Jerald Friedman v. Aarp, Inc.

855 F.3d 1047, 2017 WL 1657553, 2017 U.S. App. LEXIS 7845
CourtCourt of Appeals for the Ninth Circuit
DecidedMay 3, 2017
Docket14-56765
StatusPublished
Cited by65 cases

This text of 855 F.3d 1047 (Jerald Friedman v. Aarp, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Ninth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Jerald Friedman v. Aarp, Inc., 855 F.3d 1047, 2017 WL 1657553, 2017 U.S. App. LEXIS 7845 (9th Cir. 2017).

Opinion

OPINION

PARKER, Circuit Judge:

Plaintiff Jerald Friedman, a Medicare beneficiary, purchased private supplemental health insurance through a group Me-digap policy held by Defendant AARP Insurance Plan (“AARP”), and underwritten and sold by Defendant UnitedHealth Care Insurance Company (“UnitedHealth”). Medigap policies offer supplemental private health insurance to cover costs not covered by Medicare. Friedman filed this putative class action alleging, in essence, that AARP, through its arrangement with Medigap, transacts insurance without a license in violation of the California Insurance Code. Friedman sought relief pursuant to California’s Unfair Competition Law and the common law. The district court granted Defendants’ motion under Rule 12(b)(6) and dismissed the complaint with prejudice. We reverse.

I

AARP, a not-for-profit corporation formerly known as the American Association of Retired Persons, is a dominant figure in the market for Medigap health insurance. See Vencor Inc. v. Nat’l States Ins. Co., 303 F.3d 1024, 1026 (9th Cir. 2002) (describing Medigap health insurance). 1 Approximately one-third of all Medigap policyholders nationwide are enrolled in AARP’s program, more than three times AARP’s closest competitor. AARP does not itself provide insurance coverage, nor is it licensed to do so. Rather, it is the group policyholder for Medigap coverage underwritten and sold by UnitedHealth, the country’s largest health insurer. In 2011, Friedman purchased UnitedHealth Medigap coverage through AARP’s group policy.

AARP and UnitedHealth’s Medigap arrangement is governed by a 1997 joint venture agreement (the “AARP-United Agreement” or the “Agreement”). The Agreement requires that individuals wishing to purchase Medigap coverage from UnitedHealth do so through AARP’s group policy. The Agreement also requires that AARP administer key aspects of the program, which involves two principal tasks.

First, AARP solicits its members’ enrollment in the Medigap program. An agreement between AARP and its subsidiary trust, Defendant AARP Insurance Plan (the “AARP Trust”) contractually obligates AARP to “solicit member participation in the [Medigap] Plan by direct mail and otherwise.” ER 299. 2 AARP discharges this duty through television com *1050 mercials, its website, and other forms of advertisements. For example, a website owned by Defendant AARP Services, Inc., a for-profit, wholly-owned subsidiary of AARP, explained why AARP members should- “get an AARP Medicare Supplement Plan.” ER 276. It emphasized that: (i) AARP Medicare Supplement Plans are the “only Medicare Supplement plans endorsed by AARP”; (ii) the plans are “[i]n-sured by UnitedHealthcare Insurance Company, the insurer serving the most Medicare supplement enrollees nation wide”; and (iii) there is a “94% Customer Satisfaction Rate of those surveyed.” ER 276. Many of the marketing materials owned and controlled by AARP state in bold font: “This is a solicitation of insurance.” See, e.cg., ER 270, 272, 276, 278.

Second, AARP collects insurance premiums from members through the AARP Trust and remits the appropriate payment to UnitedHealth. The AARP-United Agreement also allows AARP to invest the collected payments prior to remittance to UnitedHealth. Significantly, AARP deducts and retains 4.95% of each dollar paid by UnitedHealth Medigap enrollees prior to remitting the premiums to United-Health. Whether this deduction was plausibly alleged to be an insurance commission is a key issue on this appeal.

The initial version of the AARP-United Agreement referred to this retained amount as an “allowance.” ER 99. However, following settlement of a dispute with the Internal Revenue Service, AARP and UnitedHealth amended their agreement to provide that the “allowance” would be referred to as a “royalty.” Compl. ¶ 46, ER 20. Defendants assert that the 4.95% retention is a permissible royalty payment made by UnitedHealth in exchange for its use of AARP’s intellectual property (ie., its logo) in connection with the Medigap program. The complaint, however, characterizes this arrangement quite differently:

[I]n exchange for AARP’s administering of the insurance program and the marketing, soliciting, and selling or renewing AARP Medigap policies on behalf of UnitedHealth, as well as its collecting and remitting insurance premiums on behalf of UnitedHealth, AARP earns a 4.95% commission, disguised as a “royalty,” on each policy sold or renewed.

Compl. ¶ 51, ER 22. In short, Friedman alleges that the 4.95% retained by AARP is a commission on the sale of insurance that is charged over and above the actual monthly premium that UnitedHealth charges for Medigap coverage which AARP is not entitled to collect because it is not licensed to transact insurance in California. See Cal. Ins. Code § 1631 (providing that persons subject to the California Insurance Code “shall not solicit, negotiate, or effect contracts of insurance” without a license).

Friedman is not the first to question AARP’s retention of its fee pursuant to the AARP-United Agreement. At some point, according to allegations in the complaint, regulators began to question AARP’s tax-exempt status in light of the substantial income AARP was earning through this arrangement. In 2011, the House Committee on Ways and Means reviewed the circumstances surrounding AARP’s retention of the 4.95% fee. Although Defendants argue here that this fee is taken out of the insureds’ premium payments, Br. of Appel-lee 7, 32, AARP’s CEO testified to the Committee that the “royalties have nothing to do with the premiums of beneficiaries,” and that “[n]one of the money is taken out of any of the premiums,” Compl. ¶ 63, ER 28-29 (internal quotation marks omitted). Friedman alleges that AARP has concealed the fact that the 4.95% supposed “royalty” was an insurance commission collected in addition to the actual premium charged by UnitedHealth, and was an amount he otherwise would not have paid.

*1051 Friedman filed a putative class action alleging violations of California’s Unfair Competition Law, Cal. Bus. & Prof. Code §§ 17200-17210; money had and received; and conversion. The gravamen of his complaint is that by soliciting insurance and accepting an insurance commission, AARP unlawfully transacts insurance without a license in violation of the California Insurance Code. This conduct, according to Friedman, constitutes an unfair business practice under California law that has caused harm to him and the purported class.

Defendants moved to dismiss pursuant to Rule 12(b)(6). The district court granted the motion and dismissed the complaint with prejudice. The court concluded that “Plaintiff has not plausibly alleged that AARP acted improperly as an ‘unlicensed insurance agent’ who was paid a ‘commission’ for the ‘sale’ of insurance.” ER 5-6. Rather, it concluded that AARP’s actions “are entirely consistent with [a] permissible arrangement.” ER 6.

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855 F.3d 1047, 2017 WL 1657553, 2017 U.S. App. LEXIS 7845, Counsel Stack Legal Research, https://law.counselstack.com/opinion/jerald-friedman-v-aarp-inc-ca9-2017.