Baltimore County MD v. Cigna Healthcare

238 F. App'x 914
CourtCourt of Appeals for the Fourth Circuit
DecidedJune 5, 2007
Docket06-1877
StatusUnpublished
Cited by31 cases

This text of 238 F. App'x 914 (Baltimore County MD v. Cigna Healthcare) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fourth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Baltimore County MD v. Cigna Healthcare, 238 F. App'x 914 (4th Cir. 2007).

Opinions

KING, Circuit Judge:

Plaintiff Baltimore County, Maryland, (“Baltimore County” or the “County”) appeals from the district court’s Memorandum and Order denying its motion to remand this lawsuit to state court and denying its motion to file a Second Amended Complaint. See Baltimore [916]*916County v. Cigna Corp., CCB-05-511 (D.Md. Aug. 3, 2005) (the “Opinion”). Baltimore County initially filed suit in Maryland state court, but Connecticut General Life Insurance Company (“Connecticut General”), one of the defendants, removed the proceeding to the District of Maryland. The district court then dismissed the non-diverse defendants, Art Johnson and Cigna Healthcare Mid-Atlantic, Inc. (“Cigna HMA”), from the action, relying on the doctrine of fraudulent joinder, and concluded that it possessed diversity jurisdiction. After discovery, the court awarded summary judgment to Connecticut General, the only remaining defendant. See Baltimore County v. Conn. Gen. Life Ins. Co., CCB-05-511 (D.Md. July 14, 2006).

Baltimore County contends that the court erred in its conclusion that it possessed jurisdiction, in its denial of the County’s motion to file a Second Amended Complaint, and in its award of summary judgment to Connecticut General. As explained below, we agree with the County that Connecticut General failed to establish that Johnson was fraudulently joined in this lawsuit. We therefore vacate the court’s summary judgment award, reverse its holding that it possessed jurisdiction, and remand to permit a further remand to the appropriate state court.

I.

A.

This civil action stems from a group life insurance policy (the “Policy”) issued by Connecticut General, a subsidiary of Cigna Corporation, covering Baltimore County’s employees.1 The Policy had been in effect since 1966 and was written by a predecessor of Connecticut General. Connecticut General acquired the Policy in 1991 and reissued it under its own name in 1993. The Policy requires Baltimore County to make monthly premium payments to Connecticut General in return for life insurance coverage for Baltimore County’s employees. A portion of these monthly payments was allocated by Connecticut General into two reserve funds: the Incurred But Not Reported Reserve (the “IBNR”), and the Premium Stabilization Reserve (the “PSR”). The IBNR was originally established by Connecticut General to pay claims incurred during a policy year but not reported until after the policy year ended. It was not subject to or created under the Policy, and there was no written agreement between the County and Connecticut General concerning how the balance in the IBNR would be distributed if the Policy was terminated.

The PSR was created pursuant to an amendment to the Policy in 1970. The PSR permitted the County to be credited with dividends if the premiums paid by the County during the Policy year exceeded the charges for benefit claims and other expenses. Although the PSR was held by Connecticut General, the County could use the PSR to make up for any shortfalls that occurred between premium payments and benefit claims. Pursuant to the Policy, any funds remaining in the PSR after termination of the Policy and a final settlement of the County’s account would be returned to the County. The Policy also provided that “[cjhanges may be made in the policy only by amendment signed by the Policyholder and by the Insurance Company acting through its President, Vice President, Secretary or Assistant Sec[917]*917retary. No agent may change or waive any terms of the policy.” J.A. 118.2

In July 1995, Robert Behler, a Baltimore County employee, became the administrator for several of the County’s insurance plans, including its group life insurance plan with Connecticut General. Behler testified that, sometime between 1995 and 1997, he agreed that Connecticut General could move a substantial sum of money from the PSR into the IBNR. Behler explained that Joe Mock, an employee of Connecticut General who served as Baltimore County’s account manager, asked him to approve the movement of these funds for tax purposes. Behler testified that Mock advised him that the transferred money would be treated as if it were still in the PSR. Thus, Behler believed that the money moved from the PSR to the IBNR, like any funds remaining in the PSR, would be returned to Baltimore County at the termination of the Policy. Unfortunately, this agreement on Connecticut General’s movement of money from the PSR into the IBNR was never reduced to writing.

Mock testified in his deposition that he does not remember making any such representations to Behler. Mock later explained that, for the Policy year ending August 31, 1995, Connecticut General began applying its own underwriting standards to calculate the amount of premiums paid that would go into the IBNR, instead of using those standards previously applied by Connecticut General’s predecessor. The financial statements indicate that during the 1993-1994 and the 1994-1995 Policy years, the IBNR increased from $150,000 to $409,000. After this increase in the IBNR, the funds in the IBNR continued to accumulate interest. Mock explained by deposition that the interest was used by Connecticut General to help offset the administrative expenses of managing Baltimore County’s account.

After Mock was transferred to another position within Cigna Corporation, Art Johnson, another employee of Connecticut General, became Baltimore County’s account manager. Behler testified that he explained and reiterated to Johnson his understanding with Mock concerning the money transferred by Connecticut General from the PSR to the IBNR. He stated that Johnson did not object to or correct this understanding in any way and thus acknowledged the arrangement. Johnson testified, however, that he did not recall any such conversation with Behler. While working with the County on the Policy, Johnson would also send financial reports to the County, indicating the sum of money in the IBNR and showing that those funds were accumulating interest. Behler explained that these documents reaffirmed his understanding that the funds in the IBNR would be returned to the County upon termination of the Policy because the IBNR was earning interest.

Baltimore County decided to terminate the Policy at the end of the 2001-2002 Policy year, with the Policy’s final date being August 31, 2002. As part of its final account settlement, Connecticut General concluded that the total benefit claims were $2,999,539 for the final Policy year, with administrative costs and profits of $171,635. Thus, Baltimore County owed $3,171,174 to Connecticut General. The County had paid premiums of only $2,065,987 for the final Policy year, leaving a deficit of $1,105,187.

Connecticut General applied this deficit against the sum of $723,385 then in the PSR, which resulted in a final deficit of $381,802. Baltimore County never paid Connecticut General this deficit balance. Connecticut General’s records also show [918]*918that it paid $328,844 in unreported claims for the final Policy year, reducing the balance in the IBNR from $540,087 to $211,243. This $211,243 balance in the IBNR serves as the basis for Baltimore County’s Complaint in this case, as the County contends that it is entitled to reimbursement of the IBNR funds from Connecticut General. To the contrary, Connecticut General asserts that it is entitled to keep the IBNR funds because it remains liable for any future unreported claims from the final Policy year.3

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Cite This Page — Counsel Stack

Bluebook (online)
238 F. App'x 914, Counsel Stack Legal Research, https://law.counselstack.com/opinion/baltimore-county-md-v-cigna-healthcare-ca4-2007.