Sieving v. Continental Casualty Company

CourtDistrict Court, N.D. Illinois
DecidedApril 26, 2021
Docket1:20-cv-05127
StatusUnknown

This text of Sieving v. Continental Casualty Company (Sieving v. Continental Casualty Company) is published on Counsel Stack Legal Research, covering District Court, N.D. Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Sieving v. Continental Casualty Company, (N.D. Ill. 2021).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF ILLINOIS EASTERN DIVISION

David Sieving, ) ) Plaintiff, ) ) ) v. ) No. 20-cv-5127 ) ) Continental Casualty Company ) ) Defendant. ) )

Memorandum Opinion and Order Plaintiff David Sieving is a California resident insured under a group long-term care policy issued by Defendant Continental Casualty Company (“Continental”). In September 2016, Continental sent a letter to Mr. Sieving informing him that his insurance premium would increase by 95.5%. The letter also provided that due to regulatory requirements that varied by state, the premium increase would likely not be uniformly implemented across insured individuals nationwide. Mr. Sieving initiated the instant putative class-action lawsuit against Continental alleging, inter alia, breach of contract and fraud. Specifically, Mr. Sieving contends Continental was required to make any premium increases consistent across a nationwide class, and further that it was foreclosed from raising premiums at all for insureds, such as Mr. Sieving, who had purchased inflation-protection coverage in the form of an automatic benefit increase. Continental has moved to dismiss the complaint in its entirety [15]. For the reasons that follow, the motion to dismiss is granted in part and denied in part.

I. In reviewing the sufficiency of a complaint pursuant to a motion to dismiss under Federal Rule of Civil Procedure 12(b)(6), I “accept all well pled facts as true and draw all permissible inferences in favor of the plaintiff.” Agnew v. Nat’l Collegiate Athletic Ass’n, 683 F.3d 328, 334 (7th Cir. 2012). To survive a motion to dismiss, the complaint must state a claim “that is plausible on its face” after conclusory allegations are disregarded. W. Bend Mut. Ins. Co. v. Schumacher, 844 F.3d 670, 675 (7th Cir. 2016) (quoting Ashcroft v. Iqbal, 556 U.S. 662, 678– 79 (2009)). Long-term care insurance covers a variety of services for

people who become unable to care for themselves, including assistance in the home, adult daycare, assisted living, and nursing home services. Continental, a Delaware corporation headquartered in Illinois, issued and delivered the group long-term care policy at issue, policy number 9774, to the Employees Long Term Care Insurance Trust (“Employees Trust”), located in Illinois, in September 1989. Mr. Sieving, who was an employee of Northrop Grumman Space Systems Division at the time, purchased a certificate under the policy with an effective date of July 1, 2003. Mr. Sieving was able to purchase his certificate because his employer had access to insurance through Northrop Grumman Federal Credit Union Space Systems Division, a participating organization under

the policy. When Mr. Sieving bought his certificate, he purchased inflation protection with an automatic-benefit-increase option. That is, he selected a higher premium of $110.80 per month (more than double what his “base rate” premium would have been), and in exchange, his benefit level automatically increased by 5% each year, compounded annually. The automatic benefit increases had the purpose of helping protect Mr. Sieving against the increasing costs of long-term care over time. The insurance policy itself included the following language,1 under the heading “PREMIUM”: “We cannot change the Insured’s

1 The insurance policy was referred to in but not attached to the complaint. However, Continental appended a copy of the policy to the motion to dismiss. While a document central to and referred to in the complaint may often be considered on a motion to dismiss without converting it to a motion for summary judgment, here, Mr. Sieving disputes the authenticity of the version of the policy Continental attached. See ECF No. 33 at 2. “Because the polic[y] [is] not ‘concededly authentic,’ it would be unfair to consider [it] in conjunction with the defendant’s motion to dismiss.” Hallie v. Wells Fargo Bank, N.A., No. 2:12-cv-235, 2013 WL 3872814, at *2 (N.D. Ind. July 24, 2013) (citing Tierney v. Vahle, 304 F.3d 734, 738 (7th Cir. 2002)); accord Wells Fargo Bank, N.A. v. Worldwide Shrimp Co., No. 17 CV 4723, 2019 WL 4189480, at *3-4 (N.D. Ill. Sept. 4, 2019). Accordingly, for instant purposes, I premiums because of age or health. We can, however, change the Insured’s premiums based on his or her premium class, but only if We change the premiums for all other Insureds in the same premium class.” ECF No. 1 ¶ 23. Mr. Sieving alleges that he reviewed and relied upon a

marketing brochure issued by Continental at the time he purchased his certificate. Id. ¶ 30. The marketing brochure provided, with respect to premium changes: LEVEL PREMIUM RATES DO NOT INCREASE JUST BECAUSE YOU GROW OLDER Since your premium is based on a fixed daily benefit and on your age at the time you apply, CNA [Continental] can predict the appropriate premium to charge you. As a result, premiums are expected to remain level over your lifetime. CNA reserves the right to change premiums for the entire plan if necessary based on our experience, but you can never be singled out for a rate increase

because you get older, become ill, or file claims. Id. ¶ 29. In an outline of coverage attached to the brochure, Continental also included the following language: OUR RIGHT TO CHANGE THE PREMIUM. Your premium is based on your age on your application date. Your premium will

consider only the portions of the policy that were cited in the complaint. not increase because you grow older. It will remain the same unless the rates are increased for everyone in your age group; you cannot be singled out for a rate increase for any reason. Id. ¶ 34. The brochure also featured rate tables showing premium

amounts based on age at the time of purchase and benefit level. Id. ¶ 37. In addition, the brochure included a section describing the two available inflation-protection options available under the policy. Under the first option, called the “Future Purchase Option” feature, the insured would be given an opportunity to increase benefits every three years, which he or she could accept or decline. The benefit increase would trigger a premium increase based on the insured’s age at the time of the increase. The second option, which Mr. Sieving selected, was called the “Automatic Benefit Increase Option.” That option was described as follows: For an additional fixed premium, this allows your

benefits to increase automatically every year. If you choose this option, your daily Nursing Home and Community Based Care Benefits and your Lifetime Maximum Benefit Amount will all increase by 5% per year, compounded annually for as long as you are insured, with no corresponding annual increase in premium and without further proof of insurability, even while you are withdrawing benefits. Id. ¶ 67. The brochure included a pro and con section for the automatic benefit increases, listing as pros “Level, easy to budget premium,” and “Benefits go up every year without corresponding

premium increases.” Id. ¶ 68. Mr. Sieving’s premiums did not increase for thirteen years. However, on September 1, 2016, Continental sent a letter to Mr. Sieving informing him that his premium would increase by 95.5%, with a 70% increase occurring as of November 1, 2016, and a 15% increase occurring November 1, 2017. In a Frequently Asked Questions section appended to the letter, Continental included the following language: 6.

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Sieving v. Continental Casualty Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sieving-v-continental-casualty-company-ilnd-2021.