Ward v. Dixie National Life

CourtCourt of Appeals for the Fourth Circuit
DecidedNovember 29, 2007
Docket06-2022
StatusUnpublished

This text of Ward v. Dixie National Life (Ward v. Dixie National Life) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fourth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Ward v. Dixie National Life, (4th Cir. 2007).

Opinion

ON REHEARING

UNPUBLISHED

UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT

No. 06-2022

MARTHA WARD, on behalf of herself and all others similarly situated,

Plaintiff - Appellant,

versus

DIXIE NATIONAL LIFE INSURANCE COMPANY; NATIONAL FOUNDATION LIFE INSURANCE COMPANY,

Defendants - Appellees,

and

PALMETTO MARKETING ASSOCIATES, INCORPORATED; PATTI JENKINS,

Defendants.

----------------------------

SOUTH CAROLINA DEPARTMENT OF INSURANCE; AMERICA’S HEALTH INSURANCE PLANS, INCORPORATED,

Amici Supporting Appellees. No. 06-2054

MARTHA WARD, on behalf of herself and all others similarly situated,

Plaintiff - Appellee,

NATIONAL FOUNDATION LIFE INSURANCE COMPANY,

Defendant - Appellant,

DIXIE NATIONAL LIFE INSURANCE COMPANY,

Defendant - Appellee,

SOUTH CAROLINA DEPARTMENT OF INSURANCE; AMERICA’S HEALTH INSURANCE PLANS, INCORPORATED,

Amici Supporting Appellant.

Appeals from the United States District Court for the District of South Carolina, at Columbia. Joseph F. Anderson, Jr., Chief District Judge. (3:03-cv-03239-JFA)

Argued: May 23, 2007 Decided: October 5, 2007

Decided on Rehearing: November 29, 2007

2 Before MICHAEL and TRAXLER, Circuit Judges, and WIDENER,1 Senior Circuit Judge.

Vacated in part, affirmed in part, dismissed in part, and remanded by unpublished per curiam opinion.

ARGUED: Richard Ara Harpootlian, Columbia, South Carolina, for Martha Ward, on behalf of herself and all others similarly situated. Elliot H. Scherker, GREENBERG & TRAURIG, L.L.P., Miami, Florida, for Dixie National Life Insurance Company and National Foundation Life Insurance Company. ON BRIEF: Tobias G. Ward, Jr., TODD & WARD, P.C., Columbia, South Carolina, for Martha Ward, on behalf of herself and all others similarly situated. C. Allen Foster, Kevin E. Stern, GREENBERG & TRAURIG, L.L.P., Washington, D.C.; J. Calhoun Watson, SOWELL, GRAY, STEPP & LAFFITTE, L.L.C., Columbia, South Carolina, for Dixie National Life Insurance Company and National Foundation Life Insurance Company. Jeffrey A. Jacobs, SOUTH CAROLINA DEPARTMENT OF INSURANCE, Columbia, South Carolina, for the South Carolina Department of Insurance, Amicus Curiae Supporting Dixie National Life Insurance Company and National Foundation Life Insurance Company. Joni Hong, AMERICA’S HEALTH INSURANCE PLANS, INC., Washington, D.C.; Markham R. Leventhal, Mitchell D. Sprengelmeyer, JORDEN BURT, L.L.P., Miami, Florida, for America’s Health Insurance Plans, Inc., Amicus Curiae Supporting Dixie National Life Insurance Company and National Foundation Life Insurance Company.

Unpublished opinions are not binding precedent in this circuit.

1 Judge Widener heard oral argument in this case but died prior to the time the decision was filed. The decision is filed by a quorum of the panel. 28 U.S.C. § 46(d).

3 PER CURIAM:

Plaintiff Martha Ward sued National Foundation Life

Insurance Company (National) and Dixie National Life Insurance

Company (Dixie), asserting that National refused to pay the full

amount of benefits owed under supplemental cancer insurance

policies that were issued by Dixie and later assigned to National.

The district court certified a statewide (South Carolina) plaintiff

class rather than the multistate class Ward sought to represent,

and the court later granted summary judgment in favor of National

on the breach of contract claims. Ward appealed and National

cross-appealed. In a prior opinion, we concluded that although the

district court properly limited the plaintiff class to South

Carolina residents, the court improperly granted summary judgment

on the breach of contract claims, and we remanded for further

proceedings on those claims. We dismissed National’s cross-appeal

without prejudice. See Ward v. Dixie Nat’l Life Ins. Co., 2007 WL

2914954 (4th Cir. Oct. 5, 2007).

Ward filed a petition for rehearing, and National,

supported by various amici, filed a petition for rehearing and

rehearing en banc. We granted Ward’s petition for panel rehearing

and denied National’s petition for rehearing, thus vacating our

prior opinion.2 See Fourth Circuit I.O.P. 40.2. Dispensing with

2 Because no member of the court called for a vote on National’s petition for rehearing en banc, the petition was denied. See Fourth Circuit Local Rule 35(b).

4 further briefing and argument, we now vacate the district court’s

decision granting summary judgment in favor of National, and we

remand with instructions for the district court to instead enter

judgment in favor of Ward on the breach of contract claims. In

light of our remand, we conclude that it would be premature for us

to consider the class certification issue. We therefore dismiss

without prejudice National’s cross-appeal.

I.

In August 1990 Ward purchased a cancer treatment benefit

policy from Dixie covering both herself and her husband. Ward’s

policy is a type of supplemental insurance under which direct

payments are made to the policyholder when an insured patient

undergoes covered cancer treatments. Benefits under this kind of

policy are paid regardless of whether the patient has other

insurance sufficient to cover all medical expenses. When the

patient has other insurance covering cancer treatments, the

policyholder is able to retain the money received as a result of

the supplemental coverage.

Benefits under Ward’s policy vary as to the procedure

performed. In some sections the policy provides clear caps as to

the maximum benefit to be paid. For example, the policy provides

a “Schedule of Operations” listing the maximum amount to be paid

-- ranging from $150 for skin excisions to $3000 for removal of an

5 intracardiac tumor -- for a variety of operations. In many other

sections of the policy no dollar amounts are provided, and benefits

are calculated in relation to the “actual charges” for the covered

procedures. Section (F) of the policy, titled “X-ray Therapy,

Radium Therapy, Radiation Therapy, and Chemotherapy Benefit,”

provides an example of this language:

We will pay the actual charges for teleradiotherapy, using either natural or artificially propagated radiation, when used for the purpose of modification or destruction of tissue invaded by cancer. We will also pay the actual charges made for plaques or molds or the administration internally, interstitially, or intracavitarially of radium or radioisotopes in sealed sources for the purpose of modification or destruction of tissue invaded by cancer. We will also pay the actual charges for cancericidal chemical substances and the administration thereof for the purpose of the modification or destruction of tissue invaded by cancer.

J.A. 221. Although the phrase is used repeatedly throughout the

policy, no definition for “actual charges” is provided.

Dixie assigned Ward’s policy to National in 1994. In

2001 Ward began filing claims under the policy after her husband,

James Ward (James), was diagnosed with prostate cancer and started

receiving treatment. Shortly thereafter, a dispute between Ward

and National arose over how benefits paid in the amount of the

“actual charges” are calculated.

For a number of years after the assignment, National

appears to have calculated benefits in the same manner that Dixie

had previously done. Specifically, when the benefit owed was based

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