Litigation Issues in Long Term Care Insurance: Representing Insurance Companies in a Complex and Developing Market
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Listed in The Best Lawyers in America® Insurance Law, 2007-2024 Commercial Litigation, 2011-2024 Litigation – Insurance, 2016-2024 Mass Tort Litigation / Class Actions – Defendants, 2021-2024 Listed in Benchmark Litigation "Local Litigation Star," Alabama, 2011-2021, 2023 "Litigation Star," 2024 Listed in Mid-South Super Lawyers, Insurance Coverage, 2016-2021 Listed in Alabama Super Lawyers, Insurance Coverage, 2008-2015 Listed in Birmingham Business Journal, "Best of the Bar," Insurance 2005 Listed in B-Metro, "Top Lawyers," 2019-2020 Martindale-Hubbell® AV Preeminent Rated Danny Aycock, et al. v. Bankers Life and Casualty Company, et al., CV 2004-91 (Circuit Court of Lauderdale County, Ala. 2004) Successfully consolidated two class action lawsuits alleging the client’s agent accepted applications and premiums but never submitted either to the company at any time. All class action allegations were struck from the complaint, and the cases were sent to arbitration. All claims were resolved with contribution from the agent. Hurst v. Bankers Life and Casualty Company(Western District of Texas) Plaintiff asserted claims for breach of contract, fraud, negligence, bad faith, and deceptive trade practices arising out of the denial of plaintiff’s claim for assisted living facility benefits under an insurance policy. Plaintiff claimed that he was entitled to insurance coverage for his stay at a “care home.” The insurer denied plaintiff’s claim for benefits because the facility was not a licensed assisted living facility. The parties filed cross-motions for partial summary judgment on plaintiff’s breach of contract claim. The U.S. District Court for the Western District of Texas granted the defendant insurance company’s motion and denied the plaintiff beneficiary’s motion, thereby entering summary judgment in favor of the insurer and dismissing plaintiff’s breach of contract claim with prejudice. The court held that the insurer did not breach the terms of the insurance policy and that the “care home” was operating in violation of Texas law. The court held that because the services provided to the plaintiff were not provided by an assisted living facility that met the licensing requirements of the state as required by the policy, the expenses did not qualify as “covered expenses” under the policy. Irene A. Rountree v. Washington National Insurance Company, 6:07-cv-14, 2007 WL 1500293 (S.D. Ga. Won dismissal of all claims for defendant insurance company in which plaintiff alleged breach of contract, fraud, bad faith and negligent misrepresentation. Mollica, et al. v. Conseco Insurance Company, et al., 2:07-cv-1753-IPJ (N.D. Ala. ) Obtained summary judgment on all claims, including promissory fraud, fraudulent misrepresentation, fraudulent suppression, negligence, wantonness and quantum meruit, in a case in which several agents alleged, among other things, that our client had made various misrepresentations in connection with the rollout of a new universal life insurance product. Philadelphia Life Insurance Company Sales Practices Litigation, 6:01-md-1404-19-DAB (M.D. FL ) Two named plaintiffs brought a nationwide life insurance sales practices class action. While plaintiffs' motion for class certification was pending, we moved for summary judgment on plaintiffs’ claims. The court reserved ruling on class certification and then granted our client’s motions for summary judgment in their entirety. Plaintiffs appealed to the Eleventh Circuit, which affirmed the decision relating to one plaintiff in its entirety and upheld the dismissal of all of the claims of the second plaintiff except for two claims. Subsequently, after extensive briefing, the court denied class certification. Plaintiffs sought to appeal the certification decision to the Eleventh Circuit, but their petition was denied. Ruby Sandock, on behalf of herself and all others similarly situated, v. Bankers Life and Casualty Company, 1:08-cv-3218 (N.D. Ill.) Within six months of filing, obtained a Rule 12(b)(6) dismissal of plaintiff's claims for violations of the Illinois Consumer Fraud and Deceptive Business Practice Act, unjust enrichment and breach of contract in a nationwide class action stemming from client Bankers Life and Casualty Company’s alleged failure to comply with provisions of its long-term care policies. Sheldon and Estelle Langendorf, et al. v. Conseco Senior Health Insurance Company, 08-CV-3914 (N.D. Ill. ) Won dismissal of plaintiffs’ class action complaint against client Conseco seeking damages for failure to pay health insurance claims based on breach of contract and violations of the Illinois Consumer Fraud and Deceptive Business Practice Act; later reached a nationwide class settlement with respect to all claims. The Center for Restorative Breast Surgery, LLC, et al. v. Blue Cross Blue Shield of Louisiana, et al., 06-9985 (E.D. LA ) Defended an action filed by a medical provider and various patients against an insurance client in Louisiana state court, which was removed and then consolidated with 30 other similar cases against various entities related to our client. In an attempt to destroy diversity, plaintiff amended its pleadings, but we able to get the medical provider to stipulate that federal jurisdiction based on diversity still existed in our case and that the case should remain in federal court. Subsequently, the medical provider dismissed the other federal cases without prejudice so that it could focus on its state court lawsuits against the other entities. Because we were the only defendant to have filed an answer, ours was the only federal case in which the medical provider could not file a unilateral notice of dismissal. We negotiated a stipulation of dismissal with the medical provider in which we were able to condition any refiling of plaintiff's claims on certain terms, including venue and the filing of ERISA claims only. William and Marion Boyles v. Pioneer Life Insurance Company, 01-4592-CA (20th Judicial Circuit, Collier County, Fla. ) Successfully opposed class certification in this nationwide class action alleging our client’s agents marketed and sold unnecessary and inappropriate policies to the elderly. Plaintiffs’ counsel also filed 13 identical lawsuits in other Florida courts; we successfully opposed the addition of punitive damages claims in each case. W.T.Paine v. Jefferson National Life Insurance Company f/n/a Conseco Variable Insurance Company, 2:07-CV-00124-JLH (E.D. Ariz. ) Obtained summary judgment on behalf of client insurance company in a case where plaintiffs alleged breach of multiple insurance contracts by treating payments as loans, thereby allegedly miscalculating the value of the policies. In addition to breach of contract claims, the case involved allegations of fraud, bad faith, deceptive trade practices, and intentional infliction of emotional distress/outrage