Kuei-I Wu v. Mamsi Life & Health Insurance

256 F.R.D. 158, 2008 U.S. Dist. LEXIS 107359
CourtDistrict Court, D. Maryland
DecidedOctober 15, 2008
DocketCivil Action No. RDB-07-1170
StatusPublished
Cited by7 cases

This text of 256 F.R.D. 158 (Kuei-I Wu v. Mamsi Life & Health Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Maryland primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Kuei-I Wu v. Mamsi Life & Health Insurance, 256 F.R.D. 158, 2008 U.S. Dist. LEXIS 107359 (D. Md. 2008).

Opinion

MEMORANDUM OPINION

RICHARD D. BENNETT, District Judge.

Plaintiff Kuei-1 Wu (“Wu”) filed this class action lawsuit in the Circuit Court for Baltimore County against her healthcare provider, MAMSI Life and Health Insurance Co. (“MLH”), and MLH’s parent companies, Mid-Atlantic Medical Services LLC, and Mid-Atlantic Medical Services, Inc. (“MAM-SI”) for breach of contract (Count 1), breach of the duty of good faith and fair dealing (Count II), and civil conspiracy (Count III). Defendants removed this action on May 3, 2007. Wu seeks injunctive relief, monetary damages, and restitution. Wu alleges that, in the event that an insured is in an automobile accident, Defendants illegally direct providers to collect Personal Injury Protection (“PIP”) from an automobile insurer as a precondition to submitting a claim for payment of medical services. This scheme, Wu contends, is in direct violation of section 19-507 of the Insurance Article of the Maryland Code, which provides that PIP benefits “shall be payable without regard to ... any collateral source of medical, hospital, or wage continuation benefits.” Md.Code. Ann., Ins. § 19-507(a)(2).

Before being removed to this Court, the Circuit Court for Baltimore County certified a class that is the subject of the pending motions. After litigating the class certification in state court for over thirty months, both parties now seek modifications to the state court’s class certification order. Defendants filed a Motion for Clarification of Class Membership (Paper No. 80) and Plaintiffs filed a Cross Motion for Clarification of Class Definition (Paper No. 87). On August 20, 2008, this Court conducted a hearing on both pending motions pursuant to Local Rule 105.6 (D.Md.2008). For the reasons that follow, Defendants’ Motion for Clarification of Class Membership is GRANTED IN PART and DENIED IN PART and Plaintiffs’ Cross Motion for Clarification of Class Definition is DENIED.

It should be noted, however, that the parties’ extensive briefs address several complicated issues that relate primarily to the merits of Plaintiffs’ case, not necessarily the appropriate size of the class. Therefore, this Memorandum Opinion will deal exclusively with the issues relating to class size, reserving for a later time issues going to the merits of the case.

BACKGROUND

Wu initiated this action on September 24, 2004, by filing a three-count class action complaint in the Circuit Court for Baltimore County against three separate MAMSI entities — MLH, MAMSI LLC, and MAMSI Inc. Wu’s complaint states that the relationship between the Defendants is as follows: “[MLH] is an insurance company licensed to issue health insurance policies in the State of Maryland. [MLH] is the wholly-owned subsidiary of [MAMSI LLC]. Previously, [MLH] was a wholly-owned subsidiary of [MAMSI Inc.], which ... recently merged with [MAMSI LLC].” (Compile 4-6.)

Almost three years prior to filing suit, on September 26, 2001, Wu was involved in an automobile accident while she was a full-time student at the University of Maryland. At the time of the accident, Wu carried at least two insurance policies — (1) a health insur-[161]*161anee plan issued by MLH; and (2) an automobile policy issued by GEICO. Wu’s health insurance plan was not governed by the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001, et seq. because (1) the plan covered students, not employees and (2) she was covered under a state governmental plan. See 29 U.S.C. § 1003(a) (“[T]his title shall apply to any employee benefit plan ----” (emphasis added)); id. § 1003(b)(1) (“The provisions of this title shall not apply to any employee benefit plan if ... such plan is a governmental plan.”).

Wu sought treatment with participating healthcare providers under the Preferred Provider Option (“PPO”) plan to which Wu belonged. (Comply 21.) The participating providers had agreed with MAMSI to provide medical care to members. In exchange, they were paid at a negotiated rate, and further agreed not to balance, bill, or collect any other amount from members for whom they provided “Covered Services.” (Id.) MAMSI’s contract with Wu contained a Coordination of Benefits provision that explicitly excluded any no-fault automobile insurance payments, such as PIP, from being considered in the application of the Coordination of Benefits procedures. (Id. ¶ 18.) Wu alleges that, “in a separate document known as the Provider Manual for Physicians and Practitioners, MAMSI illegally directs all providers within its healthcare plans that when the patient has been involved in an automobile accident, the providers must collect PIP benefits from the patient’s automobile insurer first, before submitting any claims to MAMSI for payment.” (PL’s Cross Mot. 4; see id. Ex. A.) Thus, according to Wu’s Complaint, MAMSI paid the participating healthcare providers for services rendered to Wu only after her PIP benefits were exhausted.

Wu’s Complaint sought certification of a two separate classes of individuals: (1) a general class of all insureds who had coverage under both the “Defendants’ healthcare insurance policies” and an automobile insurance policy with PIP coverage, regardless of whether any putative class member had been involved in an automobile accident; and (2) a subclass of the same insureds who were also involved in an automobile accident and “whose mandatory PIP coverage was entirely exhausted by the Defendants’ preferred providers prior to the Defendants paying such preferred providers on any claims made by the Defendants’ insured.” (Compl.lffl 8-9.)

Approximately thirty months after Wu filed her Complaint, during which time Defendants “vigorously opposed certification of any class” (Defs.’ Mem. Supp. Mot. Clarification 4), the Circuit Court for Baltimore County granted in part and denied in part Wu’s class certification motion on April 5, 2007. The circuit court did not certify the larger general class, reasoning that there was no legally cognizable injury unless and until the individual had been involved in a motor vehicle accident and filed a related claim with MAMSI. The circuit court did, however, certify the smaller subclass consisting of “all owners of MAMSI healthcare plans since September 23, 2001 that also have automobile insurance policies, have had an automobile accident, and whose mandatory PIP coverage was partially or entirely exhausted prior to the use of any MAMSI healthcare benefits.” (Defs.’ Notice of Removal, Ex. C, at 13.) In the last sentence of the state court’s opinion, it defined “MAMSI” to include the three named Defendants in this case: MLH, the indemnity health insurance company with which Wu was insured, and MAMSI LLC and MAMSI Inc., the parent companies. (Id.) It also included in that definition two additional subsidiary health maintenance companies (“HMOs”) under the MAMSI corporate umbrella, but with which Wu did not have an insurance policy: M.D. Individual Practice Association, Inc. (“MDI-PA”) and Optimum Choice, Inc. (“OCI”). (Id.)

The class certification order on April 5, 2007 brought into the case for the first time class members with employee health plans governed by ERISA. As mentioned previously, Wu’s individual claim was not preempted by ERISA, but the state court class certification order included class members with claims that were preempted by ERISA.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Fariasantos v. Rosenberg & Associates, LLC
303 F.R.D. 272 (E.D. Virginia, 2014)
In re Titanium Dioxide Antitrust Litigation
962 F. Supp. 2d 840 (D. Maryland, 2013)
Kuei-I Wu v. Mamsi Life & Health Insurance
269 F.R.D. 554 (D. Maryland, 2010)
Cassese v. Washington Mutual, Inc.
262 F.R.D. 179 (E.D. New York, 2009)
Mendez v. Radec Corp.
260 F.R.D. 38 (W.D. New York, 2009)

Cite This Page — Counsel Stack

Bluebook (online)
256 F.R.D. 158, 2008 U.S. Dist. LEXIS 107359, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kuei-i-wu-v-mamsi-life-health-insurance-mdd-2008.