HORWITZ EX REL. v. Bankers Life and Cas. Co.

745 N.E.2d 591, 319 Ill. App. 3d 390, 253 Ill. Dec. 468, 2001 Ill. App. LEXIS 61
CourtAppellate Court of Illinois
DecidedFebruary 16, 2001
Docket1 — 00—0336
StatusPublished
Cited by39 cases

This text of 745 N.E.2d 591 (HORWITZ EX REL. v. Bankers Life and Cas. Co.) is published on Counsel Stack Legal Research, covering Appellate Court of Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
HORWITZ EX REL. v. Bankers Life and Cas. Co., 745 N.E.2d 591, 319 Ill. App. 3d 390, 253 Ill. Dec. 468, 2001 Ill. App. LEXIS 61 (Ill. Ct. App. 2001).

Opinion

JUSTICE GREIMAN

delivered the opinion of the court:

Plaintiff Fern Horwitz (Horwitz), by her father and attorney-in-fact, brought this action on behalf of herself and a purported class of policyholders who were allegedly injured by the manner in which the defendant insurance company, Bankers Life & Casualty Company (Bankers), calculated and applied its premium rates for individual health insurance policies. Plaintiff claimed that the manner in which Bankers calculated those premiums breached its contract (counts III and IV), violated section 364 of the Illinois Insurance Code (Insurance Code) (215 ILCS 5/364 (West 1994)) (counts I and II), and violated section 2 of the Illinois Consumer Fraud and Deceptive Business Practices Act (Consumer Fraud Act) (815 ILCS 505/2 (West 1994)) (count VI). She also claimed that Bankers breached its contract with her by increasing her premiums twice — rather than once — during a few years that her coverage was in effect (count V), and that Bankers fraudulently concealed from her some of the practices she claims were unlawful (count VII).

Initially, the trial court partially granted summary judgment as to count III in plaintiffs favor and summary judgment as to count V in defendant’s favor. Bankers then asked the court to reconsider its ruling as to count III, which was granted. Ultimately, the trial court dismissed all of plaintiffs claims, holding that: (1) plaintiffs policy was governed by Colorado law; (2) plaintiffs breach of contract and consumer fraud claims were barred by the filed rate doctrine; (3) no private right of action exists under section 364; and (4) defendant had not breached its contract by increasing premiums more than once during certain policy years. However, the court only decided Horwitz’s individual claims and never decided whether the case should proceed as a class action. Plaintiff now appeals the trial court’s ruling on counts I through III, V and VI of her third amended complaint. 1 For the reasons that follow, we affirm in part, reverse in part, and remand the cause for further proceedings.

This case arose from a dispute between Horwitz and Bankers regarding premium increases for plaintiffs individual health insurance policy. Specifically, plaintiff alleges that, beginning in February 1991, defendant increased her premiums by amounts greater than permitted by the terms of her policy. She also claims that, beginning in 1991, defendant increased her premiums more often than allowed by her policy. These formed the bases of plaintiffs complaint.

In February of 1985, Joel Horwitz, plaintiff’s then-husband, purchased a family policy from Bankers under form CR-97N. At that time, the Horwitz family was living in Denver, Colorado. In September of that year, plaintiff became disabled by mental illness. In September of 1986, while divorce proceedings were pending and the Horwitzes still lived in Colorado, Mr. Mark Gilbert (Gilbert), plaintiffs father, asked Mr. Horwitz to agree to the issuance of a separate policy, in plaintiffs own name, for which plaintiff would be solely responsible. Mr. Horwitz agreed, and plaintiffs individual policy was issued to her on October 2, 1986, at which time she was residing at the Colorado Mental Health Institute in Fort Logan, Colorado.

In approximately September of 1987, plaintiff moved to Illinois and became an Illinois resident. Defendant, however, continued to treat her policy as a Colorado policy in accordance with its established practice concerning insureds who move from state to state. In short, to avoid confusion regarding premium rates and coverages, in such instances, Bankers follows a “state of issuance” rule, under which it continues to apply the premium rates and coverages of the state of issuance. Thus, defendant charged plaintiff the Colorado premium rates after plaintiff moved to Illinois. Defendant also notified plaintiff of this fact after she moved and invited her to convert her policy to an Illinois policy. Plaintiff declined and paid the Colorado premium rates throughout the life of her policy.

In February of 1995, plaintiff filed a two-count complaint that asserted claims under section 364 of the Illinois Insurance Code and for breach of contract, based on defendant’s use of its experience with claims and losses under form CR-97N to determine the premium rates applicable to that form. In February of 1997, plaintiff filed her third amended complaint, which contained seven counts that were all based on the allegations of “the death spiral,” which will be described hereinafter.

In her complaint, plaintiff asserted that the defendant gutted the value of the policy by “closing the block” — meaning that the policy series was no longer sold to new customers. The impetus for such action, plaintiff argued, is that as the number and amount of loss claims (loss experience) grow larger for a policy series, an insurance company becomes trapped in having to renew an economically improvident policy. The effect of Bankers’ response to this phenomenon, however, was that Bankers began pricing its renewal premiums based on the loss experience of just that closed block group. In other words, by “closing the block,” Bankers’ calculations of what the policyholder’s renewable premiums should cost arose only from the statistical data of those remaining in the closed block group. As this limited pool of insureds became older and more sickly, the argument continued, their claims increased and their renewal rates, or premiums, rose. 2 As they rose, healthy insureds, who could obtain coverage elsewhere, cancelled their policies, leaving behind only those policyholders whose medical condition prevented other coverage. Those who could not qualify for new coverage, consequently, either died or could no longer afford to keep their coverage alive by paying the dramatic premium increases. Ultimately, plaintiff asserted, Bankers was able to force their healthcare costs to be shifted from Bankers to the insureds (resulting in, effectively, self-insurance) and accomplished nonrenewal by forcing them off the policy. This is what is referred to by plaintiff as the “death spiral.”

Counts I, II, iy and VII were dismissed under section 2 — 615 of the Code of Civil Procedure (735 ILCS 5/2 — 615 (West 1994)) as follows. On November 20, 1995, and on May 24, 1996, the circuit court dismissed with prejudice plaintiffs claims alleging a violation of section 364 of the Illinois Insurance Code, on the ground that no private right of action exists under section 364. These claims were counts I and II of plaintiff’s original complaint and were subsequently repleaded in all of the amended complaints. On June 13, 1997, the circuit court dismissed without prejudice plaintiffs claims alleging (a) breach of contract based on allegedly selective premium increases, and (b) fraudulent concealment, which were counts IV and VII of plaintiffs third amended complaint. Plaintiff never repleaded these claims.

However, counts III and V were made the subjects of cross-motions for partial summary judgment. While the circuit court partially granted summary judgment to defendant on count V it also partially granted summary judgment to plaintiff on count III.

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Bluebook (online)
745 N.E.2d 591, 319 Ill. App. 3d 390, 253 Ill. Dec. 468, 2001 Ill. App. LEXIS 61, Counsel Stack Legal Research, https://law.counselstack.com/opinion/horwitz-ex-rel-v-bankers-life-and-cas-co-illappct-2001.