Articles Posted in Class Action

by
Plaintiffs were both insured by USAA Casualty Insurance Company under auto insurance policies that provided medical payments coverage. Plaintiffs filed a complaint against USAA arguing that USAA’s practice of sending medical claims to Auto Injury Solutions (AIS) for review was an improper cost containment scheme designed to deprive Montana consumers of their first-party medical pay benefits. Plaintiffs subsequently filed a motion to certify a proposed class. The district court issued its order certifying the class, concluding “all members of the proposed class were subject to the same claims processing procedure of outsourcing claims to AIS. USAA appealed from the certification order. The Supreme Court reversed, holding that the district court abused its discretion by certifying the class under Mont. R. Civ. P. 23(a) and under Mont. R. Civ. P. 23(b)(3). Remanded. View "Byorth v. USAA Casualty Insurance Co." on Justia Law

by
The underlying claim in this case, which had been appealed on three previous occasions, concerned an exclusion in the State’s health benefit insurance plan, which allowed the State to coordinate benefits in violation of Montana’s made whole laws. Jeanette Diaz, Leah Hoffman-Bernhardt, and others similarly situated (collectively, Diaz) filed suit alleging that third-party administrators and the State (collectively, Defendants) had violated employees’ made whole rights under Montana law. During the various appeals, the Supreme Court concluded that the district court certified and defined a class and that the district court correctly denied the State’s motion for summary judgment. In this, the fourth appeal, Diaz appealed a district court order determining the manner in which prejudgment interest on payments due to class members was to be calculated. The Supreme Court affirmed the district court’s order declaring interest to begin thirty days following the Court’s decision in Blue Cross & Blue Shield of Montana v. Montana State Auditor. Remanded for the district court to correct the date to be applied for determining the calculation of prejudgment interest. View "Diaz v. State" on Justia Law

by
This case arose out of claims asserted by multiple people against Blue Cross and Blue Shield of Montana, now known as Caring for Montanans, Inc. (CFM) and Montana Comprehensive Health Association (MCHA). The claimants asserted that while they were insured by CFM or MCHA, they submitted claims that the insurers denied based upon exclusions contained in their health insurance policies. These exclusions generally provided that the insurer would not pay for health care costs of the injured insureds if the insureds received, or were entitled to receive, benefits from any automobile liability policy. These exclusions were subsequently disapproved by the Montana Commissioner of Insurance, and the insureds sought the previously-denied benefits. The district court certified a class of claimants for settlement purposes only. The court then held a fairness hearing on a proposed settlement agreement and approved the settlement. Several class members objected to the settlement and appealed to the Montana Supreme Court, arguing they should have been allowed to conduct further discovery to ascertain the fairness of the settlement agreement. The Supreme Court agreed with the objectors and remanded the case to the district court for further discovery and a second fairness hearing. The district court allowed further discovery, held a second fairness hearing, and determined that the same settlement agreement was fair, reasonable, and adequate. The Objectors again appealed. Finding no reversible error, the Supreme Court affirmed. View "Pallister v. BCBS" on Justia Law

by
When Kent Roose was injured in an automobile crash his wife was an employee of Lincoln County, which provided health benefits via a group health plan (the Plan) that was part of Joint Powers Trust (JPT). Employee Benefit Management Services, Inc. (EBMS administered the Plan. The Plan contained an exclusion stating that medical benefits would not be paid when any automobile or third-party liability insurance was available to pay medical costs. EBMS denied Roose’s request for reimbursement for medical expenses he paid out of the liability insurance payment he received from the tortfeasors’ insurer. Roose subsequently brought suit against EBMS and JPT. The Supreme Court held that the exclusion violated Mont. Code Ann. 2- 18-902(4). Appellants subsequently reimbursed Roose the requested amount. In 2014, Roose filed a motion for partial summary judgment and class certification, arguing that Appellants violated section 2-18-902 through systematic practices that amounted to seeking subrogation against the tortfeasor’s liability carrier before Roose was made whole. Roose also sought class certification on behalf of every member of Appellants’ plans subject to Montana law that contained the coverage exclusion. The district court granted Roose’s motion. The Supreme Court affirmed, holding that the district court did not abuse its discretion in certifying the class or in defining the class. View "Roose v. Lincoln County Employee Group Health Plan" on Justia Law

by
Plaintiffs were laborers who worked on the construction and rehabilitation of two multi-family housing projects. Plaintiffs filed this wage and hour action and moved for certification of a proposed class including all laborers, tradesmen, and craftsmen who worked for Monfric, Inc., the general contractor, or its subcontractors and who were not paid prevailing wages during the construction and rehabilitation of the housing projects. The district court denied Plaintiffs’ motion for class certification, concluding that Plaintiffs failed to demonstrate numerosity of the proposed class. The Supreme Court affirmed, holding that the district court did not abuse its discretion when it concluded that Plaintiffs failed to establish that their proposed class was so numerous as to make joinder of its remaining members in a single action impracticable. View "Morrow v. Monfric" on Justia Law

by
Plaintiff was injured in an accident while driving a business vehicle owned by Mattress King, Inc. and insured by Mountain West Farm Bureau. Plaintiff, whose personal vehicles were insured by Safeco Insurance Company of Illinois, filed a claim with Safeco for medical payment benefits. Plaintiff received medical payment benefits from Safeco and an undisclosed amount of underinsured motorist benefits from Mountain West. Believing Safeco wrongfully refused to pay additional claimed benefits, Plaintiff brought a class action suit against Safeco. The district court ultimately ruled in favor of Safeco. The Supreme Court affirmed, holding that the “other insurance” clauses in Plaintiff’s automobile liability policy were valid and, as applied in this case, did not constitute de facto subrogation. View "Scheafer v. Safeco Ins. Co. of Ill." on Justia Law

by
Plaintiff was involved in a motor vehicle accident caused by another driver. As a result of the accident, Plaintiff sustained both bodily injury and property damage. Plaintiff carried an automobile insurance policy through United Services Automobile Association General Indemnity Company (USAA). USAA paid vehicle repair and car rental costs, after which it sought subrogation for the property damage expenses from the tortfeasor’s automobile liability insurer. Plaintiff subsequently filed an action on behalf of himself and a putative class of plaintiffs, alleging that USAA violated Montana law by seeking subrogation for property damage loss before its insured had been made whole with respect to related personal injuries. The U.S. district court certified a question to the Montana Supreme Court, which answered by holding that Montana law does not prohibit an insurer from exercising its right of subrogation under the limited, specific circumstances presented in the certified question. View "Orden v. United Servs. Auto. Ass'n" on Justia Law

by
In the 1990s, Defendants (Employers) created a sick-leave policy allowing employees to bank their sick leave in a continued illness bank (CIB). In 2002, Employers modified the terms of the CIB to create the CIB pay-out benefit, which allowed a capped amount of unused CIB hours to be paid to departing employees who completed twenty-five years or more of service. In 2008, Employers terminated the CIB pay-out benefit, and only employees who had reached twenty-five years of employment with Employers were entitled to their earned but unused CIB hours upon termination. Plaintiffs in this case represented employees who had not reached twenty-five years of service before the benefit ended. Plaintiffs brought a class action complaint against Employers. The district court granted summary judgment for Employers. The Supreme Court affirmed, holding that the district court did not err in determining that (1) Employers’ policies did not constitute a standardized group employment contract; (2) the CIB pay-out benefit was not deferred compensation or wages under the Montana Wage and Wage Protection Act; and (3) the covenant of good faith and fair dealing did not apply to Plaintiffs’ claims. View "Chipman v. Northwest Healthcare Corp." on Justia Law

by
Steve Sangwin, a State employee, was a qualified subscriber and beneficiary of the State of Montana Employee Benefits Plan (Plan), which was administered by Blue Cross and Blue Shield of Montana (BCBS). Steve's daughter, McKinley, was also a beneficiary under the Plan. This case arose after BCBS denied a preauthorization request for a medical procedure for McKinley on the grounds that the procedure was "experimental for research." Steve and his wife (collectively, the Sangwins) initiated this action by filing an amended complaint setting forth five counts, including a request for certification of a class action. The Sangwins defined class members as other beneficiaries of the Plan who had their employee benefits denied by the State based on the experimental exclusion for research in the past eight years. The district court granted the Sangwins' motion for class certification. The State appealed. The Supreme Court (1) affirmed the district court's order defining the class; but (2) reversed and remanded with respect to the question certified for class treatment, holding that the district court abused its discretion in specifying for class treatment the question of whether the State breached its contract of insurance with the plaintiffs. View "Sangwin v. State" on Justia Law

by
This interlocutory appeal arose from the district court's order certifying a class in Plaintiff's class action against Defendant, Allstate Insurance Company. Plaintiff's class action claim arose out of the Supreme Court's remand of his initial non-class third-party claim against Allstate in Jacobsen I. In Jacobsen I, Plaintiff filed a complaint against Allstate for, among other causes of action, violations of the Montana Unfair Trade Practices Act. Plaintiff sought both compensatory and punitive damages. The Supreme Court ultimately remanded the case for a new trial. On remand, Plaintiff filed a motion for class certification, proposing a class definition encompassing all unrepresented individuals who had either third- or first-party claims against Allstate and whose claims were adjusted by Allstate using its Claim Core Process Redesign program. The district court certified the class. The Supreme Court affirmed the class certification but modified the certified class on remand, holding that the district court did not abuse its discretion by certifying the Mont. R. Civ. P. 23(a)(2) class action but that the certification of class-wide punitive damages was inappropriate in the context of a Rule 23(b)(2) class. Remanded. View "Jacobsen v. Allstate Ins. Co." on Justia Law