Lindley v. Life Investors Insurance

267 F.R.D. 382, 2010 U.S. Dist. LEXIS 13821, 2010 WL 653022
CourtDistrict Court, N.D. Oklahoma
DecidedFebruary 17, 2010
DocketNo. 08-CV-379-CVE-PJC
StatusPublished
Cited by24 cases

This text of 267 F.R.D. 382 (Lindley v. Life Investors Insurance) is published on Counsel Stack Legal Research, covering District Court, N.D. Oklahoma primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lindley v. Life Investors Insurance, 267 F.R.D. 382, 2010 U.S. Dist. LEXIS 13821, 2010 WL 653022 (N.D. Okla. 2010).

Opinion

OPINION AND ORDER

PAUL J. CLEARY, United States Magistrate Judge.

Before the Court is Plaintiffs Motion to Compel Documents Identified Nos. 1-386 on Defendant’s Consolidated Privilege Log (Dkt. #222); Plaintiffs Sixth Motion to Compel Information Concerning Defendant’s Knowledge and Consideration of “Actual Charges” (Dkt. # 156); Defendant’s Motion for Protective Order from Request No. 40 of Plaintiffs Second Requests for Production (Dkt. # 181) and Plaintiffs Rule 56(F) Motion for an Enlargement of Time to Respond to Defendant’s Motion for Summary Judgment (Dkt. # 209). The Court heard oral arguments on the motions on November 4 and 13, 2009.

Pursuant to the Court’s order at the November 13th hearing, Defendant Life Investors Insurance Company of America (“Life Investors”)1 produced for in camera review certain documents listed in the Consolidated Privilege Log (“CPL”) Document Nos. 1-3862 on November 20, 2009 (Dkt. #258). And pursuant to Plaintiff Denny Lindley’s (“Lindley”) request in the Joint Status Report Regarding Defendant’s Supplemental Privilege Log (Dkt. #273), the Court ordered the production for in camera review of documents listed on the Supplemental Privilege Log (“SPL”) by December 8, 2009. (Dkt. # 276). As all of the requested documents have been produced either to Lindley or for the Court’s in camera inspection,3 the dispute over the unproduced documents listed in the Lindley Log and SPL is now at [386]*386issue. As the disposition of the motion to compel these documents and the motion to compel and for protective order regarding Plaintiffs Document Request No. 40 turns on some of the same claims of privilege and waiver, and, as Plaintiff contends that the resolution of all these motions determines whether the Court should grant his Rule 56(F) Motion for an Enlargement of Time to Respond to Defendant’s Motion for Summary Judgment (Dkt. # 209), the Court addresses all of the motions herein.

I. BACKGROUND4

On June 16, 1995, Lindley applied for and was issued a Cancer Only Supplemental Policy (“the Policy”) by Bankers United Life Assurance Company (“Bankers United”)5, effective July 1, 1995. The Policy offers unlimited benefits for chemotherapy and radiation treatment and is “guaranteed renewable for life” as long as the premiums are paid. Lindley has paid the premiums on the Policy on a monthly basis since the effective date.

In October 2001, Lindley was diagnosed with cancer and began to submit claims for reimbursement of his medical expenses under the Policy. From October 2001 to January 2006, Life Investors reimbursed Lindley for the full amount listed on his providers’ bills. On January 27, 2006, Life Investors notified Lindley that it was instituting a new claims-handling policy limiting Lindley’s benefits under the Policy to the “actual charges” billed by his providers, which Life Investors construed as the amount “being paid to and accepted as payment by the healthcare provider.” Lindley’s Motion, Ex. 17 (Dkt. # 222). Lindley refused to comply with the new claims procedure and continued to submit his providers’ bills with the full amount of charges as he viewed Life Investors’ change in claims-handling policy as an impermissible, unilateral change in the “actual charges” term of the Policy. And thus this dispute arose.

As part of the history giving rise to this lawsuit, Life Investors made a business decision to discontinue the sale of supplemental cancer policies like Lindley’s that offered uncapped or unlimited benefits for chemotherapy and radiation treatment because of the rising costs of these treatments. Because these uncapped cancer policies were guaranteed renewable for the insured’s lifetime as long as premiums were paid, there still remained a substantial number of these undesirable policies on Life Investors’ balance sheet. This block of policies was referred to as the “Discontinued Supplemental Insurance (“DSI”)” policies.

Due to the increasing loss ratio (claims paid/premiums collected) on these DSI policies, Life Investors imposed a 30% rate increase on the DSI policy premiums in 2000 and again in 2003. Since 2002, Life Investors had been offering less expensive cancer policies with capped benefits to encourage policyholders to change policies. The pool of policyholders within the closed book of DSI policies shrank, presumably after some policyholders exchanged their unlimited benefit policies for cheaper capped benefit policies; thus, the remaining pool became more dense with cancer patients “in claim,” and the loss ratio on the DSI policies continued to in[387]*387crease.6 Thus, in 2004, Life Investors implemented another 30% premium rate increase.

As a result of the continuing rate increases, Kelly Adams (“Adams”),’ Vice-President and CFO of Life Investors, asked Steven Gwin (“Gwin”), an actuary with Life Investors, to head up a taskforce convened to consider possible solutions to avoid or mitigate the effect of rising premium rates on the DSI policies, i.e., the “DSI Taskforce.” The DSI Taskforce was convened in April 2004 and included Life Investor officers and employees from the financial, actuarial, claims and legal departments who undertook a comprehensive review of the problem, meeting once or twice a week for approximately 15 months.

After completing its initial review, the DSI Taskforce concluded that the term “actual charges” in the DSI policies meant that Life Investors was required to pay only the discounted amounts actually paid the health providers by third-party payors, such as health insurers, rather than the billed or list charges submitted by the health providers, the amount of benefits Life Investors had been paying its policyholders’ claims for chemotherapy and radiation treatments. After receiving approval from upper management to focus on this proposed change in the interpretation of “actual charges,”7 Mark Edwards (“Edwards”), Life Investors’ Assistant General Counsel and a member of the DSI Taskforce, consulted with outside counsel from May through October 2004 regarding various issues related to the proposed change. And in late October 2005, Life Investors retained the law firm of Jorden Burt LLP (“Jorden Burt”) to provide a legal opinion on the proposed change. Sometime in April 2005, Jorden Burt provided Life Investors with a 185-page report.

In July 2005, Life Investors formed a team of employees tasked with updating its claims forms and procedures to implement the change in “actual charges.” This group, which included Edwards, was referred to as the “Supplemental Insurance Claims Project Team” or “Project Team.” As a result of this process, Connie Whitlock (“Whitlock”), Life Investors’ Senior Vice-President, mailed a letter to all DSI policyholders, including Lindley, notifying them of the proper calculation of “actual charges” and that they were to submit the Explanation of Benefits (“EOB”) from their health insurer as proof of claim, rather than the health providers’ billed costs.

II. APPLICABLE LAW

Rule 26(b)(1) of the Federal Rules of Civil Procedure provides for discovery “regarding any matter, not privileged,

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267 F.R.D. 382, 2010 U.S. Dist. LEXIS 13821, 2010 WL 653022, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lindley-v-life-investors-insurance-oknd-2010.