Gunnells v. Healthplan Services, Inc.

348 F.3d 417, 2003 WL 22456752
CourtCourt of Appeals for the Fourth Circuit
DecidedOctober 30, 2003
Docket01-2419, 01-2420
StatusPublished
Cited by220 cases

This text of 348 F.3d 417 (Gunnells v. Healthplan Services, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fourth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Gunnells v. Healthplan Services, Inc., 348 F.3d 417, 2003 WL 22456752 (4th Cir. 2003).

Opinions

Affirmed in part, reversed in part, and remanded by published opinion. Judge DIANA GRIBBON MOTZ wrote the opinion, in which Judge KING concurred. Judge NIEMEYER wrote an opinion concurring in part and dissenting in part.

OPINION

DIANA GRIBBON MOTZ, Circuit Judge:

This appeal presents the question of whether the district court abused its discretion in conditionally certifying a class action in a suit brought by purchasers and beneficiaries of a multi-employer health care plan for claims growing out of the plan’s collapse. The district court conditionally granted class certification against the plan’s claims administrator, Healthplan Services Inc., as successor in interest to Third Party Claims Management, Inc. (collectively, “TPCM”) and against individual and corporate insurance agents who marketed and sold the plan. The court properly applied controlling legal principles and made well-supported factual findings supporting its decision to certify a class action against TPCM; thus, we see no abuse of discretion in that decision. However, because the court rested its class certification against the individual agents on findings grounded in a misapprehension of governing law, we must conclude that the court did abuse its discretion in certifying those separate class actions. Accordingly, we affirm in part, reverse in part, and remand for further proceedings consistent with this opinion.

[422]*422I.

Since this is an interlocutory appeal, filed even before the parties have completed discovery, the facts surrounding the claims of the purchasers and beneficiaries (collectively, “Plaintiffs”) have not been fully developed. Thus, the record to date reveals only the following rough outline of the events leading up to the present lawsuit.

Sometime in 1995, Fidelity Group, Inc., the National Association of Business Owners and Professionals (“NABOP”), and the International Workers Guild, Inc. (“IWG”), created the IWG Health and Welfare Fund (the “Fund”), which in turn offered a health care and dental plan (the “Plan”) to interested purchasers. From August 1996 until June 1997, when the South Carolina Department of Insurance ordered marketing to cease, the agents marketed and sold the Plan. Although it was purportedly marketed as an ERISA plan, the Plan never complied with ERISA requirements.

In April 1995, Fidelity hired TPCM to process claims under the Plan as a third party administrator. TPCM failed to keep pace with the claims received, creating a huge backlog of unprocessed claims. In May 1997, Fidelity fired TPCM for incompetence and attempted to transfer the claims management process to an in-house operation. Assertedly, difficulties in obtaining data from TPCM and the massive backlog it had created ultimately led to the Plan’s collapse.

Approximately 1400 employees and their families contracted for coverage under the Plan. As many as 2900 claims have gone unpaid, amounting to millions of dollars in unpaid medical bills.

In August 1998, Plaintiffs sued Fidelity Group, NABOP, IWG, and the Fund (collectively, “the Fidelity Defendants”) in state court in South Carolina. The defendants removed the case to federal court. Later in the year, Plaintiffs amended their complaint to add TPCM and the agents as defendants. In that complaint, Plaintiffs allege that one or more of the defendants engaged in negligent undertaking, fraud, negligent misrepresentation, breach of contract, civil conspiracy, and violated the South Carolina Unfair Trade Practices Act, S.C.Code Ann. § 39-5-140 (1985), and Title IX of the Organized Crime Control Act of 1970, 18 U.S.C.A. §§ 1961-68 (West 2000 & Supp.2000) (“RICO”).1 In short, Plaintiffs assert that the agents breached contractual and fiduciary duties owed to the Plaintiffs and misrepresented the Plan’s attributes through then." marketing efforts, which caused Plaintiffs to purchase the woefully deficient Plan. As to TPCM, Plaintiffs allege that it mismanaged administration of the Plan, created a huge backlog of unpaid claims, did not timely transfer information, and made it impossible to forecast rate increases accurately, resulting in the Plan’s collapse and failure to pay hundreds, if not thousands, of health care claims. In their prayer for relief, Plaintiffs

seek recovery for all legally allowable damages including refunds of premiums paid, payment of outstanding medical/dental bills, reimbursement for medi[423]*423cal bills paid by Plaintiffs where treatment occurred while Plaintiff [s were] covered by the Plan, compensation for injury to credit, compensation for injury to ability to obtain credit, time spent and costs incurred attending to the difficulties resulting from the failure of the Plan, loss of enjoyment of life attendant to the stress caused by the failure of the Plan.

Plaintiffs also seek punitive damages.

After some initial discovery, Plaintiffs moved for certification of a class, pursuant to Federal Rule of Civil Procedure 23(b)(3), of “all entities and people who purchased the Fidelity Plan or who were provided with coverage under the Fidelity Plan in South Carolina at any time.” In addition, with respect to certain “agent-specific” claims, Plaintiffs moved for certification of subclasses consisting of “all entities and persons who purchased the Fidelity Plan from or were provided the Fidelity Plan by that particular agent in South Carolina.”

After refusing to certify any claims under the South Carolina Unfair Trade Practices Act, see S.C.Code Ann. § 39-5-140(a) (West 1985) (a person “may bring an action individually, but not in a representative capacity, to recover actual damages”), the district court granted Plaintiffs’ class certification motion in large part. Gunnells v. Fidelity Group, Inc., No. 2:98-2639-23 (D.S.C. Sept. 28, 2001) (located at J.A. 1244-1271). The court conditionally granted Plaintiffs’ motion for class certification with respect to their mismanagement claim against TPCM. Moreover, although the court declined to certify Plaintiffs’ civil conspiracy and RICO claims against the agents, it did certify subclasses to permit Plaintiffs to pursue their four theories of liability— negligent undertaking, fraud, negligent misrepresentation, and breach of contract — via separate class actions against each of the twenty-three agents that as-sertedly sold insurance to a named class representative, withholding “ruling on the certification of the agent classes for which there [wa]s currently no representative.” J.A. 1265 n.21.

Pursuant to Federal Rule of Civil Procedure 23(f), both TPCM and a number of agents2 (collectively, “the Agents”) petitioned for permission to file an interlocutory appeal, which we granted.

II.

Class actions must meet several criteria. First, the class must comply with the four prerequisites established in Rule 23(a): (1) numerosity of parties; (2) commonality of factual and legal issues; (3) typicality of claims and defenses of class representatives; and (4) adequacy of representation. Fed.R.Civ.P. 23(a).

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348 F.3d 417, 2003 WL 22456752, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gunnells-v-healthplan-services-inc-ca4-2003.