Sylvester v. Cigna Corp.

369 F. Supp. 2d 34, 35 Employee Benefits Cas. (BNA) 2130, 2005 U.S. Dist. LEXIS 8644, 2005 WL 1111889
District Court, D. Maine·Decided May 9, 2005·No. 1:03-cv-00176·Published·Cited by 30 cases

Opinion

ORDER ON PROPOSED CLASS ACTION SETTLEMENT

SINGAL, Chief District Judge.

Before the Court is Plaintiffs’ Motion for Approval of Settlement and for Class Certification (Docket # 55) as supplemented and amended by Plaintiffs’ Motion for Approval of Amended Settlement Agreement and Notice Plan (Docket # 66) and Plaintiffs’ Second Supplemental Memorandum in Support of Approval of Amended Settlement Agreement and Notice Plan (Docket # 81). In connection with this motion, Defendants have filed a Memorandum in Support of Plaintiffs’ Motion for Approval of Amended Settlement Agreement and Notice Plan (Docket # 65). In addition, Counsel for Plaintiffs have filed their Application for Award of Attorneys’ Fees (Docket # 56), along with the Class Counsel’s Supplemental Memorandum in Support of Application for Award of Attorneys’ Fees (Docket # 67) and Class Counsel’s Second Supplemental Memorandum in Support of Application for Award of Attorneys’ Fees (Docket # 83). For the reasons explained below, the Court DENIES the motions seeking approval of the proposed settlement (Docket # s 55, 66 & 81) and, therefore, finds the applications for attorneys’ fees (Docket #s 56, 67 & 83) are MOOT.

I. BACKGROUND

A. The Claims

Plaintiffs filed their initial complaint (Docket # 1) against Defendants on July 15, 2003. Plaintiff then filed an amended complaint (Docket #24) on January 7, 2004. This Amended Complaint asserts claims against more than fifty different corporate entities that allegedly underwrote or administered health insurance plans to which Plaintiffs had subscribed (hereinafter collectively referred to as “Defendants” or “CIGNA”). The claims asserted include statutory claims under both the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1132, and the Racketeer Influenced and Corrupt Organizations Act (“RICO”), 18 U.S.C. § 1962, as well as common law claims, such as breach of contract, fraud, fraudulent concealment, negligent misrepresenta *37 tion, unjust enrichment, accounting and punitive damages.

Although the Amended Complaint names eight individual Plaintiffs, it asserts that these individual Plaintiffs wish to act as representatives for an entire class of people eligible to bring such claims against CIGNA. They describe that class as: “All subscribers to Healthsource Plans at any time between January 1, 1986 and December 31, 1997,who made payments to medical product or service providers under a percentage coinsurance plan, where an agreement existed between any of [the Defendants] and the provider to accept a discounted fee and where [the Defendants] did not use that discount in calculating the subscriber’s coinsurance payment as required by the Healthsource Plans (the “Class”).” 1 (Am.ComplJ 114.)

As described in the Amended Complaint, Defendants allegedly misled the Class into making coinsurance payments that exceeded the amount actually due under the terms of their CIGNA plans. CIGNA allegedly reaped the benefit of this overpayment and thereby paid out less on the benefit claims filed by Plaintiffs. By way of illustration, Plaintiffs’ Amended Complaint offered the following description of what it described as Defendants’ “scheme”:

[A]ssume an inpatient procedure was performed during the Class Period on a [CIGNA] Plan subscriber with a list price of $1,000. The subscriber pays her percentage coinsurance, for example 20% or $200, unaware that [CIGNA] negotiated a secret provider discount whereby the actual allowed cost of the procedure is $600. Since the subscriber has paid $200 out of [the] actual allowed cost of $600, the [CIGNA] Plan now pays only $400 to the provider. As a result of this scheme, the subscriber has paid 33.33% of the actual cost, instead of 20%, and the [CIGNA] Plan has paid only 66.67% of the cost, instead of the 80% called for under the terms of the [CIGNA] Plan. Since the subscriber’s correct coinsurance obligation is, in this example, 20% of the actual cost of $600, or $120, [CIGNA] has overcharged the subscriber $80 for the covered service.
... [A]fter clearly breaching its contractual obligations to the subscriber, [CIGNA] then knowingly sent via U.S. mail a false Explanation of Benefits stating that the allowed cost was $1000, while it concurrently sent a Remittance Advice to the medical provider showing the actual discounted amount for the covered service was $600.

(Am. Compl. ¶¶ 79 & 80.) The Amended Complaint further claimed that the illustration just described had been “replicated ... in hundreds of thousands or more ... claims between 1986 and 1998.” (Am. ComplV 81.)

B. Discovery Leads to Settlement Negotiations

Between October 2003 and March 2004, the parties engaged in discovery that included production of approximately 112,-000 pages of documents and CIGNA’s claims data as well as depositions of three class representatives and two of Defen *38 dants’ corporate representatives. The Court had previously allowed the parties to proceed simultaneously with discovery on the merits and discovery related to class certification finding that the issues were “significantly intertwined.” (Order on Defs.’ Obj. to and Request for Amendment (Docket # 17) at 2.) However, the Court had set a deadline of March 5, 2004 for Plaintiffs to file their motion for class certification.

Apparently, during discovery, Plaintiffs’ Counsel determined that the harm caused by Defendants’ alleged “scheme” was not as damaging or widespread as they had initially imagined. 2 Rather, based on analysis of data provided by CIGNA, the expert actuaries hired by Plaintiffs determined that the total damages were approximately $2.9 million. (See Dec. 6, 2004 Hearing Tr. (Docket # 64) at 11.) Defendants also hired an actuary to perform an analysis of the claims data they had produced. Defendants’ expert estimated that Plaintiffs’ damages were approximately $2.3 million. (See id.) In light of this information, counsel for both sides apparently began discussing the potential of settling the case in March 2004 (prior to filing a motion for class certification). These discussions culminated in a two-day mediation session held on June 23, 2004 and July 7, 2004.

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Sylvester v. Cigna Corp., 369 F. Supp. 2d 34, 35 Employee Benefits Cas. (BNA) 2130, 2005 U.S. Dist. LEXIS 8644, 2005 WL 1111889 (D. Me. 2005).

369 F. Supp. 2d 34 (Sylvester v. Cigna Corp.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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