Joan Hangarter, a chiropractor who operated her own business, obtained an “own occupation” disability insurance policy in 1989 from Paul Revere Life Insurance Company. She filed a claim for total disability in July 1997 based on shoulder, elbow, and wrist pain. Paul Revere paid Hangarter benefits for an eleven-month period and then terminated her benefits based upon the opinion of its medical examiners and claim investigators that Han-garter was not “totally disabled” and continued to work and earn income, making her ineligible for benefits under the policy. Hangarter brought a diversity action alleging violation of Cal. Bus. & Prof.Code § 17200 (the Unfair Competition Act, or UCA), breach of contract, breach of the covenant of good faith and fair dealing, and intentional misrepresentation against Paul Revere and its parent company, Un-umProvident Corp. The jury returned a $7,670,849 verdict in Hangarter’s favor, $5 million of which was for punitive damages. Raising a multitude of issues, Defendants appeal the district court’s post-verdict denial of judgment as a matter of law (JMOL), the jury’s award of damages, and a permanent injunction issued by the district court under the UCA.
We affirm the district court’s denial of a JMOL and the jury’s award of damages. We reverse the district court’s permanent injunction under the UCA.
I. BACKGROUND
Joan Hangarter owned her own chiropractic practice in Berkeley, California. On a typical day, she would treat between 30 and 50 patients. In 1989, Hangarter purchased an individual “own occupation”
Though she continued to be treated by Drs. Berry and Isono, Hangarter’s condition did not improve. Between 1996 and 2000 Hangarter had 3 Magnetic Resonance Imaging studies (MRIs), which Dr. Isono interpreted as having abnormal findings. The third MRI in May 2000 showed her condition to be growing worse, despite treatment by Drs. Berry and Isono. Dr. Berry diagnosed Hangarter’s symptoms as epicondylitis, cervical intervertebral disk syndrome, and tendinitis. Dr. Isono offered only surgery to correct the problem, which Hangarter rejected based on her past negative experience with post-surgery pain medication. Hangarter eventually discontinued seeing Dr. Isono and was treated solely by Dr. Berry, whose chiropractic manipulations gave her some pain relief.
In 1999, Paul Revere employed an “independent medical examiner” (IME), Dr. Aubrey Swartz, to examine Hangarter and her medical records. In contrast to the findings of Drs. Isono and Berry, Dr. Swartz concluded that Hangarter’s condition was “normal” and that she would be able to see two chiropractic patients an hour. Dr. Edward Katz, an orthopedic surgeon, at the request of Hangarter’s counsel, reviewed her medical records 1 and examined her in July 2001, two years after Dr. Swartz. Dr. Katz disagreed with Dr. Swartz’s conclusions. He found 75% range of motion in her neck, spasm and tenderness in the right trapezius muscle, and reduced grip strength in her arm. Dr. Katz also found evidence of cervical disk disease, a depressed biceps reflex on Han-garter’s right side along with numbness and tingling of the middle finger of her right hand, an indicator of nerve root compression affecting the sensory portion of the nerve going down the arm. Dr. Katz reviewed the reports of the MRI scans of Hangarter’s cervical spine taken in May 1997, finding mild to minimal central canal stenosis, a narrowing of the spinal canal which causes some compression on the spinal canal or the nerve roots. He concluded that Hangarter suffered from lateral epicondylitis, more commonly called tennis elbow, cervical disk disease, and rotator cuff tendinitis, and that her condition was worsening. Drs. Katz, Berry, and Isono testified that Hangarter could not maintain a normal, continuous chiropractic occupation.
While Hangarter was receiving benefits from her policy, she hired Dr. Parissa Peymani to adjust patients while she assisted with office management. Dr. Pey-mani testified that after she started working, Hangarter stopped seeing all but five to seven of her patients, which Dr. Berry
On May 21, 1999, Paul Revere terminated Hangarter’s “total disability” benefits. The letter claimed that Hangarter was ineligible for benefits under the policy as she was not “totally disabled” and was working and earning income. After Paul Revere terminated Hangarter’s benefits, it attached her bank account for the insurance premiums, until the account was drained, at which point the company can-celled her policy. Hangarter subsequently brought a diversity action against Defendants alleging violation of § 17200 of the Unfair Competition Act, breach of contract, breach of the covenant of good faith and fair dealing, and intentional misrepresentation. After eleven days of trial, a jury of six returned a unanimous verdict for Hangarter. The total award was $7,670,849, including $5,000,000 for punitive damages, $1,520,849 for past and future unpaid benefits, $400,000 for emotional distress, and $750,000 for attorneys’ fees. The district court also issued a permanent injunction under the UCA. Defendants filed a motion for a JMOL or for a new trial, which the district court denied.
See Hangarter v. Paul Revere Life Ins. Co.,
II. DISCUSSION
We review the denial of a- motion for a JMOL de novo.
See Monroe v. City of Phoenix,
JMOL should be granted only if the verdict is “against the great weight of the evidence, or it is quite clear that the jury has reached a seriously erroneous result.”
EEOC v. Pape Lift, Inc.,
A. Total Disability
1. Jury Instruction
We review de novo jury instructions that are challenged as a misstate
Defendants argue that the district court’s jury instruction on the meaning of “total disability” was a misstatement of California law. The district court’s instruction to the jury stated:
TOTAL DISABILITY
Plaintiffs policy defines “total disability” as follows:
“Total Disability” means that because of Injury or Sickness:
a. you are unable to perform the important duties of your Occupation; and
b. you are not engaged in any other gainful occupation; and
c. you are under the regular and personal care of a physician.
This means, according to the law in California, that plaintiff is eligible for benefits if she is unable to perform the substantial and material duties of her own occupation in the usual and customary way with reasonable continuity.
The district court’s jury instruction was based upon the California Supreme Court’s holding in
Erreca v. Western States Life Ins. Co.,
Defendants argue that because the “total disability” provision of Paul Revere policy was unambiguous, the district court’s imposition of
Erreca’s
definition of “total disability” was unwarranted under California law. Contrary to Defendants’ position, California law
requires
courts to deviate from the explicit policy definition of “total disability” in the occupational policy context
2
where it is necessary to “offer protection to the insured when he is no longer able to carry out the substantial and material functions of
his
occupation.”
Austero v. Nat’l Cas. Co.,
Defendants also contend that the imposition of Erreca’s definition of total disability in this case obviated the'policy's partial or residual disability provision.
4
This argument also disregards California law. In
Wright v. Prudential Ins. Co. of America,
No logical reason appears, however, why the same rule should not be applied where the policy provides for both total and partial disability in order to make the total disability clause ‘operative and to prevent a forfeiture’ of the indemnity provided by that clause. In either case a literal interpretation of the total disability clause would defeat the very purpose of insurance against total disability,because it rarely happens that an insured is so completely disabled that he can transact no business duty whatever. The rule quoted has been applied in many eases where the policy in suit provided for both total and partial disability .... The fact that the insured may do some work or transact some business duties during the time for which he claims indemnity for total disability or even the fact that he may be physically able to do so is not conclusive evidence that his disability is not total, if reasonable care and prudence require that he desist.
Id. at 761-62 (citations omitted) (emphasis added). The fact that the policy in this case contained a residual or partial disability clause does not make the district court’s jury instruction inconsistent with California law. 5
The district court therefore did not erroneously misstate California law in its jury instruction.
2. Jury’s Total Disability Finding
“[T]he question of what amounts to total disability is one of fact....”
Erreca,
The jury’s special verdict made the specific finding that at the date her benefits were terminated by Defendant, “Plaintiff was unable to perform the substantial and material duties of her own occupation in the usual and customary way with reasonable continuity.” Defendants argue that “undisputed evidence” demonstrates that Hangarter “continued to manage her business profitably” and engaged in a “gainful occupation” in violation of the precise terms of the policy. Given that the district court correctly applied California law in formulating its jury instruction for “total disability,” our relevant inquiry is only whether the jury’s factual finding of total disability, pursuant to the jury instruction, was supported by substantial evidence. The fact that some evidence might demonstrate that Hangarter violated the precise terms of the policy is immaterial.
There was sufficient evidence for the jury to find that Hangarter was totally disabled. Though there is conflicting evidence in the record regarding Hangarter’s medical condition, the jury’s determination that before the date of termination Han-garter was physically unable to perform “the substantial and material duties of her own occupation in the usual and customary way with reasonable continuity” is supported by substantial evidence. Three doctors testified that Hangarter could not maintain a continuous, normal chiropractic occupation. While Defendants note that Hangarter made a handful of attempts to perform chiropractic adjustments, futile attempts to return to one’s previous occu
Though Hangarter hired another chiropractor from 1997-1999 to treat her patients while she performed clerical tasks incidental to her primary occupation, this is insufficient to disqualify her from being “totally disabled” under California law. Hangarter had an
occupational
policy with Paul Revere, and was insured against losses stemming from her inability to perform her occupation as a chiropractor. Her occasional stints as an office manager do not constitute the occupational practice of chiropractic medicine. Under California law, the performance of tasks
incidental
to one’s profession does not demonstrate that an individual is not “totally disabled.”
See Culley v. New York Life Ins. Co.,
Similarly, the fact that Hangarter’s enterprise possibly made a profit during this time period is also immaterial. As the California Supreme Court noted in Erreca:
The insurer also stresses the magnitude of the respondent’s enterprise and his income therefrom. Such matters have no proper place in the determination of whether respondent is totally disabled from performing remunerative work. Disability insurance is designed to provide a substitute for earnings when, because of bodily injury or disease, the insured is deprived of the capacity to earn his living.... It does not insure against loss of income. The respondent receives his income from his ranches as an owner or lessor; his labor contributes nothing toward it. The contention of the insurer would lead to the strange conclusion that a bedridden merchant is not totally disabled from performing gainful work because he receives a substantial income from a business, the management of which he has been forced to abandon to others.
Erreca,
Substantial evidence supports the jury’s finding that Hangarter was unable to perform the substantial and material duties of her occupation as a chiropractor in a normal and continuous way. The district court therefore did not err in declining to disturb the jury’s finding that Hangarter was totally disabled.
B. Jury’s Bad Faith Determination
A cause of action for breach of the implied covenant of good faith and fair dealing in the insurance context is characterized as insurance bad faith, for which a plaintiff may recover tort damages. “The key to a bad faith claim [under California
Though the existence of a “genuine dispute” will generally immunize an insurer from liability, a jury’s finding that an insurer’s investigation of a claim was biased may preclude a finding that the insurer was engaged in a genuine dispute, even if the insurer advances expert opinions concerning its conduct.
See Chateau Chamberay,
1. The insurer may have misrepresented the nature of the investigatory proceedings;
2. The insurer’s employees lied in depositions or to the insured;
3. The insurer dishonestly selected its experts;
4. The insurer’s experts were unreasonable; or
5. The insurer failed to conduct a thorough investigation;
Chateau Chamberay,
Substantial evidence was presented at trial that the jury could have relied upon in determining that Defendants engaged in a biased investigation. Frank Caliri testified that Paul Revere’s letter terminating Hangarter’s benefits was misleading, deceptive, and fell below industry standards as it incorrectly advised Han-garter about her rights under the policy.
7
The letter claimed that Hangarter was “working,” and therefore was in violation of the policy. This statement, as Paul Revere acknowledged in the same letter, was false because Hangarter had already sold her chiropractic business. Indeed, the letter went on to deny Hangarter any
Evidence was also presented that Defendants exhibited bias in selecting and retaining Dr. Swartz as the IME. Paul Revere used Dr. Swartz nineteen times from 1995 to 2000. Caliri testified that when an insurer “use[s] the same [IME] on a continual basis,” the medical examiner becomes “biased” because they “lose their independence.” Similarly, evidence showed that in thirteen out of thirteen cases involving claims for total disability, Dr. Swartz rejected the insured’s claim that he or she was totally disabled. Moreover, Defendants’ letter retaining Dr. Swartz, written by an in-house medical consultant who had never examined Han-garter, claimed that there were no objective findings for a disabling injury. Caliri testified that this letter “bias[ed]” and “predispos[ed] the doctor” against finding disabling injuries by “telling him [Defendants’] opinion.”
Additionally, Hangarter offered evidence that Defendants had developed and applied to her case file a comprehensive system for targeting and terminating expensive claims, such as those stemming from “own occupation” policies where the insured was a disabled professional who had been receiving benefits for months or years. Dr. William Feist testified that Defendants in the mid-to-late 1990s had instituted “unethical” policies such as “round table claim reviews” that were made with the goal of achieving a “net termination ratio” (the ratio of the value of terminated claims compared with new claims). 9 Caliri similarly testified that the round table process violated the insurance industry principle of looking at each policy claim objectively and on a case-by-case basis.
Viewing the evidence in Hangarter’s favor, we conclude that the district court did not err in determining that the jury had substantial evidence before it to find that the Defendants engaged in a biased, and thus “bad faith,” investigation.
C. Future Damages Jury Instruction
The district court instructed the jury that if it found that Defendants “breached [their] duty of good faith and
Nonetheless, Defendants’ argument is unavailing on the merits. In
Egan v. Mutual of Omaha Ins. Co.,
We have never held, however, that future policy benefits may not be recovered in a valid tort cause of action for breach of the implied covenant of good faith and fair dealing.... Thus, in applying to these facts the general rule for fixing tort damages ..., the jury may include in the compensatory damage award future policy benefits that they reasonably conclude, after examination of the policy’s provisions and other evidence, the policy holder would have been entitled to receive had the contract been honored by the insurer.
Id.
at 149 n. 7 (emphasis added). The California Court of Appeal in
Pistorius v. Prudential Ins. Co.,
It is well established that a state court’s interpretation of its statutes is binding on the federal courts unless a state law is inconsistent with the federal Constitution.
Adderley v. Florida,
The district court therefore did not misstate California law in instructing the jury that Defendants could be liable for future damages.
D. Punitive Damages
1. Availability under California Law
We review de novo the availability of punitive damages.
EEOC v. Wal-Mart Stores, Inc.,
“Viewing the facts in a light most favorable to the judgment,” we conclude that the jury’s award of punitive damages was consistent with California law.
Bertero v. Nat’l Gen. Corp.,
Additionally, California courts have stated that biased medical examinations and claims targeting practices could serve as a basis for punitive liability under California law. Id. at 897. As the court in Moore held,
[l]ooking at the record, as we must, in a light most favorable to the judgment, it appears the jury could properly have concluded the conduct of defendant in this case was highly reprehensible. The jury could conclude that defendant consciously pursued a practice or policy of cheating insureds out of benefits by obtaining incorrect opinions of total disability from treating physicians.
Id. (citations omitted). Moreover, the jury “could conclude that plaintiffs own treating physician was misled by defendant’s systematic claims practices and that defendant acted in bad faith by summarily,denying plaintiffs claim even though her treating physician had indicated she could not work at her regular occupation.” Id.
Finally, California courts have held that punitive damages are warranted where the cumulative evidence “supports a finding of intent to injure, since [e]vidence establishing ‘conscious disregard of another’s rights’ is evidence indicating that the defendant was aware of the probable consequences of his or her acts and willfully and deliberately failed to avoid those consequences.”
Notrica v. State Comp. Ins. Fund,
The district court therefore did not err in concluding that the jury’s award of punitive damages was consistent with California law.
2. Constitutional Due Process
Current Supreme Court jurisprudence instructs courts reviewing the constitutionality of punitive damages awards to consider the “reasonableness of a punitive damages award,” of which the “most important indicium ... is the degree of reprehensibility of the defendant’s conduct.”
BMW of North America, Inc. v. Gore,
The jury’s awarding of punitive damages in this case satisfies the general framework laid out in
Gore. See State Farm Mut. Auto. Ins. Co. v. Campbell,
Defendants argue that the Supreme Court’s decision in
State Farm
compels the conclusion that, in order to be constitutional, punitive damages in this case should be limited to no more than $1,000,000. Defendants’ argument is essentially that because their conduct in this case is less invidious than the defendant’s conduct in
State Farm,
the 1:1 ratio of punitive damages to compensatory damages applied in that case should equally apply here.
State Farm’s
1:1 compensatory to punitive damages ratio is not binding, no matter how factually similar the cases may be.
11
In
The ratio in this case is approximately 2.6: 1, well within the Supreme Court’s suggested range for constitutional punitive damages awards.
See id.
(“Single-digit multipliers are more likely to comport with due process, while still achieving the State’s goals of deterrence and retribution ... ”). Given that due process prohibits only a “grossly excessive” award, leaving to the states
“considerable flexibility
in determining” whether “the damages awarded [were] reasonably necessary to vindicate the State’s legitimate interest in punishment and deterrence,” the district court did not err in concluding that the jury’s award of punitive damages was within constitutional parameters.
Gore,
E. Evidentiary Errors
“To reverse a jury verdict for evidentia-ry error,” Defendants must show that the district court abused its discretion and that the error was prejudicial.
Tennison v. Circus Circus Enters., Inc.,
1. Expert Witness Frank Caliri
a. Qualifications
Rule 702 requires that a testifying expert be “qualified as an expert by knowledge, skill, experience, training, or education.” Fed.R.Evid. 702. Rule 702 “contemplates a
broad conception
of expert qualifications.”
Thomas v. Newton Int’l Enters.,
Defendants assert that the district court abused its discretion in admitting the testimony of Caliri because he lacked sufficient qualifications to testify about claims adjustment standards in the context of an insurance bad faith claim.
12
Caliri has
“Clearly, this lays at least the
minimal foundation
of knowledge, skill, and experience required in order to give ‘expert’ testimony” on the practices and norms of insurance companies in the context of a bad faith claim.
Thomas,
b. Ultimate Issue Testimony
“It is well-established ... that expert testimony concerning an ultimate issue is not per se improper.”
Mukhtar v. Cal. State Univ., Hayward,
Defendants contend that Caliri’s testimony that Defendants failed to comport with industry standards inappropriately reached legal conclusions on the issue of bad faith and improperly instructed the jury on the applicable law. This argument is unavailing. Caliri’s testimony did not improperly embrace the issue of bad faith under Fed.R.Evid. 704(a). While Caliri’s testimony that Defendants deviated from industry standards supported a finding that they acted in bad faith, Caliri never testified that he had reached a legal conclusion that Defendants actually acted in bad faith (i.e., an ultimate issue of law).
See Ford v. Allied Mut. Ins. Co., 72
F.3d 836, 841 (10th Cir.1996) (concluding that “expert witness for [the defendant] was permitted to testify” to
“the issue of bad faith
” by showing that the defendant relied on both “Iowa law” and “industry practice that before there is payment ..., one looks at the total coverage available at
Moreover, Caliri’s testimony did not improperly usurp the court’s role by instructing the jury as to the applicable law. Although Caliri’s testimony that Defendants departed from insurance industry norms relied in part on his understanding of the requirements of state law, specifically California’s Unfair Settlement Claims Practice § 2695, “a witness may refer to the law in expressing an opinion without that reference rendering the testimony inadmissible. Indeed, a witness may properly be called upon to aid the jury in understanding the facts in evidence even though reference to those facts is couched in legal terms.”
Specht v. Jensen,
The district court therefore did not abuse its discretion in concluding that Cali-ri’s testimony did not improperly invade the province of the jury or the court.
c. Reliability
Rule 702 allows admission of “scientific, technical, or other specialized knowledge” by a qualified expert if it will “assist the trier of fact to understand the evidence or to determine a fact in issue.”
Daubert v. Merrell Dow Pharmaceuticals, Inc.,
That said, “far from requiring trial judges to mechanically apply the
Daubert
factbrs' — or something like them — to both scientific and non-scientific testimony,
Kumho Tire
heavily emphasizes that judges are entitled to broad discretion when discharging their gatekeeping function.”
United States v. Hankey,
Given that, unlike scientific or technical testimony, the reliability of Caliri’s testimony was not contingent upon a particular methodology or technical framework, the district court did not abuse its discretion in finding Caliri’s testimony reliable based on his knowledge and experience. We thus conclude that the district court’s inquiry was sufficient to comply with its gatekeep-ing role, as we have interpreted it in
Mukhtar,
2. William Feist’s Deposition
a. Qualifications
As discussed, Fed.R.Evid. 702 “contemplates a
broad conception
of expert qualifications.”
Thomas,
The district court therefore did not abuse its discretion in finding Feist qualified to discuss Provident’s handling of disability claims.
b. Unavailability
Defendants argue that the district court erred in finding Feist “unavailable.” Feist’s residence in Alabama placed him outside of the court’s subpoena power under Fed.R.Civ.P. 45, and he was thus unavailable pursuant to Fed.R.Civ.P. 32(a)(3), which permits deposition testimony where “the witness is at a greater distance than 100 miles from the place of trial or hearing.” The admitted deposition was from the Alameda County Superior Court case United Policyholders v. Provident Life and Accident Ins. Co., UnumProvident Corp., and Bay Brook Med. Group. In the United Policyholders case, a partner of Defendants’ counsel, representing Provident Life & Accident Insurance Co. and UnumProvident, cross-examined Feist. Defendants therefore had ample opportunity to cross-examine Feist and satisfied Fed.R.Evid. 804(b)(1). See Fed.R.Evid. 804(b)(1) (“Testimony given ... in a deposition ... [is admissible where] the party against whom the testimony is now offered, or, in a civil action or proceeding, a predecessor in interest, had an opportunity and similar motive to develop the testimony by direct, cross, or redirect examination.”).
c. Fed.R.Evid. 102 and I0S
To be admissible, evidence must be relevant under Fed.R.Evid. 402 and its probative value must not be substantially outweighed by the danger of unfair prejudice under Fed.R.Evid. 403. Defendants argue that Feist’s testimony regarding the elaims-handling procedures at Provident should have been excluded because it bore no direct relationship to Paul Revere’s handling of Hangarter’s claim and was therefore irrelevant and prejudicial.
The jury could have reasonably inferred that the claims handling procedures at Provident were carried over to Paul Revere as a subsidiary of UnumProvident after Unum and Provident merged. This inference was not unwarranted given that Ralph Mohney controlled claims-handling at both Provident and Paul Revere and Paul Revere’s handling of Hangarter’s claim employed practices similar to those used at Provident.
See Murray v. Toyota Motor Distribs., Inc.,
The district court therefore did not abuse its discretion in concluding that Feist’s deposition was relevant to Hangar-ter’s claims.
3. Provident Documents
Defendants argue that some of the documents produced by Provident in
The documents also had a sufficient nexus to Hangarter’s claim. The documents confirmed that Provident’s claims handling practices were adopted by Paul Revere after Provident merged with Unum in 1999 to form UnumProvident. See Exhibits 153/155 (stating that it was necessary to “Bring Wooster [ (Paul Revere headquarters) ] reporting into conformance with Chattanooga [ (Provident) ] standards.”). Additionally, Caliri testified that depositions of Provident employees demonstrated that the companies worked together to transition Provident’s claims handling practices to Paul Revere. Finally, Caliri testified that Hangarter’s claim went to a round table review on September 9, 1997 and that the adjuster handling her claim stated that the purpose of the review was to “explore[ ] termination options,” consistent with the alleged corporate policies of UnumProvident.
The court therefore did not abuse its discretion in allowing Hangarter to introduce documents produced by Provident in another lawsuit.
4. Stephen Rutledge Testimony
Defendants argue that the district court improperly excluded the testimony of Stephen Rutledge, who was to testify that both the percentage of monthly individual disability claims that Paul Revere paid and Paul Revere’s total pay-outs for the individual disability line of insurance increased during the relevant time period.
Defendants’ contention is unpersuasive. The district court rejected Rutledge’s testimony because it related to
all individual
disability claims, and not to only own occupation disability claims. Hangarter’s entire case was premised upon the theory that Defendants purposefully terminated her claim because it was a high cost, own occupation disability claim. An increase in disability payouts does little to disprove Hangarter’s theory that Defendants intended to terminate claims such as Han-garter’s. The district court therefore was within its discretion in excluding this evidence as irrelevant and prejudicial under Rules 402 and 403, particularly given its potential to confuse the jury.
See McEuin v. Crown Equip. Corp.,
“Rule 42(b) of the Federal Rules of Civil Procedure confers broad discretion upon the district court to bifurcate a trial, thereby deferring costly and possibly unnecessary proceedings.... ”
Zivkovic v. S. Cal. Edison Co.,
Defendants argue that the district court abused its discretion in trying the issues of liability for contract damages and liability for punitive damages for tortious breach of that contract together before the same jury. Defendants cite
Mathews v. Eldridge,
The district court’s decision to decline to bifurcate the trial comported with normal trial procedure. “[S]ince the evidence usually overlaps substantially, the normal procedure is to try compensatory and punitive damage claims together with appropriate instructions to make clear to the jury the difference in the clear and convincing evidence required for the award of punitive damages.”
McLaughlin v. State Farm Mut. Auto. Ins. Co.,
The district court therefore did not abuse its discretion in trying the issues of liability for contract damages and liability for punitive damages for tortious breach of that contract together before the same jury.
G. Standing and the UCA
The district court held that Defendants violated the TJCA and in turn ordered them to "obey the law" and refrain from "future violations, including, but not limited to, targeting categories of claims or claimants, employing biased medical examiners, destroying medical reports, and withholding from claimants information about their benefits."
The district court erred in concluding that Hangarter had Article III standing to pursue injunctive relief under the UCA. “Article III standing requires an injury that is actual or imminent, not conjectural or hypothetical. In the context of injunc-tive relief, the plaintiff must demonstrate a
real or immediate threat
of an irreparable injury.”
Clark v. City of Lakewood,
Because Hangarter lacked standing to prosecute an UCA claim for injunctive relief, on remand, the district court shall vacate the injunction. .
III. CONCLUSION
We affirm the district court’s denial of a JMOL and the jury’s award of damages and reverse the district court’s permanent injunction under the UCA.
AFFIRMED IN PART, REVERSED IN PART, and REMANDED. Defendants to bear costs. 18
Notes
. These records included the files of Dr. Iso-no, the MRI reports of Hangarter's right shoulder and cervical spine taken in 1997, the records and deposition of Dr. Linda Berry, the electromyogram ("EMG”) studies of March 6 and March 30, 1998, the report of Dr. Swartz and another doctor retained by Paul Revere, and the MRI report of May 12, 2000.
. The California Supreme Court in
Erreca
defined total disability in the context of a general, nonoccupational disability policy. Han-garter's policy was an
occupational
policy, as opposed to a nonoccupational policy which "does not insure the plaintiff in respect to any particular occupation. The general or total disability which it insures against is akin to ... provisions defining total disability as that which prevents the insured 'from engaging in any occupation, or performing any work whatsoever for remuneration or profit.’"
Joyce v. United Ins. Co. of America,
. Although the instruction eliminated the policy's requirement that Hangarter not be engaged in "any other gainful occupation” in order to receive “total disability” benefits, that appears proper under California law, even if the policy language seems unambiguous.
See Moore,
. The policy provides residual disability benefits if the insured is unable to perform one or more of the important duties of her occupation; is unable to perform the important duties of her occupation for more than 80% of the time normally required to perform them; or her loss of earnings is equal to at least 20% of her former earnings while engaged in her occupation or another occupation; and she is under the regular and personal care of a physician.
. Defendants rely on
Dietlin v. Gen. Am. Life Ins. Co.,
. Hangarter testified that "most of the money [earned during this time] went all to overhead.” Though the record is unclear on this issue, Hangarter and Dr. Peymani testified that Hangarter saw, at most, five to seven patients during a year. Hangarter then hired Dr. Peymani to "take over” her practice. She later replaced Dr. Peymani, and shortly afterward sold her practice altogether. When her benefits were terminated, she was not engaged in any occupation.
. Defendants respond to Caliri's testimony by stating that under California law the insurer has no obligation to inform the insured about benefits set forth clearly in the policy. This, however, does not rebut Caliri's observation that Defendants’ failure to inform Hangarter fully about her rights under the policy generally fell below industry customs and norms.
. If an insurance policy is part of an employee welfare benefit plan governed by ERISA, then a plaintiff's state law claims relating to that policy are preempted and federal law applies to determine recovery.
See Pilot Life Ins. Co. v. Dedeaux,
. Caliri also testified, based on internal Provident documents, that Defendants set goals for terminating whole blocks of claims without reference to the merits of individual claims for benefits; e.g., a directive that each adjuster will maintain a list often claimants "where intensive effort will lead to successful resolution of the claim. As one drops off another name will be added.” He referred to testimony by Ralph Mohney and Sandra Frye that “resolution” of claims meant their “termination.” Caliri testified that Hangarter's case file was taken to a round table on September 9, 1997.
. Fed.R.Civ.P. 51 provides that "[n]o party may assign as error the giving or the failure to give an instruction unless that party objects thereto before the jury retires to consider its verdict, stating distinctly the matter objected to and the grounds of the objection.” Fed. R.Civ.P. 51 (2002). Though Defendants did not object to the jury instruction, they did object to the
admission
of evidence of future policy benefits in their motion in limine no. 3. While "deficient in terms of the plain language of Rule 51,” this objection "fall[s] within the limited exception we have recognized for a pointless formality.”
Voohries-Larson v. Cessna Aircraft Co.,
. That said, there are important factual distinctions between State Farm and the case at bar. In
State Farm
the "compensatory damages for the injury suffered ... likely were based on a component [ (emotional distress) ] which was duplicated in the punitive award.”
State Farm,
. Defendants' argument that Caliri lacked specialized knowledge as to insurance bad faith claims relies heavily on
City of Hobbs v. Hartford Fire Ins. Co.,
. Defendants .rely heavily on
Thompson v. State Farm Fire & Cas. Co.,
. Caliri testified as to whether Defendants’ practices were consistent with insurance industry standards. This sort of analysis is dependent upon the witness's knowledge of, and experience within, the insurance industry.
. We grant Defendants' February 10, 2004 motion to augment the Excerpts of Record with Defendants’ Motion to Strike Caliri's tes- ' timony.
. Ralph Mohney, the former vice president of claims for Provident, assumed responsibility for group disability claims with Provident’s acquisition of Paul Revere in 1997 and maintained this role after the merger with Unum in 1999 for UnumProvident. Mohney was Senior Vice President, Customer Care, for UnumProvident at the time Hangarter's claim was investigated and her policy terminated.
. We reach no conclusion as to whether Hangarter’s UCA claim is viable on the merits under California law.
. As noted in footnote 15 above, we grant Defendants’ February 10, 2004 motion to augment the Excerpts of Record with Defendants' Motion to Strike Caliri's testimony.
