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The Collaborative Clearinghouse for Lawsuits and Other Claims Against ACE Group Insurance Companies

MINNS v. INDEMNITY INSURANCE COMPANY OF NORTH AMERICA et al

ATTENTION: It is possible that this information may no longer be current and therefore may be inaccurate. The index contains both open and closed cases and is not a complete list of cases in which an ACE Insurance Group company is involved. This information is provided to give interested persons an idea of the issues disputed in the indexed cases. For a full understanding of a case, one should read the rest of the court file, including the response. For the most up-to-date and complete information on a case, visit www.pacer.gov or contact the clerk of the relevant court.

Case Number: 
1:16-cv-00003 Search Pacer
Opposing Party: 
Michael Minns
Court Type: 
Federal
US District Court: 
District of the Virgin Islands
Date Filed: 
Jan 12 2016

COMPLAINT

COMES NOW, Plaintiff, MICHAEL MINNS, by and through his undersigned counsel
and for his complaint against Defendants, INDEMNITY INSURANCE COMPANY OF
NORTH AMERICA and GOOD HEALTH WORLDWIDE LIMITED, hereby alleges as
follows:

JURISDICTION

  1. Plaintiff, Michael Minns, is a citizen and resident of the Georgetown, Exuma,
    Bahamas.
  2. Plaintiff is informed and believes, and therefore alleges, that Defendant Indemnity
    Insurance Company of North America is, and at all times mentioned was, a corporation
    organized under the laws of Florida with its principal offices located at 436 Walnut Street,
    Philadelphia, Pennsylvania, and can be served through its Registered Agent, CT Corporation c/o
    Trident Trust Company, Waterfront Center, Suite A, 72 Kronprindsens Gade, St. Thomas, Virgin
    Islands, 00802.
  3. Plaintiff is informed and believes, and therefore alleges, that Defendant
    Goodhealth Worldwide Limited is, and at all times mentioned was, a corporation organized
    under the laws of Florida with its principal offices located 201 S. Biscayne Blvd., Miami,

Florida, and can be served through its AETNA Global Benefits Administrators Inc.’s Registered
Agent, CT Corporation System, 1200 S. Pine Island Road, Plantation, Florida, 33324.

  1. The citizenship of Plaintiff and Defendants is diverse and the amount in
    controversy, exclusive of interest and costs, exceeds the sum of Seventy-Five Thousand Dollars
    ($75,000.00). Therefore, this Court has jurisdiction over this matter pursuant to 28 U.S.C. §
    1332.
  2. Venue is proper and dictated by the underlying insurance agreement between the

Parties.

UNDERLYING FACTS

  1. GOODHEALTH, an AETNA Company, along with Indemnity Insurance
    Company of North America, offered the Elite Healthcare Plan.
  2. On September 1, 1998, Plaintiff Michael Minns become an insured under an
    individual Elite Healthcare Plan health insurance Policy No. EMX000562 (“Policy”), which
    covered both Plaintiff and his wife Sandra Minns as a named additional insured.
  3. The Policy was "in force for the Period of Cover noted in Your Policy Schedule and
    [was] renewable subject to the terms provided at the time of each Renewal Date/Review Date."
    Policy, Gen. Conditions ^ 8.
  4. The Period of Coverage for the Policy ran from November 29, 2012 through
    November 28, 2013.
  5. At all material times the Policy was subject to HIPPA, and particularly the
    obligation of an insurer to offer its insureds, including Plaintiff, health insurance coverage under
    another health insurance policy when the existing policy is cancelled without cause by the

insurer.

  1. Beginning on January 16, 2013, Sandra Minns required repeated and long term
    cancer-related medical treatment covered by the Policy at the Cleveland Clinic in Cleveland,
    Ohio.
  2. Beginning in January 2013, pursuant to the procedure outlined in the Policy,
    Plaintiff and Sandra Minns submitted claims with supporting documents for re-imbursement of
    medical expenses to GOODHEALTH-AETNA Global Benefits.
  3. Defendants did not reimburse Plaintiff for the medical expenses incurred and
    covered by the Policy during the course of medical treatment for Sandra Minns.
  4. General Conditions, paragraph 14 of the Policy, obligates AETNA to give 30
    days’ notice of cancellation by certified mail, stating: "If there is any other reason why We would
    be required to cancel Your Policy, We would provide you with thirty (30) days notice via certified
    mail." Policy, Gen. Conditions ^ 14.
  5. On April 30, 2013, Indemnity Insurance Company of North America issued
    Plaintiff Michael Minns a letter advising him that AETNA was no longer offering Elite
    Healthcare Plan insurance and notifying him that his enrollment in the plan would terminate on
    May 30, 2013, six months before the expiration of the Policy period.
  6. The Policy unambiguously provides that notice must be sent by certified mail,
    however, the letter was shipped to Plaintiff by FedEx International Air.
  7. No replacement or transitional Health Insurance coverage was offered by
    Defendants to Plaintiff.
  8. As a consequence of the early and improper termination of the Policy, Plaintiff
    Michael Minns has incurred expenses for cancer-related medical treatments for his wife Sandra

Minns, which otherwise would have been covered under the Elite Healthcare Plan.

  1. On June 16, 2015, Sandra Minns passed away.

COUNT I

DECLARATION WITH RESPECT TO DEFENDANTS’

BREACH OF CONTRACTUAL LIABILITY

  1. Plaintiff repeats and re-alleges the allegations set forth in paragraphs 1 through

19.

  1. Plaintiff complied with all the obligations under the Policy. The Defendants
    refused or failed to reimburse Plaintiff for medical expenses incurred by his late wife. The Policy
    requires that Defendants pay those sums which Plaintiff and his late wife incurred up the
    Policy’s limits.
  2. Defendants failed to provide insurance which would have covered medical
    expenses incurred by Plaintiffs wife and unilaterally terminated the Policy.
  3. Plaintiff seeks a declaration that Defendants were contractually obligated to pay
    for medical expenses incurred by Plaintiff up to the Policy limits of $1,000,000. Plaintiff seeks a
    money judgment in addition to or as an alternative to a declaration concerning Defendants’
    contractual liability under the Policy.

COUNT II

BREACH OF CONTRACT TERMINATION PROVISIONS OF POLICY

  1. Plaintiff repeats and re-allege the allegations set forth in paragraphs 1 through 23.
  2. As described in Paragraphs 14 through 17 above, Defendants failed to follow the
    termination process required by the Policy, and had Defendants sent notice of termination by
    certified mail, Plaintiff would have had extended coverage through November 2013.
  3. As a result of Defendants’ breach, Plaintiff has incurred liability for medical

charges incurred by his late wife, for which he seeks reimbursement from Defendants.

COUNT III

BREACH OF IMPLIED COVENANT OF GOOD FAITH AND FAIR DEALING

  1. Plaintiff repeats and re-alleges the allegations set forth in paragraphs 1 through

26.

  1. Virgin Islands law governs the policy. Policy, Gen. Conditions ^15.
  2. Under Virgin Islands law insurance carriers owe a duty of good faith, honesty,
    and equity in all insurance matters. See 22 V.I.C. § 2.
  3. Furthermore, Virgin Islands law recognizes the implied covenant of good faith
    and fair dealing with respect to contracts.
  4. Defendants breached the duty of “good faith, honesty, and equity” and the implied
    covenant of good faith and fair dealing when it cancelled the Policy prior to the expiration of the
    Period of Cover while Sandra Minns was undergoing cancer related treatment covered by the
    Policy without offering any alternative health insurance to Plaintiff to assure continuity of
    coverage.
  5. Plaintiff had a reasonable expectation that the Policy would last at least through
    the Period of Cover, as provided in General Conditions paragraph 8 of the Policy; the Policy
    would not be cancelled except for reasons specifically set forth in General Conditions paragraph
    14 of the Policy; if the Policy was to be cancelled prior to the end of Period of Cover it would
    give Mr. Minns 30 days written notice by certified mail, as provided by the General Conditions
    paragraph 14 of the Policy; and/or Plaintiff would be offered the option to purchase other
    individual health insurance coverage offered by Aetna upon notice of termination as required by

HIPPA.

  1. As of result of Defendants’ breach. Plaintiff suffered damages in the form of
    uninsured medical expenses otherwise covered under the Policy during the period of coverage.

WHEREFORE, Plaintiff prays for a declaration that the Defendants were obligated to
pay Plaintiff for the cancer-related medical treatment of Sandra Minns; for judgment against
Defendants for the full amount of the non-reimbursed medical expenses, inclusive of pre and
post judgment interest, cost and fees; as well as punitive damages for Defendants’ reckless
disregard for the rights of Plaintiff.

The provided text is an excerpt from a document filed in this case. For a full understanding of the case, one should read the complete court file, including the response.