Doiron v. Conseco Health Insurance

240 F.R.D. 247, 2007 U.S. Dist. LEXIS 20111
CourtDistrict Court, M.D. Louisiana
DecidedFebruary 15, 2007
DocketCivil Action No. 04-784-JJB-CN
StatusPublished
Cited by1 cases

This text of 240 F.R.D. 247 (Doiron v. Conseco Health Insurance) is published on Counsel Stack Legal Research, covering District Court, M.D. Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Doiron v. Conseco Health Insurance, 240 F.R.D. 247, 2007 U.S. Dist. LEXIS 20111 (M.D. La. 2007).

Opinion

RULING ON MOTION FOR CLASS CERTIFICATION

BRADY, District Judge.

This matter is before the court on a Motion for Class Certification filed by the plaintiff (doe. 85). The defendant, Conseco Health Insurance Company (“Conseco”), has filed a Memorandum in Opposition to the plaintiffs Motion for Class Certification (doc. 90). The parties have also filed supplemental documents in support of their respective positions.

BACKGROUND FACTS

The proposed lead plaintiff, Diana Doiron, filed suit against the defendant alleging that the defendant has breached its contractual obligations. Specifically, the plaintiff alleges that on or about March 1, 1988, she purchased a policy of cancer insurance for herself, and her husband, Steve Doiron.1 The plaintiff further alleges that the policy obligated the defendant to pay specified benefits for charges incurred if she or her husband was diagnosed with cancer. The plaintiff maintains that unlike medical insurance, the cancer policy required that the benefits be paid directly to the policyholder if the policyholder met the required terms and conditions of the policy.

On or about March 27, 2001, Steve Doiron was diagnosed with cancer. Mr. Doiron underwent medical treatment for his condition including radiation treatment and chemotherapy treatment. Mr. Doiron passed away due to his illness on December 23, 2001. The plaintiff alleges that she submitted proof of loss, medical records, medical bills, and other documentation to Conseco to obtain the medical benefits due under the policy. Conseco paid some of the benefits but denied other benefits.

The plaintiff asserts that the defendant’s failure to pay all of the benefits is a breach of its contractual obligations. The plaintiff desires to have the litigation certified as a class action to include other plaintiffs who are similarly situated. The plaintiff contends that “she, and the members of the SubClasses she seeks to represent, were and will continue to be denied claims for benefits for certain charges they commonly and typically incurr(ed), and which claims Conseco consistently deny(ied), for their radiation treatment and/or chemotherapy treatment.”2

The plaintiff proposes two sub-classes. One sub-class would consist of policyholders who incurred specified charges as part of their radiation treatment and whose claims were or will be denied by Conseco (Radiation Treatment Subclass). The other sub-class would be composed of policyholders who incurred specified charges as part of their chemotherapy treatment and whose claims were or will be denied by Conseco (Chemotherapy Treatment Sub-Class).

ANALYSIS

1. Defining the Class

The plaintiff proposes the following subclasses:

[250]*250Radiation Treatment Sub-Class: All persons, since June 15, 2001, who are/were insured by a “ZH” supplemental cancer insurance policy form purchased in Louisiana from Capitol American Life Insurance Company or Conseco Health Insurance Company, and who, while a resident of Louisiana, submitted a claim for the payment of benefits under the Radiation / Chemotherapy Benefit provision of the “ZH” policy for one or more of the following charges: office visit/consultation charges; treatment planning charges; treatment management charges; simulation charges; dosimetry charges; treatment device charges; medical radiation physics charges; isodose plan charges; radiation special services charges; and/or supportive and protective drug charges, incurred as part of the policyholder’s radiation treatment, and which claims were or will be denied by Conseco through the date of final judgment in this case.
Chemotherapy Treatment Sub-Class: All persons who, since June 15, 2001, are/were insured by a “ZH” supplemental cancer insurance policy form purchased in Louisiana from Capitol American Life Insurance Company or Conseco Health Insurance Company, and who, while a resident of Louisiana, submitted a claim for the payment of benefits under the Radiation/Chemotherapy Benefit provision of the “ZH” policy for one or more of the following charges: office visit/consultation charges; medical supply charges; solution charges; procedure charges; and/or supportive and protective drug charges, incurred as part of a policyholder’s chemotherapy treatment, and which claims were or will be wrongfully denied by Conseco through the date of a final judgment in this case.

(Emphasis added).

The defendant objects to the language in the Chemotherapy Treatment Sub class which states that the class incurred claims which “were or will be wrongfully denied by Conseco through the date of a final judgment in this case.”

The plaintiff concedes that the inclusion of the word “wrongfully” is improper and states that it removed the term from the Radiation Treatment Sub-class definition, but the word was inadvertently left in the Chemotherapy Treatment sub class definition.

Accordingly, the court will omit the word “wrongfully” from the Chemotherapy Treatment sub-class definition and will consider the proposed sub-classes with the amended definition.

II. Class Certiñcation: Overview of Rule 23

This court has substantial discretion in determining whether to certify a class action pursuant to Rule 28 of the Federal Rules of Civil Procedure.3 Nevertheless, despite the discretionary nature of a class certification ruling, this court must conduct a rigorous analysis to ensure that the requirements of Rule 23 have been met.4 As movers for class certification, the plaintiffs bear the burden of proving that the elements of Rule 23 have been met.5

Rule 23(a) sets forth four threshold requirements that must be satisfied by the putative class before a case is certified as a class action. The plaintiff must establish that: 1) the class is so numerous that joinder of all members is impractical (“numerosity”); 2) questions of law or fact are common to the class (“commonality”); 3) the claims or defenses of the representative parties are typical of the claims or defenses of the class (“typicality”); and 4) the plaintiff and its counsel will fairly and adequately protect the interest of the class (“adequacy of representation”).

[251]*251If these four prerequisites are met, the plaintiff must further satisfy one of the three categories listed in Rule 23(b). Under 23(b), the plaintiff must show that: 1) separate actions would result in inconsistent adjudications or the non-parties interests will be substantially impaired; 2) final injunctive or declaratory relief is appropriate to the class as a whole; or 3) common questions of law or fact predominate over any questions affecting only individual members and a class action is the superior method of fairly and efficiently adjudicating the controversy.

III. Rule 23(a)

A) Numerosity

Rule 23(a)(1) requires that the class be so numerous that joinder of all members is impracticable. Although numbers alone are not dispositive of the numerosity inquiry,

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Cite This Page — Counsel Stack

Bluebook (online)
240 F.R.D. 247, 2007 U.S. Dist. LEXIS 20111, Counsel Stack Legal Research, https://law.counselstack.com/opinion/doiron-v-conseco-health-insurance-lamd-2007.