UnitedHealth Group Inc. v. Columbia Casualty Co.

47 F. Supp. 3d 863, 2014 U.S. Dist. LEXIS 134956, 2014 WL 4783394
CourtDistrict Court, D. Minnesota
DecidedSeptember 25, 2014
DocketCase No. 05-CV-1289 (PJS/SER)
StatusPublished
Cited by16 cases

This text of 47 F. Supp. 3d 863 (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., 47 F. Supp. 3d 863, 2014 U.S. Dist. LEXIS 134956, 2014 WL 4783394 (mnd 2014).

Opinion

ORDER

PATRICK J. SCHILTZ, District Judge.

Plaintiff UnitedHealth Group Inc. (“United”) brought this coverage 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. This case is now in its ninth year. The Court has ruled on numerous non-dispositive motions, disposi[866]*866tive motions, and motions in limine, and certain matters were tried to juries in May 2012 and June 2013. United has exhausted its primary insurance and settled with some of its excess insurers. At this point, there are effectively three excess insurers remaining in this case: Executive Risk Specialty Insurance Company; First Specialty Insurance Corporation; and Starr Excess Liability Insurance International Limited (collectively “the insurers”).

This matter is before the Court on the insurers’ motion for summary judgment on Counts V and VI of United’s second amended supplemental complaint. In Counts V and VI, United seeks coverage for the “AMA claim,” which is by far the largest of the underlying claims. For the reasons that follow, the Court grants the insurers’ motion.

I. BACKGROUND

On January 14, 2009, United executed a $350 million settlement (“the Settlement”) of two putative class actions: American Medical Association v. United Healthcare Corp., No. 00-2800 (LMM/GWG) (S.D.N.Y. removed Apr. 12, 2000) CAMA ”)1 and Malchow v. Oxford Health Plans, Inc., No. 08-935 (FSH/PS) (D.N.J. filed Feb. 19, 2008) (“Malchow ”). UA0432.2 Broadly speaking, the AMA and Malchow actions involved similar factual allegations against United, various United subsidiaries, and various entities related to United. To simplify the discussion of AMA and Malchow, the Court will collectively refer to the defendants in those cases as “United” except when it is necessary to distinguish among them.

A. United’s Coverage Actions

This action had been pending for over three years when United executed the Settlement. Shortly after executing the Settlement, United amended its complaint in this case to seek coverage for the portion of the Settlement attributable to the claims asserted against United in the AMA action. ECF No. 336 ¶ 3; see also ECF No. 556 ¶¶ 1-3.3

At about the same time, United filed a separate lawsuit seeking coverage for the portion of the Settlement attributable to the claims asserted against United in the Malchow action.4 See UnitedHealth Grp. Inc. v. Columbia Cas. Co., No. 09-0210 (PJS/SRN) (D. Minn, filed Jan. 29, 2009) (“the '09 action”). United filed the separate '09 action — rather than amending its complaint in this action — because United sought coverage for the Malchow claim under a tower of insurance that differed from the tower of insurance that is at issue in this case.5 See id. ECF No. 44 ¶ 43.

[867]*867The Court dismissed most of the '09 case in February 2010. In essence, the Court held that the Malchow action was not covered under United’s insurance policies, and thus United’s insurers were not obligated to indemnify United for the amounts that it paid to defend and settle the Malchow claim. Id. ECF No. 151. The parties then stipulated to entry of judgment, and the Court dismissed the case with prejudice. Id. ECF Nos. 170-72. United did not file an appeal.

That brings us to the nub of the present dispute: As noted above, the Settlement covered both the AMA claim and the Malchow claim. In the '09 case, this Court held that the portion of the Settlement attributable to the Malchow claim was not covered. In this case, United is seeking to be indemnified for the portion of the Settlement attributable to the AMA claim. Thus, United’s claim for indemnity requires a jury to allocate the Settlement between the (uncovered) Malchow claim and the (potentially covered) AMA claim.6 In their motion for summary judgment, the insurers argue that the record does not contain sufficient evidence to permit a reasonable jury to perform this allocation. Familiarity with the substantive and procedural complexity of the AMA and Malchow cases is necessary to evaluate the insurers’ argument.

B. The AMA Case

United is a large health-insurance company. In the AMA lawsuit, the plaintiffs alleged that, under the terms of certain United healthcare policies, United was obligated to pay a certain percentage of the “usual, customary and reasonable” (“UCR”) rate for out-of-network medical services. UA0053-54. United determined UCR rates using databases maintained by Ingenix, a wholly owned subsidiary of United. The plaintiffs alleged that the Ingenix databases incorporated flawed, incomplete, and manipulated data, resulting in United paying less for out-of-network services than it was obligated to pay. UA0063-66. The AMA plaintiffs included healthcare providers as well as subscribers and beneficiaries of United healthcare plans.

The AMA ease was originally filed in New York state court in March 2000. UA0008. The defendants removed the case to the United States District Court for the Southern District of New York, and the case was assigned to Judge Lawrence McKenna.

Over the next nine years, Judge McKenna presided over extensive motion practice and discovery. UA1089-90. Judge McKenna issued a number of lengthy and detailed opinions, including a 75-page order granting in part the defendants’ motion for summary judgment on the claims pleaded in the third amended complaint, UA1086; a 57-page order granting in part the plaintiffs’ motion for leave to file a fourth amended complaint, UA0220; and a 40-page order granting in part the defendants’ motion to dismiss the fourth amended complaint, UA0180.

[868]*868Judge McKenna’s rulings considerably narrowed the plaintiffs’ claims. The third amended complaint consisted largely of claims under ERISA7 and claims that United had engaged in deceptive trade practices in violation of New York law. UA1088-89. Judge McKenna held that the plaintiffs were required to exhaust their administrative remedies with respect to any ERISA claim that was based on an alleged violation of a healthcare plan. UA1096-1130. He also agreed with the defendants that those plaintiffs who could not show that they had suffered out-of-pocket losses lacked standing to seek monetary damages (although they could nevertheless seek injunctive relief for breach of fiduciary duty). UA1133-39. Finally, he held that those plaintiffs whose plans named someone other than United as the plan administrator could not seek monetary benefits from United. UA1153-57.

Before issuing these rulings, Judge McKenna closely examined evidence concerning various plan terms, United’s claims practices, and individual plaintiffs’ administrative records.

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47 F. Supp. 3d 863, 2014 U.S. Dist. LEXIS 134956, 2014 WL 4783394, Counsel Stack Legal Research, https://law.counselstack.com/opinion/unitedhealth-group-inc-v-columbia-casualty-co-mnd-2014.