. Conn. 2004).

Opinion

MEMORANDUM OF DECISION

KRAVITZ, District Judge.

Citizens Communications (“Plaintiff’ or “Citizens”) brings this action against Defendants Trustmark Insurance (“Trust-mark”), RMTS Associates (“RMTS”), and American Stop Loss Insurance Brokerage Services (“ASL”), seeking declaratory relief and-damages stemming from a dispute over Defendants’ alleged breach of contractual insurance coverage obligations. All of the parties have filed motions for summary judgment [docs. # 63, 65, 70, 73]. For the reasons stated below, Plaintiffs Motion for Summary Judgment [doc. # 73] is 'DENIED; Trustmark’s Motion for Summary Judgment [doc. # 63] is GRANTED in part and DENIED in part; RMTS’s Motion for Summary Judgment [doc. # 65] is GRANTED in part and DENIED in part; and ASL’s Motion for Summary Judgment [doc. # 70] is GRANTED in part and DENIED in part.

I.

The dispute arises from a contract between Citizens and Trustmark for Trust-mark to supply medical stop-loss insurance to Citizens. Stop-loss insurance is purchased primarily by large corporations that self-insure their employees. The insurance reimburses the -corporation for *200 claims paid under its self-funded plan, usually pursuant to a high deductible. The primary purpose of stop-loss insurance is to avoid the risk of a single catastrophic claim. Citizens, as the seventh largest telephone company in the United States, with assets of nearly $7 billion (for the year ending Dec. 31, 2000), and with about 5000 employees, provides health insurance to its employees under such a self-funded health plan (the “Plan”). Citizens’ Mem. of Law in Supp. Of Summ. J. [doc. # 75], at 3; Trustmark’s Local Rule 9(c)(1) Statement [doc. #67] ¶ 1. This case involves disputes between Citizens and its stop-loss insurance provider, Trustmark, for reimbursement of medical expenses incurred by three individuals (Patrick Leggett, Thomas Grimme, and Garry Lonquist) who were beneficiaries of the Citizens Plan.

In July 1998, Citizens, through the third-party administrator of the Plan— North American Benefits Network (“NABN”) — hired Defendant ASL to serve as Citizens’ broker for acquiring medical stop-loss insurance. Amend. Compl. [doc. # 53] ¶ 16. ASL was to obtain rate quotations for stop-loss insurance with a $100,000 deductible that would reimburse Citizens for hospital and medical claims paid pursuant to the Plan. Id. In October 1998, ASL requested a rate quotation from RMTS, a company that markets the insurance products of other companies. Id. ¶ 19, 20.

The 1999 Policy. RMTS provided ASL with a rate quotation from Trustmark for the specific stop-loss insurance policy ASL had requested. Id. ¶ 22. Trustmark is an insurance company that issues stop-loss insurance coverage as well as other insurance products. Trustmark’s Local Rule 9(c)(1) Statement [doc. # 67] ¶ 4. In its rate quotation, dated October 15, 1998, RMTS presented Trustmark’s offer to ASL, stating that the proposed coverage was contingent on RMTS (and Trustmark) receiving certain information from Citizens about the persons to be covered by the policy. Id. ¶¶ 15-19. Specifically, Trust-mark requested identification of Citizens “[e]mployees and/or dependents currently disabled, under long-term treatment or on COBRA.” Id. ¶ 18. Additionally, Trust-mark requested information about “[c]laims (including names) which have exceeded $50,000 in the past twelve months and those expected to exceed $50,000 in the next twelve months with diagnosis and prognosis.” J.A. [doc. # 68] Ex.6 (emphasis in original). RMTS stated in bold-face type on the October 15, 1998 quotation that this information was “required in order for [it] to evaluate the risk and complete the application,” and stated that any proposed coverage was “contingent upon RMTS receiving the [ ] information” requested. Id. Apparently, ASL never asked Citizens to provide any of this information. Trustmark’s Local Rule 9(c)(1) Statement [doc. # 67] ¶ 23; Citizens’ Local Rule 9(c)(2) Statement [doc. # 89] ¶ 23.

However, ASL did request (through NABN) certain information from Citizens in a November 25, 1998 letter, in which ASL stated that it required, among other documents, a “[hjompleted and signed disclosure statement.” J.A. [doc. # 68] Ex. 8. NABN requested the information from Citizens in a letter dated December 15, 1998, asking that Citizens complete the Supplementary Contract Data Sheet for General Information and advising Citizens that the Data Sheet would act as a Disclosure Notice. Id. Ex. 9. The Disclosure Notice included eight questions designed to identify claims already in process as well as other potentially large claims involving individuals covered under the Citizens Plan. Question # 7 of the Disclosure Notice asked whether “any employee or dependent now enrolling for coverage had any medical condition(s) for which ex *201 penses have exceeded $10,000 in the past twelve months or which might be expected to exceed $10,000 in the next twelve months?” Id. Ex. 9 at 1832.

Marianne Seyler was at the time the Citizens benefits specialist responsible for providing information to , insurance vendors. It is undisputed that in response to Question #7, Ms. Seyler did not disclose any employees or dependents for which medical expenses might be expected to exceed $10,000 in 1999, although Ms. Sey-ler testified at her deposition that she understood that to be what Trustmark was asking for in Question # 7. Id. Ex. 11; Citizens’ Local Rule 9(c)(2) Statement [doc. # 89], ¶ 26, 27. Ms. Seyler did provide information about Citizens employees and dependents who had incurred claims in excess of $75,000 in 1998. J.A., Ex. 11. JoAnn Farrall, Citizens’ Director of Corporate Benefits and a Vice President of the company, signed the Disclosure Notice and mailed it to ASL on December 29, 1998, which forwarded it along to RMTS. Id. Neither Ms. Farrall nor Ms. Seyler advised Trustmark or RMTS that they were unable to obtain information fully responsive to Question #7. Dep. Of Marianne Seyler, J.A. [doc. # 69] Ex. 61, at 275-76.

Trustmark issued a medical stop loss insurance policy to Citizens, effective January 1, 1999, providing for an individual deductible of $100,000 with a 15/12 basis, which means that when the expenses for a covered individual exceeded $100,000 in claims paid by Citizens during 1999 for services rendered either in 1999 or the last three months of 1998, the claim would be eligible for reimbursement under the Trustmark policy. J.A. [doc. # 68] Ex. 7. The quoted monthly rate for the Trust-mark policy was determined based upon information provided by Citizens and its agents during the underwriting process. Id.

Patrick Leggett, an insulin-dependent diabetic spouse of a Citizens employee, was placed on a waiting list for a pancreatic transplant at some time in 1996 or 1997, and the procedure was pre-certified by Citizens at that time to be covered by the Citizens Plan. Citizens’ Local Rule 9(c)(2) Statement, ¶ 43. Mr. Leggett was not disclosed by Citizens on the Disclosure Form in response to the question about expected claims over $10,000 in 1999, Id. ¶48, although Citizens acknowledges that at least Ms. Farrall of Citizens knew about Mr.

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303 F. Supp. 2d 197, 2004 U.S. Dist. LEXIS 2423, 2004 WL 322348, Counsel Stack Legal Research, https://law.counselstack.com/opinion/citizens-communications-co-v-trustmark-insurance-ctd-2004.