United States Ex Rel. Loughren v. Unum Group

8/8/2019 United States Ex Rel. Loughren v. Unum Group

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613 F.3d 300 (Cite as: 613 F.3d 300)

2010 Thomson Reuters. No Claim to Orig. US Gov. Works.

Only the Westlaw citation is currently available.

United States Court of Appeals, First Circuit.

UNITED STATES ex rel. Patrick LOUGHREN, Re-lator, Appellee,

v. UNUM GROUP, Defendant, Appellant.

No. 09-1606.

Heard Feb. 1, 2010. Decided July 29, 2010.

Background: Relator brought action under quit tamprovisions of the False Claims Act, alleging that longterm disability (LTD) insurance provider, and itswholly-owned subsidiary knowingly caused theirinsureds to file baseless applications for Social Secu-rity Disability Insurance (SSDI), thereby burdeningthe Social Security Administration (SSA) with thetime and expense required to deny such claims. TheUnited States District Court for The District of Mas-sachusetts, Patti B. Saris , J., denied provider's motionfor judgment as a matter of law, and directed entry of

judgment against provider, 604 F.Supp.2d 269. Pro-vider appealed.

Holding: The Court of Appeals, Stahl, Circuit Judge,held that district court abused its discretion by prec-luding insurer from presenting certain Federal Em-ployee Retirement System (FERS) evidence.

Vacated and remanded.

West Headnotes

[1] United States 393 120.1

393 United States 393VIII Claims Against United States

393k120 Making or Presentation of FalseClaims and Other Offenses Relating to Claims

393k120.1 k. In General. Most Cited Cases False Claims Act (FCA) covers all fraudulent attemptsto cause the government to pay out sums of money. 31U.S.C.(2006 Ed.) 3729 et seq.




393k120.1 k. In General. Most Cited Cases False Claims Act (FCA) is subject to a judicial-ly-imposed requirement that the allegedly false claimor statement be material. 31 U.S.C.(2006 Ed.) 3729et seq.

[3] Federal Courts 170B 776 170B Federal Courts

170BVIII Courts of Appeals 170BVIII(K) Scope, Standards, and Extent

170BVIII(K)1 In General 170Bk776 k. Trial De Novo. Most Cited

Cases Court of appeals reviews the denial of a motion for

judgment as a matter of law, including legal decisionsmade therein, de novo.

[4] Federal Courts 170B 765

170B Federal Courts 170BVIII Courts of Appeals

170BVIII(K) Scope, Standards, and Extent 170BVIII(K)1 In General

170Bk763 Extent of Review Dependenton Nature of Decision Appealed from

170Bk765 k. Judgment Notwith-standing Verdict. Most Cited Cases

Federal Courts 170B 801


170BVIII(K) Scope, Standards, and Extent 170BVIII(K)3 Presumptions

170Bk801 k. Judgment N. O. v. MostCited Cases In reviewing the denial of a motion for judgment as amatter of law, as for matters of fact, a court of appeals
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613 F.3d 300 (Cite as: 613 F.3d 300)


views the evidence in the light most favorable to theverdict, asking only whether a rational jury could onthe basis of that evidence find as the jury has; a jury'sverdict and factual findings must be upheld unless the

facts and inferences viewed in the light most favorableto the verdict point so strongly and overwhelmingly infavor of the movant that a reasonable jury could nothave returned the verdict.




393k120.1 k. In General. Most Cited Cases As in the securities fraud arena, materiality in theFalse Claims Act (FCA) context involves a factualdetermination of the weight that the decisionmakerwould have given particular information. 31U.S.C.(2006 Ed.) 3729 et seq.




393k120.1 k. In General. Most Cited Cases The fact that an allegedly false statement constitutesthe speaker's opinion does not disqualify it fromforming the basis of False Claims Act (FCA) liability.31 U.S.C.(2006 Ed.) 3729 et seq.




393k120.1 k. In General. Most Cited Cases An opinion may qualify as a false statement for pur-

poses of the False Claims Act (FCA) where thespeaker knows facts that would preclude such an opi-nion; facts for this purpose are those which the ap-plicant could reasonably classify as true or false asopposed to legal argumentation and possibility. 31U.S.C.(2006 Ed.) 3729 et seq.




393k120.1 k. In General. Most Cited Cases A party cannot file a knowingly false claim under theFalse Claims Act (FCA) on the assumption that thefiscal intermediary will correctly calculate the value inthe review process. 31 U.S.C.(2006 Ed.) 3729 et seq.

[9] Federal Courts 170B 823


170BVIII(K) Scope, Standards, and Extent 170BVIII(K)4 Discretion of Lower Court

170Bk823 k. Reception of Evidence.Most Cited Cases Court of appeals reviews a district court's ruling ex-cluding proffered evidence for abuse of discretion; indeference to a district court's familiarity with the de-tails of the case and its greater experience in eviden-tiary matters, the court of appeals affords broad dis-cretion to a district court's evidentiary rulings.

[10] United States 393 122

393 United States

393VIII Claims Against United States 393k120 Making or Presentation of FalseClaims and Other Offenses Relating to Claims

393k122 k. Penalties and Actions Therefor.Most Cited Cases District court abused its discretion, in qui tam actionbrought under False Claims Act (FCA) against longterm disability (LTD) insurer, by precluding insurerfrom showing that federal government under FederalEmployee Retirement System (FERS) regularly re-quired applicants to apply for Social Security Disa-bility Insurance (SSDI) as condition of applying forother forms of federal benefits; case was submitted to

jury on theory that false statements alleged by relatorwere statements in the application for SSDI that theapplicant was unable to work or is disabled, andFERS evidence supported conclusion that the SocialSecurity Administration (SSA) was aware that everyfederal employee seeking FERS disability retirementbenefits was required to file an application for SSDIbenefits, such that an applicant's statement that he orshe was unable to work would carry no implied
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613 F.3d 300 (Cite as: 613 F.3d 300)


opinion as to potential eligibility, and therefore wouldnot be material under the FCA. 31 U.S.C.(2006 Ed.) 3729 et seq. William J. Kayatta, Jr. , with whom Catherine R.

Connors , Geraldine G. Sanchez , Mark Porada andPierce Atwood LLP were on brief for appellant.

Colette G. Matzzie with whom Claire M. Sylvia , PeterB. Krupp , Phillips & Cohen LLP and Lurie & KruppLLP were on brief for appellee.

Before TORRUELLA , Circuit Judge, SOUTER, As-sociate Justice ,FN* and STAHL , Circuit Judge.

STAHL , Circuit Judge.

Patrick J. Loughren (Relator) brought suit under thequi tam provisions FN1 of the False Claims Act(FCA), 31 U.S.C. 3729 et seq., alleging its viola-tion by Unum Group (Unum) and co-defendantGenex Services, Inc. (Genex) .FN2 On appeal, Unumchallenges the district court's denial of its motion for

judgment as a matter of law, the court's exclusion of certain evidence, and the court's instructions to the

jury on the element of scienter. After a thorough re-view, we affirm the district court's denial of Unum'smotion for judgment as a matter of law, but find thatthe court abused its discretion in excluding certainevidence that is highly relevant to one of the elementsnecessary to prove Unum's liability. Consequently, wevacate and remand for a new trial.

I. Background

Unum is a provider of long term disability insurance(LTD) policies. In his complaint as ultimatelyamended, Relator asserted that Unum and Genex wereliable under the FCA for knowingly causing theirinsureds to file baseless applications for Social Secu-rity Disability Insurance (SSDI), thereby burdeningthe Social Security Administration (SSA orAgency) with the time and expense required to denysuch claims. Under 31 U.S.C. 3730(b)(4) , the gov-ernment declined to prosecute the case.

At issue at trial were seven SSDI applications made bysix different Unum LTD benefits recipients. At theconclusion of evidence, the district court deniedUnum's motion for judgment as a matter of law, savefor a claim relating to one individual to whom the SSA

belatedly awarded SSDI benefits.

The jury returned a verdict against Unum on two of the remaining claims, those filed by Unum LTD reci-pients named Jennine and George, awarding damagesof $425 per proven false claim, for a total of $850.With respect to the remaining four claims, the juryreturned a verdict in Unum's favor on three anddeadlocked on the fourth. The district court deniedUnum's renewed motion for judgment as a matter of law.

Rather than proceeding to try the Relator's claimsrelating to 55 additional allegedly false claimants, thedistrict court directed entry of final judgment againstUnum on the SSDI applications filed by George andJennine, trebling the $850 in damages to $2,550 andawarding the maximum statutory penalty of $11,000for each of the two claims as provided under the FCA,31 U.S.C. 3729(a) ; 28 C.F.R. 85.3(a)(9) , for a totalaward of $24,550 .FN3

II. Facts

A. Applying for SSDI

To receive disability insurance benefits under theSocial Security Act, an applicant must be sufferingfrom a disability, 42 U.S.C. 423(a)(1) , that is, aninability to engage in any substantial gainful activityby reason of any medically determinable physical ormental impairment which can be expected to result indeath or which has lasted or can be expected to last fora continuous period of not less than 12 months. 42U.S.C. 423(d)(1)(A) . The applicant's physical ormental impairment must be

of such severity that he is not only unable to do hisprevious work but cannot, considering his age,education, and work experience, engage in anyother kind of substantial gainful work which existsin the national economy, regardless of whether suchwork exists in the immediate area in which he lives,or whether a specific job vacancy exists for him, orwhether he would be hired if he applied for work.

42 U.S.C. 423(d)(2)(A) . An applicant is deemed ableto engage in substantial gainful activity if he iscapable of doing any job that pays above a specificdollar amount set by SSA regulations. At the time of
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trial, that amount was $940 per month.

To obtain a disability determination by the SSA, anindividual must submit several related forms, includ-ing an Application for Disability Insurance Benefits(Form SSA-16-F6) (the application form) and aDisability Report-Adult (Form SSA-3368-BK) (thedisability report). The application form asks theapplicant to provide basic background information,employment history, and family information. Inquestion five, it asks the applicant to specify the timeperiod during which the applicant has been unable towork. FN4 The form instructs applicants that they willbe responsible for providing medical evidenceshowing the nature and extent of [their] disability.Though the application form does not include a defi-nition of disability, the disability report explains

how the term disability is defined by the Agency. Itstates:

You will be considered disabled if you are unable todo any kind of work for which you are suited and if your disability is expected to last (or has lasted) forat least a year or to result in death. So when we ask,when did you become unable to work, we areasking when you became disabled as defined by theSocial Security Act.

The application form explains that an applicant has theresponsibility to promptly notify the SSA of certain

events which may affect [the applicant's] eligibilityor disability benefits as provided in the Social SecurityAct. For example, if the applicant go[es] to work,or if his medical condition improves so that [he]would be able to return to work, even though [he has]not yet returned to work, he must report that infor-mation to the Agency. The application form furtherrequires the applicant's signature below the followingwarning:

I know that anyone who makes or causes to be madea false statement or representation of material fact inan application or for use in determining a right to

payment under the Social Security Act commits acrime punishable under Federal law by fine, im-prisonment or both. I affirm that all information Ihave given in this document is true.

B. Unum's Practices

Unum's LTD polices typically provide partial income

replacement to insureds who are unable to perform thematerial and substantial duties of their own occupa-tion.

Evidence was introduced at trial that most of Unum'sLTD group policies had a 180-day elimination period,before which an insured was not eligible for Unum'sLTD benefits. At the end of that 180-day period,Unum assessed whether a claimant was eligible toreceive benefits under the claimant's LTD insurancepolicy. Unum made that assessment using an ownoccupation standard for eligibility, asking whetherthe claimant was able to perform [the] occupationthat [he was] doing at the date that [he] first had [his]disability.

After the expiration of the own occupation periodunder the policy (typically two years), a claimantneeded to show that he was incapable of performingany occupation in order to continue to receive ben-efits. To assess whether a claimant was disabled underits any occupation standard, Unum would ask whether, based on the claimant's training, education,and experience, and given his restrictions and limita-tions, the claimant was capable of working in an oc-cupation that could pay him sixty percent or more of his predisability earnings. SSA's evaluation of whether an applicant is capable of performing sub-stantial gainful activity is similar, and, in fact, wasreferred to as the Social Security Administration's

any occupation eligibility requirement at trial;however, Unum's any occupation analysis is lessrigorous than the SSA's any occupation analysis.When the SSA evaluates whether an applicant is ca-pable of performing substantial gainful activity, itdoes not limit the sphere of jobs which the applicant iscapable of doing based on the applicant's predisabilityearnings.

The Unum policies at issue here provide that Unumcould reduce the amount it paid to an insured by,among other things, the amount the insured receivedor was entitled to receive as disability payments under

the SSA. Under the language of Unum's insurancecontract, an insured need not have actually received(or even applied for) an SSDI award in order forUnum to deduct the estimated amount of the award.Evidence at trial suggested that Unum had a generalpractice of requiring claimants seeking LTD benefitsto file an application for SSDI as soon as they hadbeen disabled for six months .FN5 At that point, Unum


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would send claimants a Payment Option Form,which explained that the claimant should apply forSSDI, and while his application was pending, he couldchoose to (1) have approximately 50% of his Unum

LTD insurance benefits withheld as an offset againstthe award Unum estimated he was entitled to receivefrom the SSA; or (2) receive full benefits with theunderstanding that if he were awarded SSDI retroac-tively, he would owe an overpayment to Unum. If aclaimant decided not to apply for SSDI, Unum could,and did, exercise its power to immediately reduce theclaimant's benefits by the amount of the SSDI awardUnum estimated he was entitled to receive.

Though Unum was familiar with the difference be-tween its own own occupation standard and theSSA's more rigorous any occupation standard,

Unum made no efforts to determine whether a clai-mant met the SSA's any occupation standard of eligibility before telling the individual that his benefitswould be cut if he did not apply for SSDI.

1. George

George was a heavy equipment operator who wasfifty-three at the time he applied for long-term disa-bility benefits. For years, George had been legallyblind in his left eye due to a detached retina from anold football injury. He filed his claim with Unum afterhe suffered a stroke in April 2004. The stroke had

caused blurred vision in the lower right quadrant of hisright eye.

George's claim file contained an assessment from hisphysician that George was unable to work aroundmachinery, and, more generally, that because he wasunable to see clearly, he was unable to perform anyduties. However, Unum also knew that even with hisimpairment, George walked ten to twenty miles daily.Additionally, Unum had information that George hadgraduated from high school and gone on to attendcollege for a little over two years, yet the claimshandler who processed George's claim, Thomas Bra-

sel, had not determined whether the blurred vision inGeorge's right eye impaired his ability to read.

Brasel approved George's claim on August 23, 2004,under Unum's own occupation standard, on thetheory that with [George's] vision issues and the factthat he had to work heavy machinery, those twoweren't compatible. Brasel made no assessment at

that time of George's ability to do other occupations.

Initially, George advised Unum that he had alreadyapplied for SSDI; however, when Brasel ultimatelylearned that George had not applied, he told Georgethat he had to do so. Brasel testified that he believed, atthe time, that George was eligible for SSDI bene-fits .FN6 George filed for SSDI on October 21, 2004.SSA denied George's application on January 11, 2005,on the ground that he had a capacity for substantialgainful activity.

2. Jennine

Jennine was a 38-year-old pediatric nurse who de-veloped left (non-dominant) arm, neck, and back painafter a car accident with an 18-wheeler on May 10,1999. Jennine had unsuccessful carpal tunnel surgerythree months later. Jennine was then scheduled to havesurgery on her shoulder on September 22, 1999. InAugust prior to the surgery, Jennine's physician re-ported to Unum that the prognosis for her recoveryafter the surgery was good and that her condition wasexpected to improve in three to four months.

On September 30, 1999, a week after Jennine's sur-gery, Unum received a document from Jennine de-scribing her symptomology. Jennine indicated that shewas having difficulty with the full function of her leftarm and stated that she was unable to work because of what she described as severe pain. Nonetheless, thatsame day, the Unum claims handler noted that Jenninemay improve with additional treatment and thatJennine has work capacity now. The claims handlerrequested a vocational review, and Unum's vocationalspecialist added this notation to Jennine's file, alsodated September 30, 1999:

Please consider a rehab referral when appropriate asthis young individual would have non-patient carealternatives once she recovers from shoulder sur-gery scheduled for September 22nd and possiblyeven light patient care alternatives depending on theextent of her recovery.

Also on that day, Unum approved Jennine's insuranceclaim and sent her a Payment Option Form, instructingher to file for SSDI or face a reduction in her benefits.

Jennine was familiar with SSDI eligibility require-
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ments because of her background as a nurse, and shetold Unum that she did not qualify for SSDI benefits.She further informed Unum of her intention to returnto work.

Nonetheless, Jennine applied for SSDI on October 20,1999. When the clerk at the Social Security officeasked her why she was applying (because it did notlook like [Jennine was] qualified), Jennine told herthat her disability insurance company required [her]to apply.

Jennine returned to work as a pediatric nurse coordi-nator in April 2000. After Jennine informed the SSAof her return to work, the Agency denied her applica-tion for SSDI.

III. Analysis

[1] The FCA covers all fraudulent attempts to causethe government to pay out sums of money. United States ex rel. Conner v. Salina Regional Health Cen-ter, Inc., 543 F.3d 1211, 1217 (10th Cir.2008) . Whilethe government can bring an action under the FCA, 31U.S.C. 3730(a) , the Act also provides for a privateindividual to file suit on a qui tam basis in the nameof the Government. 31 U.S.C. 3730(b)(1) ; see alsoUnited States ex rel. Lissack v. Sakura Global Capital

Markets, Inc., 377 F.3d 145, 152 (2d Cir.2004) .

At trial, the jury considered whether Unum violatedtwo provisions of the FCA, those which impose lia-bility on:

[a]ny person who-

(1) knowingly presents, or causes to be presented, toan officer or employee of the United States Gov-ernment ... a false or fraudulent claim for paymentor approval; [or]

(2) knowingly makes, uses, or causes to be made or

used, a false record or statement to get a false orfraudulent claim paid or approved by the Govern-ment....

31 U.S.C. 3729(a)(1) -(2) (2008) .FN7 The jury wasinstructed that to establish a violation of the FCA,Relator had to prove that a false or fraudulent claimwas submitted to the United States, that Unum had the

requisite scienter, and that Unum caused the submis-sion of the claim. The district court further instructedthat the Relator must prove that the allegedly falsestatement contained within the claim (that the appli-

cant was unable to work or disabled) was materialto the SSA's decision whether to pay or approve theclaim.

A. Materiality

1. Materiality Requirement

[2] We have long held that the FCA is subject to a judicially-imposed requirement that the allegedlyfalse claim or statement be material. See United Statesv. Data Translation, Inc., 984 F.2d 1256, 1267 (1stCir.1992) (citing Turner v. Johnson & Johnson, 809F.2d 90, 95 (1st Cir.1986) , for the proposition thatmateriality is established as an element of commonlaw fraud). Recently, the Supreme Court found that amateriality requirement applies in the context of sec-tions 3729(a)(2) and (a)(3) . See Allison Engine Co.,

Inc., 128 S.Ct. at 2126, 2130. Though the Court didnot consider the application of a materiality require-ment to subsection (a)(1), we see no reason why Al-lison Engine should disturb our previous reading of amateriality requirement into the statute more gener-ally.FN8 See 1 John T. Boese, Civil False Claims andQui Tam Actions 2.04, 2-171-72 (3d ed. 2006 &Supp.2010).

As the Supreme Court has held, [i]n general, a falsestatement is material if it has a natural tendency toinfluence, or [is] capable of influencing, the decisionof the decisionmaking body to which it was ad-dressed. Neder v. United States, 527 U.S. 1, 16, 119S.Ct. 1827, 144 L.Ed.2d 35 (1999) (quoting United States v. Gaudin, 515 U.S. 506, 509, 115 S.Ct. 2310,132 L.Ed.2d 444 (1995) ). Many of our sister circuitshave employed that definition in the FCA context, see,e.g., United States ex rel. Longhi v. United States, 575F.3d 458, 468-70 (5th Cir.2009) ; United States ex rel.Sanders v. North American Bus Indus., Inc., 546 F.3d

288, 297 (4th Cir.2008) (citations omitted); United States v. Bourseau, 531 F.3d 1159, 1171 (9thCir.2008) , and it is the definition Congress recentlyadopted when it amended the FCA. See 31 U.S.C. 3729(b)(4) (the term material means having a nat-ural tendency to influence, or be capable of influen-cing, the payment or receipt of money or property.).It is also the standard that the district court employed
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613 F.3d 300 (Cite as: 613 F.3d 300)


in instructing the jury, and both parties agree thatstandard was the correct one. Accordingly, we willfind that the statement reporting the date that the ap-plicant was unable to work was material if it had a

natural tendency to influence or was capable of in-fluencing the SSA's decision whether or not to awardSSDI benefits.

2. Standard of Review

[3][4] We review the denial of a motion for judgmentas a matter of law, including legal decisions madetherein, de novo. Burke v. McDonald, 572 F.3d 51, 57(1st Cir.2009) (citations omitted). As for matters of fact, we view the evidence in the light most favorableto the verdict, asking only whether a rational jurycould on the basis of that evidence find as the juryhas. Id. (citation omitted). [A] jury's verdict andfactual findings must be upheld unless the facts andinferences viewed in the light most favorable to theverdict point so strongly and overwhelmingly in favorof the movant that a reasonable jury could not havereturned the verdict. Mass. Eye and Ear Infirmary v.QLT Phototherapeutics, Inc., 552 F.3d 47, 57 (1stCir.2009) (citations omitted).

Unum contends that our review on the issue of mate-riality should fall squarely on the non-deferential sideof the review continuum, arguing that materialityhere involves alleged misrepresentations to public

officers and parsing of the SSA regulatory frame-work, and is thus a law-dominated question. In sup-port of this argument, Unum cites United States ex rel.

Berge v. Board of Trustees of the University of Ala-bama, 104 F.3d 1453 (4th Cir.1997) , in which theFourth Circuit held that the determination of mate-riality in the FCA context, although partaking thecharacter of a mixed question of fact and law, is onefor the court. FN9 Id. at 1460.

[5] As the Supreme Court has stated, the issue of materiality is a mixed question of law and fact, in-volving as it does the application of a legal standard to

a particular set of facts. TSC Indus., Inc. v. Northway, Inc., 426 U.S. 438, 450, 96 S.Ct. 2126, 48 L.Ed.2d 757(1976) ; see also In re Stone & Webster, Inc., Sec.

Litig., 414 F.3d 187, 209 (1st Cir.2005) (stating, in thesecurities fraud context, that the materiality of a falsestatement is a question for the jury) .FN10 As in thesecurities fraud arena, materiality in the FCA contextinvolves a factual determination of the weight that the

decisionmaker would have given particular informa-tion. See United States v. Job Resources for the Dis-abled, No. 97 C 3904, 2000 WL 1222205, at *3(N.D.Ill. Aug. 24, 2000) . While a district court may

determine at the summary judgment stage that un-disputed evidence demonstrates that a false statementor claim is material (or immaterial) as a matter of law,that is not the posture in which this case is presented.

When Unum moved for judgment as a matter of law, itargued that the statements at issue could not be viewedas material to the SSA's decision whether to awardbenefits because (1) the claimants had disclosed fullyand fairly the underlying facts upon which the state-ment[s] [were] made; and (2) [t]hat decision is madeby the SSA alone, after a full review of all of theavailable medical records. The district court heard

those arguments and rejected them, finding a legallysufficient evidentiary basis on which a reasonable jurycould find against Unum .FN11

We will uphold the jury's verdict unless the facts andinferences viewed in the light most favorable to theverdict point so strongly and overwhelmingly in favorof [Unum] that a reasonable jury could not have re-turned the verdict.' Mass. Eye and Ear Infirmary, 552 F.3d at 57 .

Regardless, whether we employ de novo review on theissue of materiality or a standard more deferential to

the jury's verdict, we find that on the evidence beforethe jury, the statements at issue here were material tothe SSA's payment decision.

3. Evidence of Materialit yFN12

The case was submitted to the jury on the theory thatthe false statements alleged by Relator were thestatements in the application for SSDI that the appli-cant was unable to work or is disabled. FN13

Unum argues that the statements at issue cannot bematerial because the SSA conducts an independentreview of medical and other evidence to determine theactual date that the applicant became unable to work within the meaning of the Social Security Act .FN14 Thedate reported by the applicant, Unum argues, serves asonly a starting point for this independent review, andthus cannot be material evidence of disability.Unum argues that the statement that an applicant isunable to work as of a particular date is a legal con-
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