Margery Newman v. Metropolitan Life Insurance Co
Margery Newman v. Metropolitan Life Insurance Co
Opinion
At age 56, Margery Newman purchased a long-term-care insurance plan from the Metropolitan Life Insurance Company ("MetLife"). She opted for one of MetLife's non-standard options for paying her insurance premiums; MetLife called the method she selected "Reduced-Pay at 65." When Newman was 67 years old, she was startled to discover that MetLife that year more than doubled her insurance premium. MetLife insists that the increase was consistent with Newman's insurance policy, including its Reduced-Pay-at-65 feature. Newman was unpersuaded and brought this action to vindicate her position. The district court dismissed for failure to state a claim. We conclude, however, that the dismissal was premature, and that Newman's complaint plausibly has alleged facts entitling her to relief. We therefore *997 reverse and remand for further proceedings.
I
Two documents lie at the heart of this case. The first is MetLife's "Long-Term Care Facts" brochure, which Newman reviewed before purchasing her insurance plan. The brochure describes long-term care generally and catalogs MetLife's non-standard payment options. Newman learned of MetLife's Reduced-Pay option from the brochure. The full description reads as follows:
Reduced-Pay at 65 Option:
By paying more than the regular premium amount you would pay each year up to the Policy Anniversary on or after your 65th birthday, you pay half the amount of your pre-age 65 premiums thereafter.
At the foot of the same page, MetLife instructs the reader that the brochure is only a general overview of MetLife's insurance plans, and that the policy governs the terms of the agreement.
Equipped with this information, Newman purchased a long-term-care insurance plan from MetLife and selected the Reduced-Pay option. Roughly a week later, she received the policy-the second critical document. The policy is 29 pages long. It includes just one reference to the Reduced-Pay option:
In addition, you have selected the following flexible premium payment option: Reduced Pay at 65 Semi-Annual Premium Amount:
Before Policy Anniversary at age 65 $3231.93 On or after Policy Anniversary at age 65 $1615.97
Elsewhere, the policy reserves MetLife's right to change the premium. On the first page, MetLife announces that " PREMIUM RATES ARE SUBJECT TO CHANGE ." The same paragraph continues with the statement that "[a]ny such change in premium rates will apply to all policies in the same class as Yours in the state where this policy was issued." In a section titled "Premiums," MetLife "reserve[s] the right to change premium rates on a class basis." Similar language is included in the "5% Automatic Compound Inflation Protection Rider." The policy defines more than 30 terms, but the word "class" is not among them. And the appended "Contingent Benefits Upon Lapse Rider," which provides coverage options in the event of a "Substantial Premium Increase," includes a table illustrating that that term's meaning varies with the policyholder's age at the time the policy was issued. The table accounts for policyholders who were issued their policy at ages up to "90 and over." Newman had the opportunity to review the policy for 30 days and return it for a full refund if she was dissatisfied.
From the outset, Newman paid the elevated premium associated with her Reduced-Pay option. When she reached age 65, her premium was cut in half. After Newman turned 67, however, MetLife doubled the premium. MetLife represents that this increase has been imposed on a class-wide basis, which it said at oral argument means all long-term-care policyholders, including Reduced-Pay policyholders over the age of 65. MetLife defends the increase by noting that Newman still pays half the premium of a Reduced-Pay policyholder who has not yet reached age 65, and far less than she would if she had not purchased the Reduced-Pay option. Nevertheless, at age 67, Newman's semi-annual premium jumped to $3,851.80, greater *998 than it has been at any other point during the life of the plan.
Newman filed a four-count complaint on behalf of herself and a proposed class. She has alleged that raising her post-anniversary premium is a breach of the policy, violates the Illinois Consumer Fraud and Deceptive Business Practices Act, and renders MetLife's representations and practices fraudulent. The district court granted MetLife's motion to dismiss for failure to state a claim. In its view, the contract unambiguously permits MetLife to raise Newman's premium, even after she reached age 65. This meant also that she had no claim for deceptive or unfair business practices or common-law fraud, because MetLife did nothing wrong. Newman's appeal from that decision is now before us.
II
We consider
de novo
the district court's grant of a motion to dismiss pursuant to Federal Rule of Civil Procedure 12(b)(6).
Camasta v. Jos. A. Bank Clothiers, Inc
.,
A
Illinois treats insurance policies the same way as any other contract. Parties are held to the unambiguous terms of their agreement.
Hobbs v. Hartford Ins. Co. of the Midwest,
Little in Newman's policy elucidates the terms of the Reduced-Pay option. It offers one illustration with two numbers: Newman's "before policy anniversary" premium; and her "on and after policy anniversary" premium. The first amount is twice the second. Newman deduced from this example that upon reaching her 65th birthday, her premium would drop to half of what it was the day before. MetLife agrees that this is what the policy says. The disagreement arises at the next level of detail. MetLife takes the position that the only guarantee is that from the policy anniversary following Newman's 65th birthday onward, Newman's premium will be half that of a Reduced-Pay policyholder who has not yet reached age 65. Newman reads the policy differently. She understands it to fix her post-65 premium at half the amount of her pre-65 premium.
Our independent review of the policy satisfies us that Newman has offered one reasonable interpretation of its language. The illustration, which was unexplained, reproduces the cost of her personal premium. It gives no indication whether this is the same premium that all Reduced-Pay policyholders were paying and would pay, or if it was particular to Newman. A reasonable reader easily could think, however, that "on and after" the policy anniversary following age 65, the policyholder (here, Newman) would pay half of what she personally was paying prior to that anniversary date. Since the person's 65th birthday converts the pre-anniversary premium into *999 a historical fact, a premium set at half that number likewise becomes fixed. In other words, if N is set in stone, so too is half of N.
MetLife responds that even if the portion of the policy referring to the Reduced-Pay option might be understood as we just explained, that reading is supportable only if that passage is divorced from the rest of the policy-an impermissible step. While it is true that the Reduced-Pay excerpt cannot be read alone, in this case the remainder of the contract does not win the day for MetLife.
Four times in the policy MetLife reserves its right to change the premium. Three of those instances reserve MetLife's right to do so on "a class basis" or for a "class as Yours." These passages do not resolve the ambiguity, because the word "class" is undefined. It might mean age, in which case class membership is independent of payment arrangements. But it might refer to the payment arrangement, so that everyone in the Reduced-Pay group comprises a single class and the effect of class membership is defined by the terms of the Reduced-Pay option.
Newman believes that it is the latter, and thus that the Reduced-Pay customers have purchased the right not to be treated in the same way as ordinary policyholders. The policy's inclusion of the Reduced-Pay illustration, terse as it may be, supports her interpretation. Including language about class-wide changes did not alert her that she was part of a class that is broader than her Reduced-Pay group. Absent some clarification, Newman had no reason to question her understanding that she had removed herself from the class of typical policyholders-those who had not purchased a frozen premium after age 65. Even MetLife's reservation of the right to change the premium for all policies in a "class as Yours" does not help matters. Newman knew that her premium, and those of others whom she might regard as classmates, might increase before she turned 65. But the only "class" to which she thought she belonged was one that exchanged an increased (and perhaps variable) premium pre-65 for the right to have a stable and lower premium after 65. The baseline for a person in this class was the premium she paid pre-65; nothing in the policy tipped her off that the baseline was instead whatever people of her age were ordinarily charged, no matter how often or when that number changed or what payment arrangement was in place.
The fourth suggestion that the premium might change appears in the Lapse Rider. Though the rider countenances the possibility of a "Substantial Premium Increase," its illustrative table shows that the definition depends on the policyholder's age at the time of issuance. The rider accounts for policyholders who purchased their long-term-care policy at ages greater than 65. How, then, could the rider speak to the specifics of the Reduced-Pay option, which could be issued only to people who had not yet reached their 65th birthday? A reasonable person selecting the Reduced-Pay option could conclude that the rider was beside the point.
In short, none of the four references in the policy to MetLife's right to change the premium suffice to disabuse a reasonable person of the understanding that purchasing the Reduced-Pay option took her out of the class of policyholders who were at risk of having their premium increased after their post-age-65 anniversary. The policy language is thus at least ambiguous, because it can be read reasonably to fix such a person's premium, if she had opted for the Reduced-Pay option.
What follows from that conclusion is less clear. Illinois construes ambiguous contracts against the insurer. See,
e.g.
,
*1000
Nicor, Inc. v. Associated Elec. & Gas Ins. Servs. Ltd.
,
Neither
Nicor
,
Gillen
, nor
Hobbs
rules out the possibility of admitting extrinsic evidence to disambiguate an insurance contract. In
Nicor
and
Hobbs
the contested contract was unambiguous, obviating the need to discuss extrinsic evidence.
Nicor
,
When sitting in diversity, our duty is to answer any question of state law in the same way (as nearly as we can tell) as the state's highest court would.
Bancorpsouth, Inc., v. Fed. Ins. Co.
,
B
Newman separately has alleged that MetLife violated the Illinois Consumer Fraud and Deceptive Business Practices Act ("ICFA"). The ICFA provides a remedy for consumers who have been victimized by deceptive or unfair business practices. 815 ILCS 505/2 ;
Batson v. Live Nation Entm't, Inc.
,
A deceptive-practice claim under the ICFA has five elements:
(1) the defendant undertook a deceptive act or practice; (2) the defendant intended that the plaintiff rely on the deception; (3) the deception occurred in the course of trade and commerce; (4) actual damage to the plaintiff occurred; and (5) the damage complained of was proximately caused by the deception.
*1001
Davis v. G.N. Mortg. Corp.
,
An allegedly deceptive act must be viewed "in light of
all the information
available to plaintiffs."
Phillips v. DePaul Univ.
,
MetLife's reading of the brochure is far from the only one that is possible-indeed, we find it strained. The Reduced-Pay option assures that after the anniversary date following the policyholder's 65th birthday, the holder will pay "half the amount of your pre-age 65 premiums thereafter" (emphasis added). This rationally can be read as an individualized reduction, tied to the consumer's personal baseline. The brochure never says that Newman's premium is linked to those of general policyholders. And for the reasons already discussed, MetLife's insistence that the policy clarifies matters is unpersuasive.
This case is quite different from one in which the consumer is warned about the undesirable result and simply misconstrues the material offered by the insurance company. See,
e.g.
,
Toulon v. Continental Cas. Co.
,
Turning to intent, Newman must show that MetLife intended for her (and those in her position) to rely on the brochure.
Cuculich v. Thomson Consumer Elec., Inc.
,
Nothing we have said conflicts with the Supreme Court's instruction in the analogous context of ERISA plans that summary plan descriptions are not part of the ERISA plan itself. See
CIGNA Corp. v. Amara
,
The Court's decision is faithful to language in the statute that distinguishes information about the plan from the plan itself.
Beyond the statutory distinction, Newman is in a different position from that of an ERISA beneficiary. Unlike an ERISA beneficiary, Newman is shopping on the open market. MetLife uses its brochure to compete for business. Pre-purchase, it is all a potential customer has to rely on. An employer, in contrast, is providing and describing an employment benefit. MetLife's situation is thus materially different from that of an employer offering an ERISA plan. Our decision here thus comfortably coexists with CIGNA Corp.
Returning to the Reduced-Pay policy, we must next consider whether Newman has adequately pleaded that MetLife's practices were unfair (as opposed to deceptive). Unfairness under the ICFA depends on three factors: "(1) whether the practice offends public policy; (2) whether it is immoral, unethical, oppressive, or unscrupulous; [or] (3) whether it causes substantial injury to consumers."
Robinson v. Toyota Motor Credit Corp.
,
Newman has alleged that MetLife engaged in a bait-and-switch strategy, which (if proven) would offend Illinois's public policy. The State has twice condemned the very practice Newman describes. See 215 ILCS 5/149(1) (forbidding insurance companies from misrepresenting the terms of their policies); ILL. ADMIN. CODE tit. 50, § 2012.122(b)(4) (forbidding misrepresentation in marketing policies for long-term-care insurance). MetLife does not dispute the applicability of the statute or the administrative code. It simply reiterates its position that there is no violation because the brochure did not misrepresent the policy. But we already have shown how both the brochure and the policy can be understood in the way Newman read them.
The second factor also supports Newman's complaint. Whether a practice is immoral, unethical, oppressive, or unscrupulous depends on whether it has left
*1003
the consumer with little choice but to submit to it. See
Cohen v. Am. Sec. Ins. Co.
,
Newman also has alleged substantial injury. MetLife induced her to pay a premium for eight years at a rate greater than she would otherwise have paid. She did so to reap benefits later in life. The injury lies in the difference between her elevated pre-age-65 premium and the standard premium, or the elevated premium she has had to pay (so far) for over two years. Newman's complaint alleges facts that plausibly show that MetLife's policy was both deceptive and unfair.
C
Finally, Newman has asserted that MetLife's representations about the Reduced-Pay option in its brochure and policy constitute common-law fraudulent misrepresentation and fraudulent concealment. The elements of misrepresentation largely overlap with a deceptive-practices claim under the ICFA. The plaintiff must allege:
(1) a false statement of material fact; (2) known or believed to be false by the person making it; (3) an intent to induce the plaintiff to act; (4) action by the plaintiff in justifiable reliance on the truth of the statement; and (5) damage to the plaintiff resulting from such reliance.
Doe v. Dilling
,
Newman had to provide enough in her complaint to make a plausible case for reasonable reliance.
Davis
,
Finally, Newman's complaint has alleged fraudulent concealment. For this claim, Newman must adequately plead that MetLife concealed material information while under a duty to disclose.
Connick v. Suzuki Motor Co.
,
III
Newman asserts that MetLife lured her into a policy by promising a trade of short-term expense for long-term stability. She took the deal and spent nine years investing in a plan, only to have MetLife pull the rug out from under her. Neither MetLife's brochure nor the terms of the policy forecast this possibility. These allegations were enough to state a claim under the theories Newman presented. We therefore REVERSE the district court's grant of MetLife's motion to dismiss and REMAND for further proceedings.
Reference
- Full Case Name
- Margery NEWMAN, on Behalf of Herself and All Others Similarly Situated, Plaintiff-Appellant, v. METROPOLITAN LIFE INSURANCE COMPANY, Defendant-Appellee.
- Cited By
- 97 cases
- Status
- Published