Margery Newman v. Metropolitan Life Insurance Co

885 F.3d 992
CourtCourt of Appeals for the Seventh Circuit
DecidedFebruary 6, 2018
Docket17-1844
StatusPublished
Cited by97 cases

This text of 885 F.3d 992 (Margery Newman v. Metropolitan Life Insurance Co) is published on Counsel Stack Legal Research, covering Court of Appeals for the Seventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Margery Newman v. Metropolitan Life Insurance Co, 885 F.3d 992 (7th Cir. 2018).

Opinion

Wood, Chief Judge.

At age 56, Margery Newman purchased a long-term-care insurance plan from the Metropolitan Life Insurance Company ("MetLife"). She opted for one of MetLife's non-standard options for paying her insurance premiums; MetLife called the method she selected "Reduced-Pay at 65." When Newman was 67 years old, she was startled to discover that MetLife that year more than doubled her insurance premium. MetLife insists that the increase was consistent with Newman's insurance policy, including its Reduced-Pay-at-65 feature. Newman was unpersuaded and brought this action to vindicate her position. The district court dismissed for failure to state a claim. We conclude, however, that the dismissal was premature, and that Newman's complaint plausibly has alleged facts entitling her to relief. We therefore *997 reverse and remand for further proceedings.

I

Two documents lie at the heart of this case. The first is MetLife's "Long-Term Care Facts" brochure, which Newman reviewed before purchasing her insurance plan. The brochure describes long-term care generally and catalogs MetLife's non-standard payment options. Newman learned of MetLife's Reduced-Pay option from the brochure. The full description reads as follows:

Reduced-Pay at 65 Option:
By paying more than the regular premium amount you would pay each year up to the Policy Anniversary on or after your 65th birthday, you pay half the amount of your pre-age 65 premiums thereafter.

At the foot of the same page, MetLife instructs the reader that the brochure is only a general overview of MetLife's insurance plans, and that the policy governs the terms of the agreement.

Equipped with this information, Newman purchased a long-term-care insurance plan from MetLife and selected the Reduced-Pay option. Roughly a week later, she received the policy-the second critical document. The policy is 29 pages long. It includes just one reference to the Reduced-Pay option:

In addition, you have selected the following flexible premium payment option: Reduced Pay at 65 Semi-Annual Premium Amount:
Before Policy Anniversary at age 65 $3231.93 On or after Policy Anniversary at age 65 $1615.97

Elsewhere, the policy reserves MetLife's right to change the premium. On the first page, MetLife announces that " PREMIUM RATES ARE SUBJECT TO CHANGE ." The same paragraph continues with the statement that "[a]ny such change in premium rates will apply to all policies in the same class as Yours in the state where this policy was issued." In a section titled "Premiums," MetLife "reserve[s] the right to change premium rates on a class basis." Similar language is included in the "5% Automatic Compound Inflation Protection Rider." The policy defines more than 30 terms, but the word "class" is not among them. And the appended "Contingent Benefits Upon Lapse Rider," which provides coverage options in the event of a "Substantial Premium Increase," includes a table illustrating that that term's meaning varies with the policyholder's age at the time the policy was issued. The table accounts for policyholders who were issued their policy at ages up to "90 and over." Newman had the opportunity to review the policy for 30 days and return it for a full refund if she was dissatisfied.

From the outset, Newman paid the elevated premium associated with her Reduced-Pay option. When she reached age 65, her premium was cut in half. After Newman turned 67, however, MetLife doubled the premium. MetLife represents that this increase has been imposed on a class-wide basis, which it said at oral argument means all long-term-care policyholders, including Reduced-Pay policyholders over the age of 65. MetLife defends the increase by noting that Newman still pays half the premium of a Reduced-Pay policyholder who has not yet reached age 65, and far less than she would if she had not purchased the Reduced-Pay option. Nevertheless, at age 67, Newman's semi-annual premium jumped to $3,851.80, greater *998 than it has been at any other point during the life of the plan.

Newman filed a four-count complaint on behalf of herself and a proposed class. She has alleged that raising her post-anniversary premium is a breach of the policy, violates the Illinois Consumer Fraud and Deceptive Business Practices Act, and renders MetLife's representations and practices fraudulent. The district court granted MetLife's motion to dismiss for failure to state a claim. In its view, the contract unambiguously permits MetLife to raise Newman's premium, even after she reached age 65. This meant also that she had no claim for deceptive or unfair business practices or common-law fraud, because MetLife did nothing wrong. Newman's appeal from that decision is now before us.

II

We consider de novo the district court's grant of a motion to dismiss pursuant to Federal Rule of Civil Procedure 12(b)(6). Camasta v. Jos. A. Bank Clothiers, Inc ., 761 F.3d 732 , 736 (7th Cir. 2014). A complaint survives a motion to dismiss if it states a claim that is plausible on its face. Id. The common-law and statutory fraud claims must be pleaded with the detail required under Rule 9(b)'s heightened standard. Id. The parties agree that Illinois law governs this case.

A

Illinois treats insurance policies the same way as any other contract. Parties are held to the unambiguous terms of their agreement. Hobbs v. Hartford Ins. Co. of the Midwest, 214 Ill.2d 11 , 17, 291 Ill.Dec. 269 , 823 N.E.2d 561 (2005). A policy is ambiguous if it is subject to more than one reasonable interpretation. Thompson v. Gordon , 241 Ill.2d 428 , 443, 349 Ill.Dec. 936 , 948 N.E.2d 39 (2011).

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Bluebook (online)
885 F.3d 992, Counsel Stack Legal Research, https://law.counselstack.com/opinion/margery-newman-v-metropolitan-life-insurance-co-ca7-2018.