Howard L. Chabner v. United of Omaha Life Insurance CompanyHoward L. Chabner v. United of Omaha Life Insurance Company
Plaintiff/Appellee Howard Chabner brought suit against DefendanVAppellant United of Omaha Insurance Company (“United”) for alleged violations of the Americans with Disabilities Act (“ADA”)
Upon careful review of the record we have found that no genuine issue of material fact exists, and that summary judgment for Chabner was appropriate. We do not, however, base our decision on the ADA. We instead rest our decision on California law, which provides Chabner with the remedy he seeks for the misconduct he has alleged. We therefore affirm, although not for all of the reasons relied upon by the district court.
FACTS
Howard Chabner suffers from a progressive condition called facioscapulohum-eral muscular dystrophy (FSH MD), a rare form of muscular dystrophy. The condition has confined Chabner to a wheelchair since 1991 and has caused “marked wasting” of his extremities. Chabner takes medication to help control the condition, and his doctor administers annual electrocardiograms to detect any cardiom-yopathy that may arise.
On May 3, 1993, Chabner, who was 35 years old at the time, applied to United for whole life insurance. 1 United forwarded Chabner’s application to an underwriter who had experience in underwriting insurance policies for applicants with muscular dystrophy, but not with FSH MD. United possessed no internally developed actuarial data for people with FSH MD, and so its underwriter turned to external sources to estimate Chabner’s mortality risk. The underwriter, who was not a doctor, arranged to have Chabner examined by a paramedic, reviewed Chabner’s medical records, and consulted two underwriting source materials: the Cologne Life Reinsurance Company’s “Life Underwriting Manual” (“Cologne manual”); and “Medical Selection of Life Risks” by R.D.C. Brackenridge and W. John Elder (“Brack-enridge manual”). After reviewing these materials, the underwriter authorized a policy with a “Table 6” rating, which corresponded to a mortality rate of 150 percent above standard. 2
United offered Chabner a $100,000 whole life policy at a cost of $1,076 per year. Of the $1,076 annual premium, $305.44 was applied to the cost of insurance, and the remainder was invested in the policy’s cash accumulation and surrender values. By contrast, even though the annual premium for a standard whole life policy (without an increased mortality rating) would have been the same $1,076, only $155.44 of that annual premium would have been applied to the cost of insurance, which would result in an additional $150 being invested in the policy’s cash accumulation and surrender values each year.
Chabner accepted the policy, but inquired about the reason for his nonstandard premium. United’s Vice President and Senior Medical Director of Underwriting sent Chabner a letter attempting to explain the nonstandard rating. In the letter, United acknowledged that FSH MD “has only a small effect on mortality” and stated that it reduced life expectancy by four years for a non-smoking man of his
Chabner filed his original complaint in California Superior Court on January 3, 1995, alleging violations of California’s Insurance Code, its Business and Professions Code, its Unruh Civil Rights Act, and common law fraud. After United removed the case to federal court based on diversity jurisdiction, Chabner amended his complaint to add a claim under the ADA.
3
Chabner sought class certification and moved for summary judgment on all but his fraud claim. The district court denied class certification, but granted Chabner’s motion for summary judgment.
See Chabner,
DISCUSSION
I. The ADA
The district court’s interpretation of the ADA is a question of law that we review
de novo. See Bay Area Addiction
Chabner alleges that the nonstandard premium that United charged him for his insurance policy violated the ADA. Recently, however, we held that although Title III of the ADA requires an insurance office to be physically accessible to the disabled, it does not address the terms of the policies the insurance companies sells.
See Weyer v. Twentieth Century Fox Film Corp.,
Title III of the ADA provides: “No individual shall be discriminated against on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation by any person who owns, leases (or leases to), or operates a place of public accommodation.”
Weyer, which was handed down after the district court’s order was issued, concerned the question of whether an insurance company that administers an employer-provided disability plan was a “place of public accommodation” under Title III of the Americans with Disabilities Act. We found that the term “place of public accommodation” required a connection between the good or service complained of and an actual physical place. As we explained:
[c]ertainly, an insurance office is a place where the public generally has access. But this case is not about such matters as ramps and elevators so that disabled people can get to the office. The dispute in this case, over terms of a contract that the insurer markets through an employer, is not what Congress addressed in the public accommodations provisions.
Weyer,
II. California Law
We review
de novo
the district court’s ruling that California law provides Chabner with a private right of action for violation of its Insurance Code.
See Mastro v. Witt,
A. Business and Professions Code section 17200 and Insurance Code section 10144.
In his complaint Chabner alleged violations of California Insurance Code section 10144, and California Business and Professions Code section 17200. Insurance Code Section 10144 provides, in relevant part:
No insurer issuing [life insurance] shall refuse to insure, or refuse to continue to insure, ... or charge a different rate for the same coverage solely because of aphysical or mental impairment, except where the refusal ... or rate differential is based on sound actuarial principles or is related to actual and reasonably anticipated experience....
Chabner, however, also claimed violations of California Business and Professions Code section 17200. Section 17200 is part of the Unfair Competition Law,
The California Supreme Court has held that
There are limits on the causes of action that can be maintained under
As applied to this case, the district court was correct in holding that Chabner could maintain a cause of action under
Moreover, the narrow limitations on causes of action under
United points to
Moradi-Shalal v. Fireman’s Fund Insurance Cos.,
United’s argument overlooks the fact that Chabner predicates his
B. The Unruh Civil Rights Act.
Chabner also claims that United’s actions violated California’s Unruh Civil Rights Act. The Unruh Civil Rights Act provides, in relevant part, that “[a]ll persons within the jurisdiction of this state are free and equal, and no matter what their ... disability are entitled to the full and equal accommodations, advantages, facilities, privileges, or services in all business establishments of every kind whatso-. ever.”
We may, however, “affirm the district court on a ground not selected by the district judge so long as the record fairly supports such an alternative disposition.”
Fidelity Fin. Corp. v. Fed. Home Loan Bank,
The Unruh Civil Rights Act works to ensure that all persons receive the full accommodations of any business within California, regardless of the person’s disabilities.
To determine whether the nonstandard premium was reasonable, we are again informed by Insurance Code
C. Primary Jurisdiction.
United argues that even if we agree that Chabner may sue under
We are not persuaded by United’s primary jurisdiction argument. In federal and California state courts, “[n]o rigid formula exists for applying the primary jurisdiction doctrine.”
Farmers Ins.,
In this case, vacating the district court’s order and referring the matter to the Insurance Commissioner would not serve the dual policies of primary jurisdiction. First, it is important to note that United did not seek application of the primary jurisdiction doctrine until after the district court had already found that the nonstandard premium violated Insurance Code
D. Summary Judyment.
As discussed earlier, even though Chab-ner’s state law causes of action arose under Business and Profession Code
The parties argue at length about the proper definitions of “sound actuarial principles” or “actual and reasonably anticipated experience.” For example, they dispute whether an insurance company must base its rating decisions on “hard data” that is specific to each person, or whether it may take into account more generalized estimates of mortality when it lacks specific' data. We need not resolve the debate about exactly what can justify a mortality decision as actuarially sound or related to actual and reasonably anticipated experience, for in this case there is no question that United’s mortality rating was arbitrarily high.
The mortality rating United assigned to Chabner was not actuarially sound. United assigned Chabner a' “Table 6” rating, which corresponds with a 150% mortality rating. The 150% mortality rating, in turn, reflects an estimate that Chabner’s life expectancy is nine to eleven years less than that of a standard male non-smoker. United points to the Brackenridge manual, which recommended a mortality rating of 75%—150%, and the Cologne manual, which recommended a mortality rating of 300%, to argue that the 150% mortality rating was justified. However, United’s own admissions subvert its reliance on these manuals. In his letter to Chabner, Dr. Robert Quinn, the Vice President and Senior Medical Director of Underwriting at United, admitted that FSH MD “has only a small effect on mortality.” Moreover, Dr. Quinn estimated Chabner’s life expectancy to be only four years less than standard. Even assuming that the estimate of a four year decrease in life expectancy is correct, 9 it does not justify a rating that estimates a nine to eleven year decrease. 10 Accordingly, by United’s own admission, the 150% mortality rating (i.e., the estimate of a nine to eleven year decrease in life expectancy) was not actuarially sound.
Nor does the second prong of
E. The Modification Order.
After it granted summary judgment for Chabner, the district court ordered United to modify the policy it offered Chabner such that the policy would conform with the court’s order granting summary judgment. United argues that the district court erred by ordering this modification, because the court did not specify what premium United should charge Chabner. We review the district court’s order to modify the insurance policy, ah equitable remedy, for abuse of discretion.
See United States v. Washington,
The district court order merely requires United to issue Chabner a policy that conforms with its order granting summary judgment — i.e., one that is based on sound actuarial principles or actual and reasonably anticipated experience. This injunc-tive relief is fully authorized by California law.
CONCLUSION
For the foregoing reasons, the district court’s grant of summary judgment for Appellee Chabner, and its judgment ordering Appellant United to modify the insurance policy, are AFFIRMED.
Notes
. A whole life insurance policy is designed to provide both insurance and cash value accumulation.
. The Brackenridge manual recommended a mortality rate between 75 and 150 percent for slowly progressive FSH MD. The Cologne manual recommended a mortality rate of at least 300 percent.
. Before Chabner added the ADA claim, the propriety of federal jurisdiction based on diversity may have been questionable. Chabner was a resident of California, and United was a Nebraska corporation with its principal place of business in Nebraska, but it is unclear whether the amount in controversy met the jurisdictional minimum, which was $50,000 when United removed the case in 1995.
We need not, however, rest federal jurisdiction on this questionable ground. Once in federal court, Chabner amended his complaint to add a claim under the ADA, thereby raising a federal question. Although normally “jurisdiction must be analyzed on the basis of the pleadings filed at the time of removal without reference to subsequent amendments,’’
Sparta Surgical Corp. v. National Ass'n of Sec. Dealers,
. In fact, Chabner concedes that "the question of whether there is a private right of action under Insurance Code
. Section 790.03(f) defines "[u]nfair rate discrimination” as "[m]aking or permitting any unfair discrimination between individuals of the same class and equal expectation of life in the rates charged for any contract of life insurance....”
. The fact that section 790.03 did not provide a private cause of action, whereas the Cartwright Act explicitly provided a private cause of action, was not a factor in the
Manufacturers Life
decision. As the California Supreme Court stated, both before and after
Manufacturers Life,
"whether a private right of action should be implied under [the predicate] statute ... is immaterial” to the question whether a plaintiff may maintain a
.Insurance Code
. Chabner argues that United waived its primary jurisdiction argument because it failed to raise it until after the district court had granted Chabner summary judgment. We need not decide this issue because we instead reject United's primary jurisdiction claim on the merits.
. The estimated four year decrease in life expectancy is itself questionable, given that Chabner has submitted numerous excerpts from medical manuals that indicate FSH MD does not decrease life expectancy. However, because we view the evidence in the light most favorable to United, we will assume the estimated four year decrease is more accurate than the estimated zero year decrease. Nevertheless, this does not change our conclusion—an estimate of a four year decrease in life expectancy does not justify a mortality rating with a nine to eleven year decrease.
. More than two years after Dr. Quinn sent Chabner the letter with his estimate of a four year decrease in life expectancy, he submitted a declaration to the district court that stated that when he wrote the letter he had no personal knowledge of the life expectancy associated with a Table 6 rating. Although the purpose of this declaration is to discount his earlier estimate of a four year decrease in life expectancy, it does not overcome his admission that FSH MD has only a small effect on mortality, even if we view the declaration in the light most favorable to United.
. The district court’s award of statutory damages in the amount of $1,000, and its award of attorney’s fees, are also fully supported by California law.