Millennium Laboratories, Inc. v. Allied World Insurance

135 F. Supp. 3d 1165, 2015 U.S. Dist. LEXIS 133534, 2015 WL 5772653
CourtDistrict Court, S.D. California
DecidedSeptember 30, 2015
DocketCase No. 12-cv-2280-BAS (KSC)
StatusPublished
Cited by1 cases

This text of 135 F. Supp. 3d 1165 (Millennium Laboratories, Inc. v. Allied World Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Millennium Laboratories, Inc. v. Allied World Insurance, 135 F. Supp. 3d 1165, 2015 U.S. Dist. LEXIS 133534, 2015 WL 5772653 (S.D. Cal. 2015).

Opinion

ORDER:

(1) GRANTING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT; AND

(2) DENYING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

CYNTHIA BASHANT, District Judge.

This case arises from an insurance coverage dispute in which Plaintiff Millennium Laboratories, Iric. (“Millennium”) seeks reimbursement for the money it has spent responding to an investigation by the United States Department of Justice (“DOJ”). Millennium seeks to recover under a Forcefield Healthcare Organizations Directors and Officers Liability Policy No. 0807-1511 (“the Policy”) issued by Defendant Allied World Assurance Company (USA), Inc. (“Allied World”) for the policy period of December 1,2011 to December 1, 2012.

Millennium contends that it is entitled to payment of all defense costs related to the DOJ Investigation up to the Policy’s full $5,000,000 limits of liability. Allied World, however, claims that Millennium is limited by the Sublimits of the “Regulatory Claims Coverage” in-the Policy to $100,000 recovery, which it has already paid to Millennium.

Alternatively, Allied World argues that the “Related Claims” provision in the Policy militates against recovery and that several exclusions in the Policy, including the prior or pending litigation exclusion, the prior noticed claims exclusion and the specific claims exclusion, prohibit Millennium from recovering any defense costs at all. Both sides have brought cross motions for summary judgment. .

I. BACKGROUND

Millennium is a specialty diagnostics lab- - oratory that provides services to the chronic pain market. (Declaration of Martin A. Price (“Price Decl.”) 116, ECF No. 156-2.) Specifically, Millennium provides drug testing of chronic pain patients for doctors and. other authorized health providers. (Id.) Millennium states that approximately seventy percent (70%) of,its services are paid for by private insurance programs, with most of the remainder covered by government sponsored, programs such as Medicare or Medicaid. (Price Decl. ¶ 7.) .

A. The Policy

. Millennium obtained the Policy from Allied World for the period of December 1, 2011 to December 1, 2012. (Price Decl. ¶ 8.) Among other ■ coverage, the Policy provides “Company Claims Coverage” for any “Loss [including legal costs or attorney fees] arising from a Claim ... against [1168]*1168[Millennium] for a Wrongful Act” defined as “any actual or alleged act, error, omission, neglect, breach of duty, misstatement or misleading statement.” The Policy also provides “HIPAA Claims Coverage” covering Defense Expenses “arising from a Claim ... against [Millennium] for an actual or alleged act, error or omission of [Millennium] in violation of [HIPAA] and any rules or regulations promulgated thereunder.” The Aggregate Limit of Liability for both of these types of covei-age is $5,000,000. (Declaration of Robert A Wi-ygul (‘Wiygul Decl.”) Ex. 17, §§ I.C, I.F, Policy Declarations 3A, ECF No. 161-2.)

A specific endorsement expands the definition of a “Claim” to include a “formal civil or criminal investigation of an Insured Person, which is commenced by the filing or issuance of a ... subpoena ... identifying such Insured as a person against whom a proceeding ... may be commenced.” (Wiygul Decl. Ex. 17, Endorsement 9 ¶ 4.) The definition also adds a “formal administrative or regulatory investigation of ■ an Insured, which is ' commenced by the filing or issuance of a ... subpoena ... identifying an Insured as a person-or entity against whom a proceeding ... may be commenced.” {Id. ¶ 5.)

The Policy additionally provides “Regulatory Claims Coverage” for any “Loss [including legal costs of attorney fees] arising from a Claim ... against [Millennium] for a Regulatory Wrongful Act.” (Wi-ygul Decl. Ex. 17 § I.E.) “Regulatory Wrongful Act” is defined as an:

(1)act, error, omission, misstatement, misconduct, fraud, reckless disregard or negligence committed by an Insured in the performance or failure to perform any of the following activities in the Medicaid, Medicare, Federal Employee Health Benefit or Tricare Programs:
(a) procedure coding;
(b) bill claim, cost report or data submission; or
(c)the calculation of managed care payments;
(2) offer, acceptance or payment by any Insured in exchange for any patient referrals, in violation of any state, local or federal law; or
(3) offer, acceptance of payment by án Insured in violation of any state, local or federal antikickback law.

(Wiygul Decl. Ex. 17 § II.BB.) Coverage for “Regulatory Claims” is subject to a Sublimit on Liability of $100,000. (Wiygul Decl. Ex. 17 § I.E, Policy Declarations 3C.)

The Policy states that “[a]ll Related Claims shall be deemed to be a single Claim made on the date on which the earliest Claim within such Related Claim was first made.” (Wiygul Decl. Ex. 17 § VII.D.) “Related claims” are defined as “all Claims for Wrongful Acts based upon, arising out of, directly or indirectly resulting from, or in consequence of, the same or related facts, circumstances, situations, transactions or events or the same or related series of facts, circumstances, situation, transactions or events.” (Wiygul Decl. Ex. 17 § II.CC.)

Several exclusions in the Policy are also at issue. The “Prior or Pending Litigation Exclusion” excludes coverage for any defense costs:

alleging, arising out of, based upon or attributable to ... any pending or prior: (1) litigation; or (2) administrative or regulatory proceeding or investigation of which an Insured had notice, including any Claim alleging or derived from the same or essentially the same facts, or the same or related Wrongful Acts, as alleged in such pending or prior litigation or administrative or regulatory proceeding or investigation[.]

(Wiygul Decl. Ex. 17 § III.D.) The “Prior Noticed Claims Exclusion” bars coverage for any'claim “alleging, arising out of, [1169]*1169based upon or attributable to the same or essentially the same facts alleged, or to the same or related Wrongful Acts alleged or contained, in any Claim which has been reported ... under any policy[.]” (Wiygul Decl. Ex. 17 § III.E.) And the “Specific Claims Exclusion” provides that “[n]o coverage will be available for Loss from any Claim based upon, arising out of, directiy or indirectly resulting from, in consequence of, or in any way involving” the Ameritox Action, the Aegis Action and the Robert Cunningham Action. (Wiygul Decl. Ex. 17, Endorsement 7.)

B. The DOJ Investigation

On or about March 27, 2012, August 2, 2012, February 28, 2013, March 5, 2013, April 17, 2013, and October 10, 2013, the DOJ served Millennium with “HIPAA subpoenas.” (Price Decl. ¶¶ 9-14, Exs. B-G, ECF No. 165-2-7; Wiygul Decl. Exs. 5-7.) Millennium states that shortly after receiving the initial subpoena, it provided the subpoena to Allied World. (Price Decl. ¶ 17.) In these subpoenas, a wide variety of potential health care offenses are listed, along with far-reaching broad documentary requests. (Wiygul Decl. Exs. 5-7; Price Decl. Exs. B-G, ECF No. 165-2-7.)

In several letters sent from the DOJ attorney to Millennium’s attorney in 2012, the DOJ attorney explains:

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Bluebook (online)
135 F. Supp. 3d 1165, 2015 U.S. Dist. LEXIS 133534, 2015 WL 5772653, Counsel Stack Legal Research, https://law.counselstack.com/opinion/millennium-laboratories-inc-v-allied-world-insurance-casd-2015.