Sammarco v. Anthem Insurance Companies, Inc.

723 N.E.2d 128, 131 Ohio App. 3d 544
CourtOhio Court of Appeals
DecidedNovember 20, 1998
DocketNo. C-971074.
StatusPublished
Cited by33 cases

This text of 723 N.E.2d 128 (Sammarco v. Anthem Insurance Companies, Inc.) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Sammarco v. Anthem Insurance Companies, Inc., 723 N.E.2d 128, 131 Ohio App. 3d 544 (Ohio Ct. App. 1998).

Opinion

Hildebrandt, Judge.

Plaintiffs-appellants appeal from the trial court’s judgment in which it dismissed all of their claims pursuant to Civ.R. 12(B)(6). We affirm that decision.

*549 I

BACKGROUND

The claims in this case arise out of the merger of several health insurance carriers and the subsequent termination of the plaintiffs as physicians in the provider panel of the one insurance company resulting from the merger. In 1995, Community Mutual Insurance Company merged with Associated Group Insurance Companies. In 1996, Associated Group Insurance Companies changed its name to Anthem Insurance Companies, Inc. Anthem Insurance formed Community Insurance Company and transferred substantially all of the assets it had acquired in the merger with Community Mutual to Community Insurance. Community Insurance operates under the business name Anthem Blue Cross & Blue Shield. 1

Each plaintiff contracted with Community Mutual to provide health care to patients in Community Mutual’s health-care plans. Community Mutual assigned these contracts to Anthem Insurance following the merger of those companies. However, before the merger of the companies was effected, Community Mutual terminated the contracts of all the plaintiffs, and Anthem has continued to exclude plaintiffs from the panel of providers for patients in its health-insurance system.

Plaintiffs brought suit against all the above-mentioned insurance companies, claiming that they had been terminated without cause from the companies’ provider panel and alleging causes of action based upon unjust enrichment, tortious interference with contract, breach of the implied covenant of good faith and fair dealing, wrongful discharge in violation of public policy, negligent misrepresentation, and fraud. The trial court granted the Civ.R 12(B)(6) motions of defendants, ruling that none of the causes of action alleged by plaintiffs stated a claim upon which relief could be granted.

To grant a Civ.R. 12(B)(6) motion, the court must analyze the complaint and conclude that the plaintiff can prove no set of facts entitling him to recovery. 2 All of the material allegations in the complaint are, for the purposes of this review, taken as true and all reasonable inferences made in favor of the plaintiff. 3 Appealing the trial court’s dismissal of their claims, plaintiffs in this case raise *550 five assignments of error, asserting, essentially, that their allegations, if proven, would entitle them to recovery on each of their claims. We review the trial court’s dismissal pursuant to Civ.R. 12(B)(6) de novo. 4

II

TERMINATION IN VIOLATION OF PUBLIC POLICY

First, plaintiffs claim that they have a valid cause of action for wrongful discharge in violation of public policy. The complaint alleges that the plaintiffs contracted "with Anthem 5 to provide medical care to persons insured by Anthem, that Anthem unilaterally and without any reason other than its own profit motive terminated their contracts, and that such termination violates the public policy of Ohio.

As plaintiffs argue, Ohio law permits an employee whose contract of employment is otherwise at will to sue for wrongful discharge in violation of public policy. 6 The Ohio Supreme Court in Greeley v. Miami Valley Maintenance Contrs., Inc. (1990), 49 Ohio St.3d 228, 551 N.E.2d 981, stated at paragraph two of the syllabus:

“Henceforth, the right of employers to terminate employment at will for ‘any cause’ no longer includes the discharge of an employee where the discharge is in violation of a statute and thereby contravenes public policy.”

Subsequent Ohio Supreme Court cases have fleshed out the elements of a public-policy claim and the recommended method of analysis of such a claim. 7

To date, the public-policy exception as defined in Greeley, Painter, Collins and Kulch has been applied in Ohio only in the traditional employer-employee context as a tort claim for wrongful discharge. Clearly, in this case, plaintiffs make no contention that they were employed by Anthem. The contracts between the parties stated that plaintiffs, as members of Anthem’s panel of medical providers, would be paid by Anthem for treatment rendered to certain patients (those whom *551 Anthem insured). These contracts were not the type of at-will employment contracts contemplated by the cases cited above.

However, plaintiffs claim that the termination of the contracts between them and Anthem violates public policy and should therefore not be permitted. Plaintiffs argue, “Because Ohio recognizes a public policy exception to termination at will in contracts of employment, this Court should similarly recognize a public policy exception to Anthem’s termination at will provision in its provider agreements with plaintiffs.”

Ohio courts have recognized some public-policy limitations on the enforcement of certain contracts. It is a generally accepted rule that contract terms that violate public policy are unenforceable. 8 . Also, restrictive covenants that purport to limit a physician’s ability to practice medicine in a geographic area are scrutinized more carefully than similar covenants restricting other types of employment. In this context, courts have recognized that the greater scrutiny is mandated by public-policy considerations, since limiting the ability of a physician to practice may affect the public’s ability to obtain medical care. 9

We hold that plaintiffs have failed to state a claim upon which relief can be granted. The at-will termination clause in the contract, unlike a noncompete clause, in no way prohibits a physician from treating certain patients and places no affirmative restrictions on the physician’s ability to practice where and in the manner he wants. The contracts between the parties here are ultimately contracts for payment for authorized treatment. Even though not on Anthem’s provider panel, the physician may still treat any patient who wants treatment, even those patients insured by Anthem — although the physician would have to require payment by the patient rather than the insurer. We find that the public policy discouraging restrictions on a physician’s ability to practice medicine are not implicated in this case.

Ohio law also restricts the right of some insurers to terminate the insurance coverage of an individual insured, 10

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723 N.E.2d 128, 131 Ohio App. 3d 544, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sammarco-v-anthem-insurance-companies-inc-ohioctapp-1998.