Laufer v. US Life Ins. Co.

896 A.2d 1101, 385 N.J. Super. 172
CourtNew Jersey Superior Court Appellate Division
DecidedMay 1, 2006
StatusPublished
Cited by23 cases

This text of 896 A.2d 1101 (Laufer v. US Life Ins. Co.) is published on Counsel Stack Legal Research, covering New Jersey Superior Court Appellate Division primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Laufer v. US Life Ins. Co., 896 A.2d 1101, 385 N.J. Super. 172 (N.J. Ct. App. 2006).

Opinion

896 A.2d 1101 (2006)
385 N.J. Super. 172

Anita LAUFER, on behalf of herself and all others similarly situated, Plaintiff-Respondent,
v.
The UNITED STATES LIFE INSURANCE COMPANY IN the CITY OF NEW YORK, Defendant-Appellant, and
Albert H. Wohlers & Co. n/k/a Seabury & Smith, Defendant.

Superior Court of New Jersey, Appellate Division.

Argued February 15, 2006.
Decided May 1, 2006.

*1104 Peter Jason, of the New York and Pennsylvania Bars, admitted pro hac vice, argued the cause for appellant (Duane Morris, attorney; Mr. Jason, Philadelphia, PA, Gregory R. Haworth, Newark, Suzanne H. dePillis, Hamilton and Margaret M. O'Rourke, Newark, on the brief).

Madeline L. Houston, argued the cause for respondent (Houston & Totaro, attorneys, Bloomfield; Ms. Houston and Melissa J. Totaro, on the brief).

Before Judges SKILLMAN, AXELRAD and PAYNE.

*1103 The opinion of the court was delivered by

SKILLMAN, P.J.A.D.

This appeal involves the maintainability of a class action under the Consumer Fraud Act, N.J.S.A. 56:8-1 to -20, where the complaint alleges that the putative class representative suffered an "ascertainable loss" but contains no allegation that other class members suffered any "ascertainable loss" and seeks only declaratory and injunctive relief on their behalf.

Sometime before 1993, plaintiff Anita Laufer subscribed to a group accident and sickness insurance policy as a member of an organization called Women's American ORT. The insurer that originally issued the policy discontinued coverage at the end of 1993, at which time defendant United States Life Insurance Company (U.S. Life) issued a replacement policy providing similar coverage.

The coverage provided under the U.S. Life policy included the cost of care in a "convalescent home." However, the definition of "convalescent home" excluded any facility that is "used mainly for the aged."

Defendant Albert H. Wohlers & Co. was the administrator for the group policy U.S. Life issued to members of Women's American ORT. Beginning in 1995, Wohlers sent a series of notices to policyholders, including Laufer, which indicated that the U.S. Life policy provided "nursing home" benefits. In February and March of 1995, Wohlers sent a notice that stated in part:

* IMPORTANT NOTICE *

Your Catastrophe Major Medical Insurance Plan now includes an increased Nursing Home Benefit!
Recently, you elected to increase your Nursing Home coverage by adding a new, increased NURSING HOME BENEFIT RIDER to your Catastrophe Major Medical Insurance Plan.
By adding this increased coverage to your current Catastrophe Major Medical Plan, your nursing home benefit has been improved! The Nursing Home Benefit Rider increases your coverage. . .
Up to $500 per week in benefits payable for convalescent or custodial care for a covered confinement in a nursing home. (Previously, this benefit provided you with up to $400 per week of coverage.)
*1105 Enclosed is the RIDER outlining your improved Nursing Home benefit. . . .

In September 1996 and again in February 1997, Wohlers sent another notice that stated in part:

Currently, your Catastrophe Major Medical Insurance Plan provides up to $1,000,000 in protection. IF YOU ADD THE ENHANCED BENEFIT RIDERS. . . your benefits will be INCREASED—providing you with up to $2,000,000 in total protection. PLUS. . . your Nursing Home benefit will be increased by $100 Per Week. . . .

In addition, the bills that Wohlers sent to policyholders indicated that the coverage provided under the U.S. Life policy included a "nursing home benefit."

In response to Wohlers' solicitations, Laufer increased her coverage under the U.S. Life policy, for which she paid additional premiums. According to Laufer, she had major medical insurance coverage through her employer, and the only reason she continued her coverage under the U.S. Life policy was to maintain the nursing home benefit she thought it provided. However, Laufer learned in late 2002 that the policy did not provide any nursing home benefit. As a result, she discontinued her coverage.

Thereafter, Laufer brought this action against U.S. Life and Wohlers, alleging that Wohlers' communications regarding the "nursing home" benefit provided under the U.S. Life policy violated the Consumer Fraud Act. Laufer's complaint alleges that she had suffered an "ascertainable loss" as a result of those deceptive communications, for which she seeks monetary damages.

Laufer's complaint was brought not only on her own behalf but also on behalf of a class consisting of "all persons in the United States who at any time from May 12, 1998 through the present are or have been insured under a group catastrophe major medical insurance policy underwritten by [U.S. Life] . . . and . . . administered by [Wohlers]." The complaint does not allege that other members of the class suffered any "ascertainable loss," and it seeks only declaratory and injunctive relief on their behalf. Specifically, the complaint seeks a declaration that Wohlers' communications regarding the purported nursing home benefit provided under the U.S. Life policy violated the Consumer Fraud Act and "an injunction compelling defendants to send written notice to all class members, notifying them in plain and prominent language that they do not, and have not had, nursing home coverage, and notifying them that the Court has declared that all the representations made by [Wohlers] on behalf of [U.S. Life] to the effect that there was a nursing home benefit included in class members' coverage were deceptive in violation of the . . . Consumer Fraud Act."

Laufer filed a motion for class certification under Rule 4:32-1(b)(2), which provides for class certification in cases where "the party opposing the class has acted or refused to act on grounds generally applicable to the class, thereby making appropriate final injunctive relief or corresponding declaratory relief with respect to the class as a whole[.]" The trial court issued a comprehensive written opinion that denied the motion insofar as it sought certification of a nationwide class, but granted the motion with respect to all New Jersey residents "who at any time from May 12, 1998 through the present are or have been insured under a group catastrophe major medical insurance policy underwritten by [U.S. Life] and administered by [Wohlers]." In concluding that this is an appropriate case for class certification under Rule 4:32-1(b)(2), the trial court stated:

There is little question that U.S. Life is alleged to have acted on grounds generally *1106 applicable to the class. Its Plan applies generally to all members of the putative class, and its administrator's communications with class members appears consistent, if not uniform. Since this case involves the use of form contracts and mass mailings, it is particularly appropriate to use the class action procedure. . . .
. . . I agree with Laufer's assertion that defendants' alleged violations of the [Consumer Fraud Act] likely would affect every potential class member similarly and therefore defendants have acted in [a] way which is "generally applicable to the class."

We granted U.S. Life's motion for leave to appeal from the order certifying the class.

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Bluebook (online)
896 A.2d 1101, 385 N.J. Super. 172, Counsel Stack Legal Research, https://law.counselstack.com/opinion/laufer-v-us-life-ins-co-njsuperctappdiv-2006.