Sellers, Jr. v. Anthem, Inc.

CourtDistrict Court, District of Columbia
DecidedApril 19, 2022
DocketCivil Action No. 2016-2428
StatusPublished

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Bluebook
Sellers, Jr. v. Anthem, Inc., (D.D.C. 2022).

Opinion

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

JOSEPH SELLERS, JR., et al.,

Plaintiffs,

v. Civil Action No. 16-2428 (TJK)

ANTHEM LIFE INSURANCE COMPANY,

Defendant.

MEMORANDUM OPINION AND ORDER

This case is a cautionary tale about contract negotiations and a monument to Murphy’s

Law. Plaintiffs Joseph Sellers, Jr., and Richard McClees, the trustees of a disability-benefits

plan—the Plan, for short—sued Defendant Anthem Life Insurance Company. They alleged

(among other things) that Anthem either breached two January 2015 contracts by failing to pay

the Plan money owed or—if those contracts are not enforceable—unjustly enriched itself at the

Plan’s expense. Anthem argues that the contracts governing the parties’ dealings were not created

until over a year later in 2016, that under those contracts Anthem has paid the Plan all it is owed,

and that Plaintiffs’ claims fail even if those contracts are unenforceable. On these grounds, An-

them moves for summary judgment on both counts. Plaintiffs cross-move for partial summary

judgment on the enforceability of the 2016 contracts. And they oppose Anthem’s motion, arguing

that the Court cannot resolve on summary judgment whether the purported January 2015 contracts

are enforceable or whether their unjust-enrichment claim is viable.

In summary, the Court finds that there is no genuine dispute of material fact as to whether

the alleged January 2015 contracts are enforceable. They are not. But genuine disputes of material

fact prevent the Court from deciding whether the 2016 contracts are enforceable. For that reason, the Court cannot conclude that Plaintiffs’ unjust-enrichment claim fails as a matter of law. Thus,

for all the below reasons, the Court will grant in part and deny in part Anthem’s motion for sum-

mary judgment and deny Plaintiffs’ cross-motion for partial summary judgment.

I. Factual Background

At all times relevant here, Plaintiffs Joseph Sellers, Jr., and Richard McClees (“Plaintiffs”)

were residents of Virginia and the trustees of a benefits plan (“Plan”) sponsored by the Interna-

tional Association of Sheet Metal, Air, Rail and Transportation Workers (“Union”). ECF No. 54-

1 ¶¶ 1–2, 38, 40–41; ECF No. 67 ¶¶ 38, 40–41. In these roles, Plaintiffs worked out of the Union’s

Washington, D.C., headquarters. ECF No. 54-1 ¶¶ 39, 42–43; ECF No. 67 ¶¶ 39, 42–43. The Plan

provides disability benefits to Union members employed in the rail and bus industries and is reg-

ulated under the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 et seq.

ECF No. 54-1 ¶¶ 1–3, 37, 46; ECF No. 67 ¶¶ 37, 46. The Plan maintains two separate schedules

of disability benefits: one for rail-industry employees, the other for bus-industry employees. ECF

No. 54-1 ¶ 47; ECF No. 67 ¶ 47.

Anthem Life Insurance Company (“Anthem”), an Indiana corporation headquartered there,

began providing disability insurance to the Plan’s rail-industry members in 2010 and to the Plan’s

bus-industry members in 2012. ECF No. 14 ¶ 16; ECF No. 22 ¶ 17; ECF No. 54-1 ¶¶ 2–3. For

several years, Anthem provided coverage to both sets of members under a “non-participating ar-

rangement” with the Plan. ECF No. 54-1 ¶ 4. Under this non-participating arrangement, Anthem

assumed the entire insurance risk, meaning that if claims paid by Anthem exceeded premiums paid

to Anthem, Anthem would suffer the loss, but if premiums paid to Anthem exceeded claims paid

by Anthem, Anthem would reap the profit. Id. ¶¶ 4, 50; ECF No. 67 ¶ 50. Anthem reportedly

profited handsomely under this arrangement. ECF No. 54-1 ¶ 59; ECF No. 67 ¶ 59.

2 In late 2014, Plaintiffs and other representatives of the Plan began negotiating with Anthem

representatives over the terms of the parties’ arrangement for the 2015 calendar year. ECF No.

54-1 ¶ 5. Marc Rifkind, the Plan’s counsel based out of Washington, D.C., was the Plan’s primary

point of contact with Anthem, and Mike Slifka, an account manager for Anthem based out of Ohio,

was Anthem’s primary point of contact with the Plan. See, e.g., ECF No. 52-4 at 2–4.

Although the parties’ representatives at first discussed renewal under a non-participating

arrangement, in December 2014 they broached the possibility of transitioning to a “participating

arrangement” for the 2015 calendar year. ECF No. 52-1 at 23; ECF No. 54-1 ¶¶ 7–8, 59, 61; ECF

No. 67 ¶¶ 59, 61. Under this participating arrangement, Anthem would charge higher premiums,

but the parties would share the insurance risk and thus share any loss or profit. See ECF No. 52-1

at 23–24; ECF No. 54-1 ¶ 50; ECF No. 67 ¶ 50. The parties dispute what, exactly, they discussed

as to how any profit-sharing amounts would be calculated under this participating arrangement.

Compare ECF No. 51-2 ¶¶ 9–14, and ECF No. 67 ¶¶ 62–70, with ECF No. 54-1 ¶¶ 9–14, 62–70.

But meeting minutes of their negotiations at least reflect some high-level discussion about a “50/50

split” of “excess receipts.” See ECF No. 52-1 at 35.

On January 30, 2015, the Plan decided to agree to a participating arrangement for the 2015

calendar year. ECF No. 52-1 at 35–36. That same day, Rifkind emailed Slifka with a letter at-

tachment stating that the trustees “accept Anthem’s offer set forth” in a previously shared “Final

Product & Pricing Package” specifying the premiums to be paid and benefits to be provided under

a participating arrangement for the 2015 calendar year for each benefits schedule. See ECF No.

52-4 at 2, 6; ECF No. 52-5 at 2–7. That “Package” did not, however, contain any terms specifying

how the profit sharing between Anthem and the Plan would work. See ECF No. 52-5 at 5, 7. Thus,

3 Rifkind asked Slifka to prepare written agreements containing “the terms governing the Partici-

pating Contracts for Rail and Bus” for the Plan’s “review and approval.” ECF No. 52-5 at 4; see

also ECF No. 51-4 at 4–6. Rifkind also told Slifka of the trustees’ “understanding” about one term

they expected to be in those documents—that Anthem would pay the Plan quarterly the “50%

sharing.” ECF No. 52-5 at 3.

Slifka responded to Rifkind later that same day: “[o]n behalf of Anthem, thank you for this

wonderful news. We are excited that we will continue to serve” the Plan’s participants. ECF No.

53-6 at 2. And he said that the parties would need to meet soon to “start th[e] process” of imple-

menting the participating arrangement. Id. The Plan then began paying premiums at the partici-

pating-arrangement levels. ECF No. 54-1 ¶ 89; ECF No. 67 ¶ 89. And Anthem began “operating

in ways that would suggest” an agreement was in place, including by accepting participating-ar-

rangement-level premiums, paying participating-arrangement-level benefits, and reserving funds

to pay the Plan the profit-sharing amount owed “based on what [Anthem] knew about the final

structure of that agreement at that point in time.” ECF No. 54-4 at 14; ECF No. 54-14 at 3; see

also ECF No. 54-1 ¶¶ 89–90; ECF No. 67 ¶¶ 89–90.

In May 2015, Slifka finally forwarded to Rifkind two draft “Experience Rating Refund”

(“ERR”) Agreements containing the terms to govern the parties’ profit sharing under the partici-

pating arrangement. ECF No. 51-5 at 2–8. One draft governed the profit sharing for the rail-

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