UnitedHealth Group Inc. v. Executive Risk Specialty Insurance Co.

870 F.3d 856, 2017 WL 3910115, 2017 U.S. App. LEXIS 17324
CourtCourt of Appeals for the Eighth Circuit
DecidedSeptember 7, 2017
Docket15-1076
StatusPublished
Cited by58 cases

This text of 870 F.3d 856 (UnitedHealth Group Inc. v. Executive Risk Specialty Insurance Co.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eighth Circuit 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. Executive Risk Specialty Insurance Co., 870 F.3d 856, 2017 WL 3910115, 2017 U.S. App. LEXIS 17324 (8th Cir. 2017).

Opinion

COLLOTON, Circuit Judge.

UnitedHealth Group sued several insurers in the District of Minnesota, seeking indemnity and defense costs for underlying litigation settlements under its professional liability excess insurance policies. Uni-tedHealth appeals the district court’s 2 grant of summary judgment in favor of four insurance companies. UnitedHealth contends that the court erred in three ways: (1) by granting National Union Fire Insurance Company’s summary judgment motion based on UnitedHealth’s failure to provide adequate notice of its claim; (2) by determining that UnitedHealth presented insufficient evidence on how a settlement was allocated between covered and non-covered claims; and (3) by granting summary judgment sua sponte on United-Health’s claim for certain defense costs. We conclude that the district court did not err on the allocation issue, and that Uni-tedHealth waived its objection to the asserted sua sponte order on defense costs. Because the district court’s rulings on those issues mean that National Union’s coverage would not be implicated, it is unnecessary to address the court’s separate order on the adequacy of notice to National Union. We therefore affirm.

I.

This appeal involves a dispute over insurance coverage for settlement amounts arising from two different lawsuits. Uni-tedHealth reached a single lump-sum settlement for the two actions together. There was potential insurance coverage for claims in one lawsuit but not for claims brought in the other. A dispute then arose over how to allocate the settlement amount between the covered and non-covered claims.

The first lawsuit was filed in New York in 2000. A group of plaintiffs, including several group health plans insured or administered by UnitedHealth or its subsidiaries, sued ÚnitedHealth in New York state court, and United Health removed the action to federal court. One plaintiff was the American Medical Association, and we refer to this litigation as the AMA suit. The case involved databases used by Uni-tedHealth. UnitedHealth’s subsidiary, In-genix, owned two databases that United-Health and other insurers used to calculate the usual, customary, and reasonable charges for medical services.. UnitedHealth used the databases’ calculations to determine the amount that it was. required to pay for out-of-network services. The AMA plaintiffs alleged that UnitedHealth conspired with other insurers to provide inaccurate information to the Ingenix databases to reduce payment for out-of-network benefit claims. The plaintiffs brought claims under the Employee Retirement Income Security Act, Racketeer Influenced and Corrupt Organizations Act, Sherman Act, and state law. The district court, Judge Lawrence M. McKenna, dismissed most of the ERISA and RICO claims. The antitrust claims under the Sherman Act proceeded until the case eventually was settled..

The second action was filed in 2008 in New Jersey. In February 2008, a group of plaintiffs sued Oxford Health, an entity that UnitedHealth acquired in 2004, in the United States District Court for the Dis *860 trict of New Jersey. One of the plaintiffs was named Malchow, and we refer to this action as the Malchow suit. The Malchow plaintiffs asserted claims under ERISA and violations of a state regulation, arising from breaches of contract and claims regarding Oxford's billings and payments.

That same month, the New York Attorney General served UnitedHealth with á Notice of Proposed Litigation based on allegations similar to those in the AMA suit. We refer to this action as the NYAG suit. On’ January 13, 2009, UnitedHealth settled the NYAG suit by entering into an agreement known as an Assurance of Discontinuance, under which UnitedHealth agreed to discontinue operating arid using the Ingenix database once an independent database was created. See N.Y. Exec. Law § 63(15). As’ part of this settlement, Uni-tedHealth was required to pay $50 million to help establish this ■ independent database.

The following day, UnitedHealth signed a settlement agreement to résolve both AMA and Malchow suits for $350 million. The settlement agreement did not state how the $350 million was to be allocated between the AMA plaintiffs and Malchow plaintiffs.

The AMA and Malchow plaintiffs moved to be certified as a settlement class before Judge McKenna in New York. The court reviewed the settlement agreement and held a. seven-day evidentiary hearing to determine whether the settlement was fair and reasonable. In October 2010, Judge McKenna certified the settlement class, approved; the-$350 million settlement,.and dismissed the AMA suit. Following the court’s approval,. and in accordance with the settlement agreement, the Malchow plaintiffs stipulated to the dismissal of the Malchow suit in New Jersey. • ■

After signing the settlement agreernent, UnitedHealth filed an amended complaint in this ongoing lawsuit in the District of Minnesota against its professional liability excess insurers. UnitedHealth sought damages for the insurers’ failure to indemnify it -for: (1) the AMA portion of the $360 million settlement under the Antitrust Endorsement of its professional liability insurance policy and $35 million in AMA defense costs; (2) the NYAG settlement; and (3) certain denied claims arising out of lawsuits alleging that UnitedHealth failed to reimburse certain medical expenses. In counts III and IV of its second amended complaint, UnitedHealth sought a declaratory judgment and damages for certain denied claims that are not at issue in this appeal. In counts V and VI, UnitedHealth sought a declaratory judgment and damages for an alleged breach of contract--to reimburse UnitedHealth for the costs to defend and settle the AMA suit. In counts VII and VIII, UnitedHealth sought , the same relief for alleged breaches related to the NYAG suit.

After several years of litigation, four excess insurers remain in this action: Executive Risk Specialty Insurance Company, First Specialty Insurance Corporation, Starr Excess Liability Insurance International Limited, and National Union Fire Insurance Company (collectively, the “Insurers”). Executive Risk holds the first excess insurance policy relevant to this appeal; coverage attaches at $95 million in damages. The others provide coverage at higher levels of damages.

In January 2013, the Insurers moved for partial summary judgment. National Union argued that UnitedHealth had failed to provide proper notice of the AMA claim during the policy period and thus was not entitled to any recovery from National Union for that claim. The district court agreed and dismissed UnitedHealth’s claims against National Union, based on the AMA suit. The court also ruled that *861 UnitedHealth had the burden to allocate the settlement between the potentially covered AMA

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Bluebook (online)
870 F.3d 856, 2017 WL 3910115, 2017 U.S. App. LEXIS 17324, Counsel Stack Legal Research, https://law.counselstack.com/opinion/unitedhealth-group-inc-v-executive-risk-specialty-insurance-co-ca8-2017.