Pipes v. Life Investors Insurance Co. of America

254 F.R.D. 544, 2008 U.S. Dist. LEXIS 107033, 2008 WL 5328201
CourtDistrict Court, E.D. Arkansas
DecidedNovember 21, 2008
DocketNo. 1:07CV00035 SWW
StatusPublished
Cited by9 cases

This text of 254 F.R.D. 544 (Pipes v. Life Investors Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, E.D. Arkansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pipes v. Life Investors Insurance Co. of America, 254 F.R.D. 544, 2008 U.S. Dist. LEXIS 107033, 2008 WL 5328201 (E.D. Ark. 2008).

Opinion

ORDER

SUSAN WEBBER WRIGHT, District Judge.

Plaintiff Dwight Pipes (“Pipes”) commenced this putative class action in state court against Life Investors Insurance Company of America (“Life Investors”), asserting claims for breach of contract and bad faith refusal to pay insurance claims. Pipes brings his claims individually and as administrator of the estate of Diane Pipes, his deceased wife. Life Investors removed the case to this federal court pursuant to the Class Action Fairness Act, 28 U.S.C. § 1332(d)(2). After removal, Pipes filed a [547]*547second amended complaint adding Earl Lee Purifoy (“Purifoy”) as a named plaintiff.

Pending before the Court is Plaintiffs’ motion for class certification (docket entry # 41), Life Investors’ response in opposition (docket entry # 68), and Plaintiffs’ reply (docket entry # 108). Also pending are Plaintiffs’ first and second motions to compel (docket entries # 45, # 54), Life Investors’ motions to compel (docket entry # 64, # 66), and the responses and replies to these motions (docket entries # 56, # 58, # 73, # 74). After careful consideration, and for the reasons that follow, the motion for class certification will be denied and the motions to compel will be denied without prejudice.

I.

Life Investors issued Diane Pipes and Pur-ifoy cancer only insurance policies that provide benefits for certain cancer-related treatments and expenses. After the policies were issued, Diane Pipes and Purifoy were diagnosed with cancer, and they submitted claims for benefits. Plaintiffs claim that Life Investors failed to pay the full amount of benefits due.

The benefit provisions at issue provide that Life Investors will pay the “actual charges” for specified cancer treatments.1 The policies do not provide for the coordination of benefits, thus benefits are paid regardless of whether the insured has additional insurance that pays for the same treatment. Plaintiffs claim that Life Investors breached its obligation to pay “actual charges” benefits by calculating payments based on adjusted, rather than “actual charges.” They take the position that Life Investors is required to pay “actual charges” equal to the amount billed by healthcare providers before any insurance discounts, insurance payments, or reductions or discounts of any kind.

The cancer only policies issued to Diane Pipes and Purifoy provide no definition for the term “actual charges.” However, Plaintiffs allege that prior to April 1, 2006, Life Investors interpreted the term “actual charges” to mean the amount billed by healthcare providers before any deductions. They claim that after April 1, 2006, Life Investors changed its interpretation and be-. gan paying “actual charges” benefits based on the amount that healthcare providers ultimately accept as payment in full after certain deductions.

Life Investors maintains that it has always interpreted the term “actual charges” to mean the amounts paid to and accepted as payment by the healthcare provider. According to Connie Whitlock, Life Investors’ senior vice president, in 2004 Life Investors discovered that it had been paying claims in excess of “actual charges” because claims examiners were accepting statements from healthcare providers that contained “fictitious list prices” that did not represent the amount actually accepted by healthcare providers for medical services.2 Docket entry # 69, Attach. # 9 (Whitlock Decl.). Whitlock testifies that in January 2006, Life Investors sent letters to its cancer only policyholders in Arkansas, notifying them that Life Investors was revising claim forms and procedures to ensure that the company received necessary information and documentation to support a claim for benefits based on actual charges.

The January 2006 letter to policyholders states in part: “When submitting a claim for these types of benefits, it is important to submit the appropriate information and documentation showing the actual charges being paid to and accepted as payment by the healthcare provider.” Docket entry #69, Attach. # 10 (Ex. C to Whitlock Deck).

[548]*548II.

Plaintiffs seek to certify a declaratory/in-junctive relief class, comprised of individuals identified as follows:

All insureds and beneficiaries in Arkansas who are, or between April 1, 2006 until the present have been, insured by a Cancer Only Policy issued by Life Investors Insurance Company of America which provides for the payment of certain benefits based on “actual charges.”

Docket entry # 108, at 8. The relief sought for the declaratory/injunctive relief class includes (1) a declaration that “actual charges” as used in the cancer only policy means the amount billed by healthcare providers before any insurance discounts, insurance payments, or reductions or discounts of any kind, and (2) an injunction requiring Life Investors to cease “the wrongful acts complained of in the complaint regarding ‘actual charges’ and to re-institute its prior practice of paying ‘actual charges’ benefits equal to the amount billed by healthcare providers for covered treatments before any insurance discounts, other insurance payments, reductions or discounts of any kind.” Docket entry # 108 at 30 Plaintiffs also seek certification of a damages/restitution subclass, comprised of individuals identified as follows:

All insureds and beneficiaries under Cancer Only Policies issued or sold by Life Investors Insurance Company of America, where: (i) such policies were issued in Arkansas; (ii) the policies provide for the payment of certain benefits based on “actual charges”; and (iii) benefits for “actual charges” claims were paid subject to insurance discounts, other insurance payments, reductions or other discounts, with a date of service for covered treatment after April 1, 2006.

Id. at 8. Plaintiffs generally describe the damages/restitution subclass as individuals who were paid improperly reduced “actual charges” benefits for medical treatment with a service date after April 1, 2006. By way of relief, Plaintiffs seek “restitution to policyholders who received less than the amount of ‘actual charges’ benefits to which they were properly entitled as a result of Life Investors’ incorrect interpretation of the term ‘actual charges.’” Id. at 30. In addition to restitution, Plaintiffs seek penalties and punitive damages provided under Ark.Code Ann. § 23-79-208.

Federal Rule of Civil Procedure 23(a) lists four criteria for the maintenance of a class: (1) that the class be so numerous that joinder of all members is impracticable; (2) that common questions of law and fact exist among potential class members; (3) that claims or defenses of the representative parties are typical of the claims or defenses of the class; and (4) that representative parties will fairly and adequately protect the interests of the class. In addition to the foregoing requirements, a proposed class must fall in to one of three categories provided under Rule 23(b).

Numerosity

Under Rule 23, a class action is warranted only if the class is “so numerous that joinder of all members is impracticable.” Fed.R.Civ.P. 23(a)(1).

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274 F.R.D. 243 (W.D. Arkansas, 2011)
Hunter v. Runyan
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Cite This Page — Counsel Stack

Bluebook (online)
254 F.R.D. 544, 2008 U.S. Dist. LEXIS 107033, 2008 WL 5328201, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pipes-v-life-investors-insurance-co-of-america-ared-2008.