Friedman v. AARP, Inc.
Friedman v. AARP, Inc.
Opinion of the Court
*876Presently before the court is Defendants' Motion to Dismiss. Having considered the parties' submissions, the court adopts the following Order.
I. BACKGROUND
Plaintiff Jerald Friedman ("Friedman") brings this putative class action against defendants AARP, Inc., AARP Services Inc., AARP Insurance Plan, UnitedHealth Group, Inc., and United Healthcare Insurance Company (collectively, "Defendants"). (Complaint, ¶¶ 22-30.) The court has already set forth the basic facts of the case in its prior Order, (Dkt. No. 50), which it repeats here in relevant part:
In 2011, Friedman purchased a type of health insurance policy, known as a "Medigap" policy, which is designed to offer extra coverage to Medicare beneficiaries beyond the basic Medicare benefits, including coverage of copays and deductibles that would otherwise be the patient's responsibility. (Id. ¶ 35.) Friedman purchased a Medigap policy that was endorsed by AARP, with UnitedHealth as the insurer. (Id. ¶¶ 22, 37.) All UnitedHealth Medigap policies are endorsed by AARP. (Id. ¶ 37.) For every AARP/UnitedHealth Medigap policy sold, AARP receives a payment of 4.95% of the amount paid by the insured individual. (Id. ¶ 11.)
On behalf of a putative class, Friedman alleges that AARP improperly acts as an unlicensed insurance agent in actively soliciting insurance purchases for Medigap policies on behalf of UnitedHealth. (Id. ¶¶ 11, 52, 55-57, 71-75.) AARP is not a licensed insurance agent in California. (Id. ¶ 11.) Friedman alleges, however, that the 4.95% payment that AARP receives on every AARP/UnitedHealth Medigap policy is an unlawful insurance commission, paid to AARP for its role in "selling" the Medigap policies. (Id. ¶ 51.) Though Defendants' agreements cast this payment as a royalty, paid in exchange for UnitedHealth's use of AARP's intellectual property in marketing and selling its Medigap coverage, Friedman alleges that this characterization of the 4.95% payment is false. (Id. ) Friedman alleges that "while Defendants disclose the existence of a payment in general to AARP which they term a 'royalty' paid for the use of AARP's intellectual property, Defendants hide the fact that the cost of AARP Medigap insurance includes a percentage-based commission to AARP that is funded by consumers, in addition to the insurance premium paid to UnitedHealth for coverage." (Id. ¶ 66.)
As a result, Friedman contends that he paid more for his Medigap policy than he would have paid if he had known that 4.95% went to an illegal commission. (Id. ¶¶ 14, 15, 19, 22.) Friedman further alleges that other insurance companies offer comparable plans at lower cost because the premiums for those plans do not include an unlawful 4.95% commission. (Id. ¶ 16.) He contends that this arrangement violates various provisions of the California Insurance Code, and therefore that he has a basis to bring a Unfair Competition Law claim under California Business & Professions Code § 17200 et seq.
*877On the basis of these allegations, Friedman filed a putative class action, asserting claims under the UCL as well as for money had and received and conversion. (See Compl.) Subsequently, Defendants filed a Motion to Dismiss under Rule 12(b)(6). (Dkt. 27.) This court granted the Motion, and dismissed the Complaint with prejudice. (Dkt. 50.) Friedman appealed the dismissal to the Ninth Circuit. (Dkt. 51.) The Ninth Circuit reversed the court's order dismissing the Complaint, and remanded the case to this court so that it could address Defendants' remaining arguments in its Motion to Dismiss regarding the application of the filed-rate doctrine to Friedman's claims. (Dkt. 54.)
II. LEGAL STANDARD
A complaint will survive a motion to dismiss when it contains "sufficient factual matter, accepted as true, to state a claim to relief that is plausible on its face." Ashcroft v. Iqbal ,
"When there are well-pleaded factual allegations, a court should assume their veracity and then determine whether they plausibly give rise to an entitlement of relief."
III. DISCUSSION
The threshold issue before the court on remand is whether Friedman's claims are barred by a California filed-rate doctrine. Under this doctrine, "rates duly adopted by a regulatory agency are not subject to collateral attack in court." MacKay v. Superior Court ,
A. Whether Friedman's Claims Are Barred by a State Filed-Rate Doctrine
As the court noted in its previous order, "there is currently a split of authority on the issue of whether there exists a general state filed rate doctrine in California." (Dkt. 50 at 4 n.2). Defendants argue that a state filed-rate doctrine bars Friedman's claims because he challenges insurance rates approved by a state agency, the California Department of Insurance (DOI). Defendants' key authority in support of a filed-rate doctrine for state insurance rates comes from *878MacKay v. Superior Court ,
Having found that Section 1860.1 precluded the plaintiff's claims, the MacKay court went on to reason that its holding was consistent with the operation of a state filed-rate doctrine.
Here, even assuming arguendo that a state filed-rate doctrine exists in the insurance context, it does not bar Friedman's claims because these claims are more akin to challenges to Defendants' alleged misrepresentations, rather than challenges to the approved rate, or challenges to whether the rate is reasonable in light of the statutorily prescribed loss ratios for Medigap insurance.
Defendants counter that the DOI was aware of the alleged commission payments to the AARP as part of its review of the Medigap rates. (Defs.' Supp. Br. at 12). Even if that were so, it does not mean that DOI ratified the existence or amount of the AARP payments. Pursuant to state regulations, DOI approves the overall Medigap rate in accordance with statutorily prescribed loss ratios. See 42 U.S.C. § 1395ss(r) ;
Nor would a similar doctrine, the primary jurisdiction doctrine, serve to bar Friedman's claims. Primary jurisdiction arises when "enforcement of the claim requires the resolution of issues which, under a regulatory scheme, have been placed within the special competence of an administrative body." Farmers Ins. Exchange v. Superior Ct. ,
B. Whether Friedman Has Standing
In addition to the filed-rate issue, Defendants raise several corollary issues tied to Friedman's standing to bring the present action. Under the UCL, a plaintiff must have "suffered injury in fact and ... lost money or property" as a result of the alleged violations. See Kwikset Corp. v. Sup. Ct.,
Yet Friedman's theory of economic injury is not limited to the rate charged for *880Defendants' services. According to the Complaint, "similar Medigap policies offered without the 'AARP brand' offer identical benefits often at a lower cost in part because those insurers do not secretly charge unlawful insurance agent commissions to consumers." (Compl. ¶¶ 16, 77). Put differently, "Medigap policies across carriers contain identical terms set by the federal government, [so] the only real differentiating factor between Medigap policies with different carriers is the price." (Pl.'s Opp. Br. at 23, Dkt. 38). Friedman reasons that, had the fee to AARP been disclosed, he would have sought out another Medigap policy offering the same benefits for a lower cost. (See Compl. ¶¶ 19, 80.) See also Ninth Circuit Oral Argument, Friedman v. AARP , at 14:00 (Oct. 19, 2016), https://www.ca9.uscourts.gov/media/view_video.php?pk_vid=0000010378.
At this early stage of the litigation, the court finds Friedman's allegations are sufficient to state an injury arising from Defendants' actions. Defendants' cases involving the payment of fees to unlicensed insurance agents do not disturb this conclusion. See Medina v. Safe-Guard Prods. ,
On the other hand, Friedman no longer holds a Medigap policy with Defendants.
C. Defendants' Additional Challenges
Defendants raise two additional challenges in their Motion to Dismiss. First, Defendants challenge whether Friedman's request for disgorgement is permitted under the UCL. The UCL generally limits relief to injunctions and restitution. Korea Supply Co. v. Lockheed Martin Corp. ,
Finally, Defendants argue that the Complaint does not adequately differentiate between the actions of Defendant United Health Group ("UHG") and its "operating division and corporate subsidiary" Defendant United Healthcare Insurance Company ("UHC"). At this juncture in the litigation, the court finds that Friedman has set forth a basis for the inclusion of the parent company UHG, and that the Complaint's allegations adequately provide UHG with notice of the claims brought against it. Therefore, the court denies Defendants' motion to dismiss UHG as a defendant in this action.
IV. CONCLUSION
For the reasons stated above, Defendants' Motion to Dismiss is DENIED in part and GRANTED in part. The court hereby DISMISSES Plaintiff's request for injunctive relief and disgorgement, (Compl. ¶¶ 115, 116.A, 116.C.), with prejudice.
IT IS SO ORDERED.
Plaintiff also includes class allegations that go to the Rule 23 requirements for class actions. None of those allegations is disputed in the Motion, and therefore those facts are not included here.
In Loeffler , the California Supreme Court referenced MacKay as an example of when "an action may not lie under the UCL because another statutory scheme [i.e. Section 1860.1 ] provides the exclusive means for resolving disputes. Loeffler v. Target Corp. ,
Conversely, some courts have concluded that no state filed-rate doctrine may exist. In Fogel v. Farmers Group, Inc .,
See
"In ruling on a 12(b)(1) jurisdictional challenge, a court may look beyond the complaint and consider extrinsic evidence." Warren v. Fox Family Worldwide, Inc. ,
Reference
- Full Case Name
- Jerald FRIEDMAN, Individually and on Behalf of All Others Similarly Situated v. AARP, INC., AARP Services, Inc., AARP Insurance Plan, UnitedHealth Group, Inc., and United Healthcare Insurance Company
- Cited By
- 2 cases
- Status
- Published