Doe v. Guardian Life Insurance Co. of America

145 F.R.D. 466, 16 Employee Benefits Cas. (BNA) 1400, 1992 U.S. Dist. LEXIS 21196, 1992 WL 401727
CourtDistrict Court, N.D. Illinois
DecidedApril 27, 1992
DocketNo. 89 C 7955
StatusPublished
Cited by24 cases

This text of 145 F.R.D. 466 (Doe v. Guardian Life Insurance Co. of America) 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
Doe v. Guardian Life Insurance Co. of America, 145 F.R.D. 466, 16 Employee Benefits Cas. (BNA) 1400, 1992 U.S. Dist. LEXIS 21196, 1992 WL 401727 (N.D. Ill. 1992).

Opinion

MEMORANDUM OPINION AND ORDER

ANN CLAIRE WILLIAMS, District Judge.

Plaintiffs John Doe I (“Doe I”), John Doe II (“Doe II”), and John Doe IV (“Doe IV”) brought this claim on behalf of all participants and beneficiaries of certain employee health insurance policies issued by defendants Guardian Life Insurance Company of America, (“Guardian Life”), The Travelers Insurance Company of Illinois (“Travelers”), and Blue Cross and Blue Shield of Illinois (“Blue Cross”), alleging that the defendants breached the terms of the pertinent insurance policies, breached their fiduciary duties under the Employee Retirement Income Security Act of 1974 (“ERISA”), and violated certain ERISA disclosure requirements. The plaintiffs claim that the defendants wrongfully refused to accept insurance claims that they and other beneficiaries submitted for treatment of bipolar affective disorder. The plaintiffs seek declaratory and injunctive relief, compensatory damages for benefits denied them, monetary penalties under ERISA § 502(e)(1), costs and expenses of this action, and reasonable attorney’s fees under ERISA § 502(g).

The plaintiffs subsequently brought a motion for leave to proceed in this case as a class action suit and the court referred the matter to Magistrate Judge Gottschall for a report and recommendation. During the course of the briefing on the motion, the parties brought four separate motions to strike materials submitted regarding the class certification motion. The plaintiffs moved to strike the affidavit of Dr. David A. Gehlhoff. The plaintiffs also moved to strike certain excerpts of Doe IV’s deposition testimony. Defendant Blue Cross moved to strike certain of the plaintiffs’ statements regarding Doe IV’s deposition testimony and Defendant Guardian Life moved to strike the plaintiffs’ supplemental response to Guardian Life’s second request to admit.

The Magistrate Judge, in a thorough and well reasoned report, recommended that the plaintiff’s motion to proceed as a class be denied. The Magistrate Judge also recommended that all the motions to strike be denied. For the reasons stated below, the court adopts the Magistrate Judge’s report and recommendation. Plaintiffs’ motion for leave to proceed as a class is denied and plaintiffs’ and defendants’ motions to strike are also denied.

BACKGROUND

The facts of this case were fully explained in the Magistrate Judge’s report and recommendation. For the purposes of [470]*470this opinion, a brief summary of the facts is necessary. As already noted, the plain-' tiffs are participants in employee welfare benefit plans that provide health insurance benefits under policies issued by the three defendant insurance companies in this case. The plaintiffs bring this suit on behalf of certain family members who are beneficiaries under these plans. These beneficiaries have allegedly been diagnosed as suffering from bipolar affective disorder (also known as manic depressive disorder). The plaintiffs have submitted claims for reimbursement of costs incurred in treating these individuals, but the defendants have denied their claims or limited the amount of benefits paid.

The defendants have denied such claims for reimbursement because they assert that the pertinent insurance policies classify the disorder as a “mental illness” subject to more limited coverage than treatment of a “physical illness.” The plaintiffs contend that bipolar affective disorder is a “biological, physical disorder of the brain functions, with multiple symptomatic manifestation” and assert that they are entitled to full reimbursement from their respective insurance companies for the costs of treating this illness. See Second Amended Complaint at 11 5. Because the plaintiffs believe that health insurance policies issued by the defendants to other employee benefit plans similarly limit benefits for treatment of the disorder, the plaintiffs seek to certify a class comprised of all participants and beneficiaries of these plans who have submitted health insurance claims on behalf of themselves or other beneficiaries, or have had claims submitted on their behalf for treatment of bipolar affective disorder and whose claims have been limited or denied by the defendants under the mental or emotional condition of their respective plans.

The first named plaintiff is Doe I, a partner in a law firm that established an employee benefit plan carrying an insurance policy from defendant Guardian Life. In pertinent part, Guardian Life’s policy limits coverage for the psychological treatment of mental and emotional conditions, drug abuse, and alcohol abuse. Plaintiff’s Memo, Exhibit A.1 Doe I has filed claims with Guardian Life for the treatment of his wife, Jane, purportedly for bipolar affective disorder. Guardian Life vehemently contests the nature of her condition. Guardian Life also claims that Doe I is estopped from claiming that his wife is not mentally ill based upon statements made by Doe I during earlier guardianship proceedings for the involuntary admission of his wife. Guardian Life further claims that Doe I is not an appropriate class representative because he has allegedly reached an agreement with his wife’s doctors to pay only half the amounts due to them if he succeeds and nothing if he fails in this law suit. Doe I seeks the recovery of $18,000 in expenses.

Plaintiff Doe II’s employer selected an insurance policy for its employee benefit plan offered through the Illinois Manufacturers Association (“IMA”). The IMA negotiated the provision of the policy in question from defendant Travelers. Travelers claims that all of its policies issued through IMA have some form of limitation on benefits for mental or nervous disorders, although the policies differ as to the level of benefits. Doe IPs policy covers certain expenses for non-confining mental or nervous disorders up to $1,000 and has a maximum lifetime benefit for mental disorders of $50,000. Doe II is the only one of approximately 58 participants in his plan to submit a claim of this type. His total claims exceed the $50,000 lifetime limit and he seeks the recovery of expenses totalling more than $30,000.

Doe IPs claims arise from the treatment of his son, James. Travelers, like Guardian Life, argues that Doe II is estopped from raising his claim based upon proceedings brought by Doe II for the involuntary commitment of his son. Travelers also argues that Doe IPs son suffers from a mental illness because he has undergone psycho[471]*471therapy. Travelers further argues that Doe II’s son is not a “dependent” within the meaning of the pertinent policy and thus is not entitled to their insurance coverage.

Finally, Plaintiff Doe IV is president of a small company. Doe IV purchased the company’s insurance policy from defendant Blue Cross. Blue Cross’ policy limits services for the treatment of mental illnesses to $25,000 per benefit period and $50,000 per lifetime. Outpatient mental services are reimbursed at a maximum rate of $25 per visit up to a maximum of $1,000 per benefit period and $10,000 per lifetime. “Mental illness” is defined by the policy as “those illnesses classified as mental disorders in Section II of the current edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.” Plaintiff’s Memo, Exhibit C at 26.

Blue Cross does not contest that Doe IV’s son, Joe, suffers from bipolar affective disorder. There is also no evidence that Doe IV has brought proceedings for the involuntary admission of his son.

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Bluebook (online)
145 F.R.D. 466, 16 Employee Benefits Cas. (BNA) 1400, 1992 U.S. Dist. LEXIS 21196, 1992 WL 401727, Counsel Stack Legal Research, https://law.counselstack.com/opinion/doe-v-guardian-life-insurance-co-of-america-ilnd-1992.