Kuei-I Wu v. Mamsi Life & Health Insurance

269 F.R.D. 554, 77 Fed. R. Serv. 3d 1033, 2010 U.S. Dist. LEXIS 110336, 2010 WL 4075986
CourtDistrict Court, D. Maryland
DecidedOctober 18, 2010
DocketCivil Action No. RDB-07-CV-1170
StatusPublished
Cited by3 cases

This text of 269 F.R.D. 554 (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, 269 F.R.D. 554, 77 Fed. R. Serv. 3d 1033, 2010 U.S. Dist. LEXIS 110336, 2010 WL 4075986 (D. Md. 2010).

Opinion

MEMORANDUM OPINION

RICHARD D. BENNETT, District Judge.

Plaintiff Kuei-I Wu (“Wu”), on behalf of herself and others similarly situated, filed this class action lawsuit in the Circuit Court for Baltimore County against her healthcare provider MAMSI Life & Health Insurance Co. (“MLH”), and MLH’s parent companies, Mid-Atlantic Medical Services LLC (“MAM-SI LLC”), and Mid-Atlantic Medical Services, Inc. (“MAMSI Inc.”) (collectively “MAMSI” or “Defendants”) for breach of contract, breach of the duty of good faith and fair dealing, and civil conspiracy. Defendants removed this action to this Court on May 3, 2007, pursuant to 28 U.S.C. § 1441. 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 health care providers to collect Personal Injury Protection (“PIP”) from an automobile insurer as a precondition to submitting a claim for payment of medical services. Before removal to this Court, the Circuit Court for Baltimore County certified a class that is the subject of the pending motion.1 Defendants have filed a Motion to Decertify the Class (Paper No. 143). The parties fully briefed the motion and this Court conducted a hearing on the pending motion pursuant to Local Rule 105.6 (D.Md.2010) on October 6, 2010. For the reasons that follow, Defendants’ Motion to Decertify the Class (Paper No. 143) is GRANTED.

BACKGROUND

Many of the facts of this case are thoroughly described in the Memorandum Opinion issued by this Court on October 15, 2008 and will not be recited in full here. See Wu v. MAMSI Life & Health Ins. Co., 256 F.R.D. 158 (D.Md.2008) (Paper No. 99). However, a brief discussion of the underlying facts and procedural history is warranted.

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. 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 insurance plan issued by MLH, and (2) an [557]*557automobile policy issued by GEICO. Wu’s health insurance plan was not governed by the Employment Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001, et seq.

Wu sought medical treatment with Physiotherapy Associates, a participating healthcare provider under MLH’s Preferred Provider Option plan to which she belonged. Compl. ¶¶ 20-21. Under this plan, in exchange for providing medical care to MAMSI members, participating healthcare providers were paid at a negotiated rate and agreed not to balance, bill, or collect any other amount from members for whom they provided “Covered Services.” Id. Wu’s contract with MAMSI contained a Coordination of Benefits (“COB”) provision that explicitly excluded any no-fault automobile insurance payments, such as PIP, from being considered in the application of the COB procedures. Id. at ¶ 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.” Mem. Supp. Pl.’s Cross Mot. at 4 (Paper No. 88); see id. Ex. A. Thus, according to Wu’s complaint, MAMSI paid the participating healthcare providers for services rendered to Wu only after PIP benefits were exhausted. Wu argued that this scheme was in 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).

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 certified a 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 (Paper No. 1), Ex. C at 13. The class certification order brought into the case for the first time class members with employee health plans governed by ERISA. On May 3, 2007, Defendants timely filed a Notice of Removal, having done so within thirty days of the introduction of a federal question based on ERISA preemption. See Mem. Op. (Paper No. 68) at 5-7.

After a discovery dispute was brought to this Court’s attention during a telephone conference on May 7, 2008, the parties were permitted to brief issues relating to the size of the class. 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).

The motions were framed as requests to modify the size of the class certified by the Circuit Court for Baltimore County, but the Defendants also called into question whether section 19-507 of the Insurance Article of the Maryland Code regulated health insurers. Wu argued that section 19-507 was applicable to all ERISA claims and prohibited MAMSI from making its health benefits secondary to PIP coverage. Although the class certification order from the circuit court was amended slightly, this Court did not amend the class certification order to exclude ERISA plan members because Defendants’ “argument raise[d] complex and novel questions of Maryland law that go beyond simply whether Wu can serve as class representative.” Wu v. MAMSI Life & Health Ins. Co., 256 F.R.D. 158, 165 (D.Md.2008). Furthermore, the Defendants’ “argument appear[ed] intertwined with a more fundamental question that reaches the crux of the entire case,” and that “[r]esolution in favor of Defendants on this issue could prevent any claim by Plaintiffs under 19-507, whether by a member of an ERISA plan or not.” Id. (emphasis in original).

Instead of deciding this issue of first impression under Maryland law, this Court certified the following question to the Maryland Court of Appeals:

Does Maryland Code, Insurance Article § 19-507 prohibit or restrict a Maryland health insurer or a Maryland health main[558]*558tenance organization from providing in its group or individual contracts of insurance or membership contracts that its contractual health benefits may be secondary to Personal Injury Protection (“PIP”) benefits under an automobile liability insurance policy where the automobile liability insurer is legally obligated to provide benefits for healthcare expenses?

Certification Order (Paper No. 108).

On October 20, 2009, in Mamsi Life & Health Ins. Co. v. Wu, 411 Md. 166, 983 A.2d 88

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269 F.R.D. 554, 77 Fed. R. Serv. 3d 1033, 2010 U.S. Dist. LEXIS 110336, 2010 WL 4075986, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kuei-i-wu-v-mamsi-life-health-insurance-mdd-2010.