AA SUNCOAST CHIROPRACTIC CLINIC, P.A., et al., on behalf of themselves and others similarly situated v. PROGRESSIVE AMERICAN INSURANCE COMPANY, et al.
No. 17-13003
United States Court of Appeals, Eleventh Circuit
September 12, 2019
D.C. Docket No. 8:15-cv-02543-RAL-MAP
Before JORDAN, GRANT, and HULL, Circuit Judges.
[PUBLISH]
Appeal from the United States District Court for the Middle District of Florida
GRANT, Circuit
A trio of healthcare providers brought a class action against an insurance company over a claims-handling process that they argue is illegal under Florida law. The district court certified an injunction class under
We have no occasion today to disapprove—or approve—of complaints or classes that are not before us. In this interlocutory appeal, we consider only whether the class as certified, proceeding on the complaint as alleged, is viable. And because what this “injunction” class really wants is damages—and more precisely, because the injunctive remedy that this class seeks would be improper—the answer to that question is no.
I.
Under Florida law, car insurance policies must provide personal injury protection (PIP) benefits up to $10,000.
This case is a dispute about who is allowed to make the negative EMC determination. The plaintiffs—two chiropractic providers and a medical provider that treated injured motorists insured by Progressive who thereafter assigned their insurance benefits to the providers (collectively, “Suncoast“)—allege that the defendants—the Progressive Corporation and two of its insurance underwriters, Progressive American Insurance Company and Progressive Select Insurance Company (collectively, “Progressive“)—have denied PIP insurance benefits in an illegal manner. Specifically, Suncoast alleges that Progressive relied on negative EMC determinations from non-treating healthcare providers to limit coverage to
Suncoast sued Progressive in Florida state court and sought class-action status. Progressive removed the case to federal court under the Class Action Fairness Act, which grants federal jurisdiction over certain class actions where the amount in controversy exceeds $5 million and there is minimal diversity. In its second amended complaint, Suncoast asserted two counts: one for declaratory and injunctive relief and another for damages based on breach of contract. The requested declaration would 1) declare unlawful Progressive‘s policy provision purporting to allow reductions in coverage based on negative EMC determinations by non-treating physicians, 2) declare unlawful Progressive‘s practice of relying on such determinations, and 3) find that Progressive is not permitted to disregard an affirmative EMC determination. The requested injunction would 1) restore coverage limits to $10,000 for affected policies, 2) enjoin Progressive from including policy provisions that the declaration found unlawful, 3) notify affected policyholders and providers, and 4) award costs and attorneys’ fees. The breach-of-contract claim sought damages for underpaid benefits along with interest, costs, and attorneys’ fees.
Suncoast moved to certify two classes: an injunction class under
A. All Qualified Providers who: (i) received an assignment of benefits from a Claimant under a Progressive PIP policy, (ii) provided initial or follow up medical services to a Claimant after January 1, 2013, and (iii) were given notice by Progressive that available PIP benefits were reduced to $2,500 because of a Negative EMC Determination that Progressive obtained from a Non-treating Provider; and
B. All Claimants who were notified that Progressive reduced available PIP benefits to $2,500 because of a Negative EMC Determination Progressive obtained from a Non-treating Provider.
The damages subclass was defined to include:
All Qualified Provider Class Members: (i) who were not paid in full for their services, (ii) who made a pre-suit demand to Progressive for payment pursuant to
§ 627.736(10) , and (iii) where Progressive received documentation from a duly licensed physician, dentist, physician‘s assistant or advanced registered nurse practitioner that the Claimant had an Emergency Medical Condition.
The district court refused to certify the damages subclass—which, under
Progressive sought permission for an interlocutory appeal of the injunction class certification. See
II.
We review a class certification decision for abuse of discretion. Brown v. Electrolux Home Prods., Inc., 817 F.3d 1225, 1233 (11th Cir. 2016). “But abuse of discretion is a continuum, and in the context of class actions, review for abuse of discretion often does not differ greatly from review for error.” Id. (internal quotation marks and citations omitted). In conducting this analysis, we review the district court‘s factual determinations for clear error and its legal determinations de novo. Vega v. T-Mobile USA, Inc., 564 F.3d 1256, 1264–65 (11th Cir. 2009). The party seeking class certification bears the burden to establish its propriety. Id. at 1265.
III.
A.
From there, the rules differ depending on what type of class the plaintiff purports to represent. For an injunction class under
B.
The district court already concluded that a subclass of this class cannot proceed to seek damages under
Instead of appealing that decision and fighting this case on the
The problem with this argument is that the injunction that Suncoast has requested is not an injunction at all, and its declaratory request is both minimal and unconnected to the members of its class. Suncoast‘s requested relief is not designed to address the treatment of future claims; it would instead, according to Suncoast itself, “restore claimants to the claims-handling process free of the improper cap on PIP benefits imposed by Progressive.” In other words, the injunction would mandate that Progressive reprocess all claims previously capped at $2,500 based on an outside EMC determination. That is how Suncoast frames its injury—not as the loss of money, but as the loss of an opportunity to have received money in the past for a claim that was denied. In Suncoast‘s own words: “Class members have been injured because Progressive‘s unlawful practice—use of a negative EMC determination by a non-treating provider—denied them the opportunity, guaranteed by a Florida statutes [sic], to seek PIP benefits exceeding $2,500.” This strategy of converting its claim for damages into a claim for injunctive relief sidesteps the
C.
In the real world, there are likely people with a future interest in having Progressive manage its EMC determinations in a particular way. There may even be people who are currently forgoing treatment for a past injury because their benefits have been exhausted under Progressive‘s current EMC approach. But the problem for Suncoast is that those are not the claims that it has pleaded. Suncoast‘s attempt to excise all the damages-based problems with certification thus runs into a fundamental issue: its creative conception of injunctive relief is not a viable theory of recovery under
Simply put, the denial of insurance coverage in this case—whether framed as lost money, or as a lost opportunity to get money—is a retrospective harm. Suncoast counters that “Progressive continues to refuse to provide further claims-handling based on its unlawful EMC practices, so Plaintiffs plainly have a forward-looking interest in an injunction requiring Progressive to resume claims handling.” Id. at 48 n.19. What Suncoast is not saying in that statement is that it has an interest in the proper handling of future claims. Instead, it has an ongoing interest in getting paid for past claims that have been rejected. But a “forward-looking interest” in redressing a past harm—the failure to pay all benefits allegedly owed for past claims that were already denied—is not the same thing as a future injury. And without any threat of future injury, injunctive relief is unavailable.
Second, Suncoast‘s request for relief further betrays the retrospective nature of its injury. Suncoast seeks a declaration stating that Progressive‘s practices are unlawful and asks the court to “[r]einstat[e] the full amount of PIP coverage, in the amount of $10,000, which should have been available under the affected policies.” In its brief, Suncoast describes this relief as “requiring Progressive to resume handling the Class members’ PIP claims in accordance with Florida law.” To begin, those two requests could be interpreted to describe different forms of relief. But the only outcome that any conception of this intermediary relief could ever lead to—even in the best-case scenario for any particular claimant—would be full payment of coverage benefits that have already been denied, for claims that were already processed, for injuries that were already suffered. The requested relief, again, looks backward to an injury already suffered.
True enough, Suncoast‘s complaint also asked the district court to enjoin Progressive “from including provisions in their policies which purport to allow the above, illegal conduct.” But that aside in its complaint cannot save this particular class for two reasons. As an initial matter, justifying a class that is all about damages with a de minimis request for injunctive relief is like trying to prop up a tower with a toothpick. See Robinson v. Metro-North Commuter R.R. Co., 267 F.3d 147, 164 (2d Cir. 2001) (“Insignificant or sham requests for injunctive relief should not provide cover for (b)(2) certification of claims that are
designed class seeking only this declaratory relief could not survive, but that is not the case that Suncoast has brought us.
Third, then, even if Suncoast‘s claim for injunctive and declaratory relief were more than a fig leaf attempting to cover its demand for past relief, it would run headlong into another problem: Suncoast‘s class definition itself reveals that Suncoast is seeking retrospective relief. The proposed injunction class includes:
A. All Qualified Providers who: (i) received an assignment of benefits from a Claimant under a Progressive PIP policy, (ii) provided initial or follow up medical services to a Claimant after January 1, 2013, and (iii) were given notice by Progressive that available PIP benefits were reduced to $2,500 because of a Negative EMC Determination that Progressive obtained from a Non-treating Provider; and
B. All Claimants who were notified that Progressive reduced available PIP benefits to $2,500 because of a Negative EMC Determination Progressive obtained from a Non-treating Provider.
Nothing in that definition envisions future harm. For a claimant, any future injury hinges on “the possibility that he may someday be in another car accident; sustain an injury entitling him to PIP benefits; and still be insured by [Progressive] under the same or a similar policy being interpreted the same way, thereby having this issue present itself again.” A&M Gerber Chiropractic LLC v. GEICO Gen. Ins. Co., 925 F.3d 1205, 1215 (11th Cir. 2019). The chance that lightning might strike twice is not enough to justify injunctive relief.
As for providers, Suncoast does allege that it and others like it “continue to treat Progressive insureds, and have a reasonable expectation that the dispute, and attendant harms, regarding Progressive‘s EMC Paper Review process will be ongoing into the future.”6 While a class may exist that would match this allegation, the class as defined here does not—it is both fatally overinclusive and underinclusive on
The class is also underinclusive because it fails to account for providers who have not yet faced denied claims on the allegedly wrongful basis but expect to do so in the future—it only applies to those providers already injured when past claims were denied. All of this presents more evidence that the relief sought in this
case is retrospective, not prospective. Cf. Bolin v. Sears, Roebuck & Co., 231 F.3d 970, 978 (5th Cir. 2000) (“These plaintiffs have nothing to gain from an injunction, and the declaratory relief they seek serves only to facilitate the award of damages. Thus, the definition of the class shows that most of the plaintiffs are seeking only damages.” (footnote omitted)). “What follows from this,” as in Wal-Mart, “is not that some arbitrary limitation on class membership should be imposed,” but rather that Suncoast‘s claim for retrospective relief “should not be certified under
To be clear: when we say that this class is not suitably crafted for prospective relief, we make no statement about whether other classes may pass muster. As Suncoast alleges, for example, some providers (though perhaps not the ones here, see supra at 13) may reasonably expect to see injured claimants on an ongoing basis, and therefore may be able to demonstrate the sort of future harm that injunctive relief requires. Similarly, some claimants may face a real prospect of future harm if they have exhausted their benefits up to $2,500 and are forgoing additional—that is to say, future—treatment because their insurer has indicated it will not be covered. But for all the reasons we have discussed—Suncoast‘s theory of standing (predicated on a lost opportunity), its claim for relief (seeking reprocessing of past claims), and its class definition (both over- and underinclusive)—this is not that case.
In the end, the retrospective nature of Suncoast‘s class and claim make clear that an injunction is not the right remedy in this case—indeed, it is not really the remedy that Suncoast‘s class is seeking. And because an injunction is not the right remedy,
D.
Suncoast‘s request for declaratory relief does not save the class. For one thing, like an injunction, declaratory relief requires a likelihood of future harm. Malowney v. Fed. Collection Deposit Grp., 193 F.3d 1342, 1346–47 (11th Cir. 1999); see also Gerber, 925 F.3d at 1211 (“Accordingly, if a plaintiff does not assert a reasonable expectation of future injury, he lacks standing to bring an action for declaratory relief.” (internal quotation marks, alterations, and citation omitted)). And as both we and the Supreme Court have made clear, this future interest must be alleged by the plaintiff rather than imagined by the court: “In order to demonstrate that a case or controversy exists to meet the Article III standing requirement when a plaintiff is seeking injunctive or declaratory relief, a plaintiff must allege facts from which it appears there is a substantial likelihood that he will suffer injury in the future.” Malowney, 193 F.3d at 1346–47 (citing City of Los Angeles v. Lyons, 461 U.S. 95, 102 (1983), and Cone Corp. v. Fla. Dep‘t of Transp., 921 F.2d 1190, 1205 (11th Cir. 1991)).
We will not belabor the points we have made regarding the retrospective nature of the class definition. But we will make the additional point that, in the class-action context, a request for declaratory relief must “correspond[]” with injunctive relief.
Because the declaratory relief sought here does no more than that, it does not “correspond” to injunctive relief as
* * *
This case is about damages.
REVERSED AND REMANDED.
JORDAN, Circuit Judge, concurring in the judgment.
I agree that we should reverse the order certifying a class under
In Robbins v. Garrison Property & Casualty Ins. Co., 809 F.3d 583, 587-88 (11th Cir. 2015), we interpreted
Although the plaintiffs here seek a declaration (with injunctive relief to follow) that certain insurers are violating the statute by having non-treating health care providers issue negative EMC determinations, the
The Supreme Court has not definitively told us whether the inclusion of class members who have not suffered the same harm as the named class representatives (or any harm at all) is an Article III problem or a
