UnitedHealth Group Inc. v. Columbia Casualty Co.

836 F. Supp. 2d 912, 2011 U.S. Dist. LEXIS 148422, 2011 WL 6781007
CourtDistrict Court, D. Minnesota
DecidedDecember 27, 2011
DocketCase No. 05-CV-1289 (PJS/SER)
StatusPublished
Cited by1 cases

This text of 836 F. Supp. 2d 912 (UnitedHealth Group Inc. v. Columbia Casualty Co.) is published on Counsel Stack Legal Research, covering District Court, D. Minnesota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
UnitedHealth Group Inc. v. Columbia Casualty Co., 836 F. Supp. 2d 912, 2011 U.S. Dist. LEXIS 148422, 2011 WL 6781007 (mnd 2011).

Opinion

MEMORANDUM OPINION AND ORDER

PATRICK J. SCHILTZ, District Judge.

Plaintiff UnitedHealth Group Inc. (“United”) brings this action against ten insurance companies — United’s primary insurer and nine of United’s excess insurers — asking this Court to determine, with respect to each of several dozen claims that were brought against United during the period December 1, 1998, through December 1, 2000, which of the ten insurers must indemnify United or pay United’s defense costs. In essence, then, this lawsuit represents several dozen coverage actions wrapped up into one. United’s primary insurer — Lexington Insurance Company (“Lexington”) — threw in the towel early, tendering what was left of its $60 million policy limits (which United refused to accept, until being ordered to do so, see Docket No. 123). But the nine excess insurers have soldiered on, and this lawsuit is now well into its sixth year.

This is a difficult case. The main problem with this case is that it centers on an insurance policy that is terribly written. As noted, Lexington was the primary insurer during the relevant time period, and all nine of the excess insurers, to one degree or another, followed form to the Lexington policy. Unfortunately, though, the 30-page Lexington policy was not a standard policy that would be familiar to litigators and judges. Instead, the Lexington policy was negotiated — provision-by-provision — by United and its many insurers. In negotiating the policy, the parties borrowed from other policies, but they did so with little thought as to how the provisions that they were borrowing would work together when combined within a single policy. And, when the parties took pen in hand to write their own provisions, they drafted those provisions poorly, often leaving the Court and the attorneys who are now representing the parties to wonder what the negotiators could possibly have had in mind. In short, then, the policy is a mess, chock full of provisions that are unclear, provisions that are clear but absurd, and provisions that are clear but contradicted by other provisions that are just as clear.

[916]*916Because the Lexington policy is so badly drafted, it has spawned seemingly endless disputes among the parties. Indeed, the parties seem to find new ambiguities in the policy on almost a daily basis. Sometimes, in fact, the parties discover new ambiguities after submitting briefs on a motion and before appearing in court to argue that motion. And sometimes the parties even discover new ambiguities while standing before the Court during oral argument.

This matter is now before the Court on the fourth round of summary judgment motions. This latest round of summary judgment motions can be divided into three groups:

(1) Motions concerning whether the AMA and NYAG claims are within the primary policy’s main insuring clause and antitrust endorsement;
(2) Motions concerning whether certain underlying claims are interrelated with the Shane claim; and
(3) Motions concerning United’s affirmative defenses to the counterclaim of defendant Fireman’s Fund Insurance Company (“FFIC”).

The Court addresses each set of motions in turn. Familiarity with the facts and the Court’s previous orders in this and in a related case (UnitedHealth Group Inc. v. Hiscox Dedicated Corporate Member Ltd., No. 09-CV-0210 (PJS/SRN), filed Jan. 29, 2009) is presumed. The Court will briefly summarize the facts only when necessary.

A. Standard of Review

Summary judgment is appropriate “if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(a). A dispute over a fact is “material” only if its resolution might affect the outcome of the lawsuit under the substantive law. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). A dispute over a fact is “genuine” only if “the evidence is such that a reasonable jury could return a verdict for the nonmoving party.” Id. “The evidence of the nonmovant is to be believed, and all justifiable inferences are to be drawn in [its] favor.” Id. at 255, 106 S.Ct. 2505.

B. Coverage for the AMA and NYAG Claims

The first set of motions pertains to whether the AMA and NYAG claims fall within the main insuring clause of the primary policy (i.e., the Lexington policy) or within the coverage provided by the antitrust endorsement to the primary policy. The Court addresses each of these provisions in turn, and then addresses the additional contention of the insurers that United cannot recover for the AMA claim even if some portion of that claim falls within the coverage afforded by one or both of these provisions.

1. The Main Insuring Clause

The main insuring clause of the primary policy provides as follows:

We will pay amounts any Protected Person is required to pay as damages and claim expenses, including Damages assumed under contract and related claim expenses assumed under contract, for claims that directly or indirectly result from or are related to the Operations, including but not limited to any Wrongful Act committed or allegedly committed by you or another party for whom you are alleged to be liable, in the rendering or failure to render Services [sic].

JEx64. Boldfaced terms are defined elsewhere in the policy.1 In particular, the term “damages” is defined as follows:

[917]*917Damages mean compensation to others. Damages include compensatory, exemplary, enhanced, equitable and punitive damages, settlements, and Claim Expenses awarded against or agreed to as part of a covered claim settlement by a Protected Person. If you are legally required, by statute, regulation or contract, to pay a claimant’s legal costs and any interest that applies to such costs, these costs will also be considered Damages.

JEx65.

The insurers argue that the payments United made to settle the AMA and NYAG claims are not “damages,” but rather contractual benefit payments (in the case of AMA) or a “capital investment” (in the case of NYAG). The Court disagrees with the insurers that the term “damages” excludes these payments.2 As the Court explained in connection with the last round of summary judgment motions,

the definitions of “Damages,” “Operations,” and “Services” are extremely broad.... In particular, the definition of “Damages” includes more than just compensatory damages; it expressly includes, among other things, equitable and punitive damages.
Policy § 4.5. Similarly, the definitions of “Operations” and “Services” are drafted to cover essentially everything that United does, including “the design, marketing and administration of benefit plans,” “claim handling, reviewing and adjusting,” “insurance operations,” and “development, maintenance and credentialing of provider networks.” Policy § 4.13; see also Policy § 4.18.

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836 F. Supp. 2d 912, 2011 U.S. Dist. LEXIS 148422, 2011 WL 6781007, Counsel Stack Legal Research, https://law.counselstack.com/opinion/unitedhealth-group-inc-v-columbia-casualty-co-mnd-2011.