Gough v. Transamerica Life Insurance

781 F. Supp. 2d 498, 2011 U.S. Dist. LEXIS 28407, 2011 WL 995948
CourtDistrict Court, W.D. Kentucky
DecidedMarch 17, 2011
DocketCivil Action 4:09CV-00120-JHM
StatusPublished
Cited by2 cases

This text of 781 F. Supp. 2d 498 (Gough v. Transamerica Life Insurance) is published on Counsel Stack Legal Research, covering District Court, W.D. Kentucky primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Gough v. Transamerica Life Insurance, 781 F. Supp. 2d 498, 2011 U.S. Dist. LEXIS 28407, 2011 WL 995948 (W.D. Ky. 2011).

Opinion

MEMORANDUM OPINION AND ORDER

JOSEPH H. McKINLEY, JR., District Judge.

This matter is before the Court on a motion by Defendant, Transamerica Life Insurance Company, for summary judgment [DN 15], on a motion by Plaintiffs, Michael and Carol Gough, for summary judgment [DN 23], on a motion by Defendant to strike Plaintiffs’ sur-reply [DN 45], and on a motion by Plaintiff for leave to file Judge G. Ross Anderson, Jr.’s Memorandum Opinion and to find that Judge Anderson’s decision controlling in this action [DN 47]. Fully briefed, these matters are ripe for decision.

I. STANDARD OF REVIEW

Before the Court may grant a motion for summary judgment, it must find that there is no genuine dispute as to any material fact and the moving party is entitled to judgment as a matter of law. Fed. R.Civ.P. 56(a). The moving party bears the initial burden of specifying the basis for its motion and of identifying that portion of the record which demonstrates the absence of a genuine issue of material fact. Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). Once the moving party satisfies this bur *501 den, the non-moving party thereafter must produce specific facts demonstrating a genuine issue of fact for trial. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-48, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986).

Although the Court must review the evidence in the light most favorable to the non-moving party, the non-moving party is required to do more than simply show there is some “metaphysical doubt as to the material facts.” Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986). The rule requires the non-moving party to present specific facts showing that a genuine factual issue exists by “citing to particular parts of materials in the record” or by “showing that the materials cited do not establish the absence ... of a genuine disputed]” Fed.R.Civ.P. 56(c)(1). “The mere existence of a scintilla of evidence in support of the [non-moving party’s] position will be insufficient; there must be evidence on which the jury could reasonably find for the [non-moving party].” Anderson, 477 U.S. at 252, 106 S.Ct. 2505. It is against this standard that the Court reviews the following facts.

II. BACKGROUND

This action arises under a supplemental cancer insurance policy issued by Equity National Life Insurance Company (“Equity National”) to Plaintiffs, Mike and Carol Gough (“Goughs”). Equity National is the predecessor in interest to Life Investors Insurance Company of America (“Life Investors”) and Transamerica Life Insurance Company (“Transamerica”). 1 Plaintiffs purchased a supplemental cancer insurance policy, Policy No. 01E128866, from Equity National on December 9, 1994. The Policy provided coverage for “actual charges” incurred for certain services. For several decades, the Defendant interpreted “actual charges” under these supplemental cancer insurance policies as the amount billed by the health care provider before any discount, reduction, write-off, or third-party payment. In 2006, without notice to its policyholders, Defendant altered its interpretation of “actual charges” paying benefits based upon the amount actually accepted by the health care provider as payment in full for the services rendered as reflected in the insured’s Explanation of Benefits.

In November of 2008, Carol Gough was diagnosed with breast cancer which included a partial mastectomy and began incurring charges for cancer-related services and treatments. In April 2009, Plaintiff began submitting claims for medical treatment to the Defendant under the Policy based upon the full amount billed by medical providers for her cancer treatment. James Byrne, Defendants’ Director of Claims Analysis, testified that Transamerica’s records show that Transamerica processed claims submitted by Plaintiff totaling $65,013.38 for services rendered between September 19, 2008, and April 21, 2009. Relying upon its new interpretation of “actual charges,” Defendant declined to pay Plaintiffs’ entire claim. Instead, Defendant paid benefits to Plaintiffs in the amount of $15,168.28. As a result of these actions, on November 9, 2009, Plaintiffs filed suit against Transamerica in Union Circuit Court for breach of contract for the underpayment of benefits due and owing under the policy.

Runyan v. Transamerica

Before this current action was filed, Transamerica was already litigating several cases involving the same factual and legal issues in state and federal courts *502 across the country. In fact, in 2007, three class actions were filed. See Gooch v. Life Investors Insurance Co. of America, No. 1:07CV-00016 (M.D.Tenn.2007); Smith v. Life Investors Insurance Co. of America, No. 2:07CV-00681 (Pa.Ct.C.P.2007); Pipes v. Life Investors Insurance Company of America, No. 1:07CV-00035 (E.D.Ark. 2007). Plaintiffs counsel in Pipes filed five additional cases against Defendant, including three class actions and two individual actions in various states including Arkansas, Mississippi, Michigan, and Louisiana. 2 Because plaintiffs counsel in Pipes represented the largest number of plaintiffs in related cases, counsel for Transamerica began settlement discussions with them in October of 2008. Hall v. Equity National Life Ins. Co., 730 F.Supp.2d 936, 938 (E.D.Ark.2010); Lindley v. Life Investors Ins. Co. of America, 2010 WL 944180 (N.D.Okla. March 11, 2010). The parties held confidential mediation on November 21 and 22, 2008, but did not reach a settlement. On November 21, 2008, the Pipes court denied the plaintiffs motion for class certification. Pipes v. Life Investors Ins. Co. of America, 254 F.R.D. 544, 550 (E.D.Ark.2008). “According to Transamerica’s counsel, the defendants continued to negotiate with Pipes’s counsel regarding settlement of all of the plaintiffs counsel’s related actions, even after the November mediation failed to result in a settlement.” Hall, 730 F.Supp.2d at 939.

On March 3, 2009, the parties reached a preliminary understanding on the terms of a class settlement. On March 13, 2009, a nationwide class action was filed in the Circuit Court of Pulaski County, Arkansas. See Runyan v. Transamerica Life Ins. Co., Civil Action No. CV-09-2066-3 (Circuit Ct., Pulaski County, Ark.) (hereinafter “Runyan”). “The Runyan state action essentially consolidated the claims of the plaintiffs in Pipes, Runyan, Ross, Weidman, Harris, and Nolan federal actions.” Hall, 730 F.Supp.2d at 939.

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Related

Gooch v. Life Investors Insurance Co. of America
672 F.3d 402 (Sixth Circuit, 2012)

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Bluebook (online)
781 F. Supp. 2d 498, 2011 U.S. Dist. LEXIS 28407, 2011 WL 995948, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gough-v-transamerica-life-insurance-kywd-2011.