Tolani v. Med. Mut. of Ohio

2025 Ohio 5624
CourtOhio Court of Appeals
DecidedDecember 18, 2025
Docket114356
StatusPublished

This text of 2025 Ohio 5624 (Tolani v. Med. Mut. of Ohio) 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
Tolani v. Med. Mut. of Ohio, 2025 Ohio 5624 (Ohio Ct. App. 2025).

Opinion

[Cite as Tolani v. Med. Mut. of Ohio, 2025-Ohio-5624.]

COURT OF APPEALS OF OHIO

EIGHTH APPELLATE DISTRICT COUNTY OF CUYAHOGA

AJIT TOLANI, ET AL., :

Plaintiffs-Appellants, : No. 114356 v. :

MEDICAL MUTUAL OF OHIO, :

Defendant-Appellee. :

JOURNAL ENTRY AND OPINION

JUDGMENT: REVERSED AND REMANDED RELEASED AND JOURNALIZED: December 18, 2025

Civil Appeal from the Cuyahoga County Court of Common Pleas Case No. CV-23-975686

Appearances:

The Lee Law Firm, LLC, and Brian C. Lee, for appellants.

Frantz Ward LLP, Christopher C. Koehler, and Gregory R. Farkas, for appellee.

LISA B. FORBES, J.:

Ajit Tolani (“Ajit”) and Shruti Tolani (collectively, “the Tolanis”)

appeal the journal entry that granted Medical Mutual of Ohio’s (“MMO”) motion for

summary judgment and dismissed with prejudice the Tolanis’ claims for breach of

contract and bad faith. Because we find genuine disputes of material fact exist, including but not limited to whether Ajit made an intentional misrepresentation of

material fact entitling MMO to rescind the Tolanis’ health-insurance policy (the

“Policy”), we reverse the trial court’s judgment and remand for further proceedings

consistent with this opinion.

I. Facts, Procedural History, and Pertinent Exhibits

A. Background

This case concerns MMO’s recission of the Tolanis’ health-insurance

coverage. The parties do not dispute the following facts.

In 2015, Ajit was diagnosed with a life-threatening lung condition. He

is an Indian citizen and lived in India when he was diagnosed. The Tolanis moved

to Cuyahoga County, entering the United States using a B-2 visa on December 23,

2016.

On January 30, 2017, Ajit was approved for a double-lung transplant,

which would be performed at the Cleveland Clinic. Ajit purchased from MMO the

Policy, effective February 1, 2017. He did so using the Affordable Care Act Exchange

(“ACA Marketplace” or “ACA Exchange”), which allows people to compare and

purchase health insurance from different providers. On February 9, 2017, the

Cleveland Clinic sought approval from MMO to perform a double-lung transplant

on Ajit. On March 2, 2017, MMO informed Ajit that it was rescinding his coverage.

B. Procedural History

The Tolanis filed a two-count complaint in the Cuyahoga County

Court of Common Pleas, claiming that (1) MMO breached its contract by rescinding coverage and failing to provide a 30-day notice of rescission, and (2) MMO

rescinded coverage without reasonable justification, thereby acting in bad faith.

C. MMO’s Motion for Summary Judgment

MMO moved for summary judgment on both claims made by the

Tolanis, arguing that it had been entitled to rescind Ajit’s coverage. MMO attached

to its motion numerous documents, the following of which are particularly relevant

to this appeal.

1. The Policy

Ajit’s Policy had an enrollment period of one year, effective February

1, 2017. The Policy’s “Eligibility Requirements” stated, “In order to be eligible for

this coverage, you must . . . maintain your primary legal residence in the Service Area

and live there for at least six (6) months of each year.” The definition of “Service

Area” included Cuyahoga County.

The Policy also addressed “Termination of Coverage,” stating, in part,

that “[y]our coverage stops . . . [i]mmediately upon notice if” the policyholder

“materially misrepresents information provided to Medical Mutual . . . .” The Policy

established that MMO could rescind coverage, meaning “coverage may be legally

voided all the way back to the day the plan began to provide you with coverage, just

as if you never had coverage under the plan.” Per the Policy, “coverage can only be

rescinded if you . . . make[] . . . an intentional misrepresentation of material fact, as

prohibited by the terms of your plan.” 2. Recission Letter

MMO also provided the court a letter, dated March 2, 2017, which

informed Ajit that MMO was rescinding his coverage (“Recission Letter” or the

“Letter”). The Letter stated that “[e]ligibility for a Marketplace plan is specifically

outlined in 45 C.F.R. § 155.305 ‘Eligibility Standards.’” According to the Letter,

under these standards, “[a]n individual must intend to be in the service area of the

plan for the entire period for which enrollment is sought” and “must intend to reside

in the service area.” MMO had determined that Ajit did “not meet the residency

requirement for a Marketplace plan” because his “only intent for being in the area is

to receive medical care” and he “plan[ned] to leave the United States as soon as . . .

care is complete, estimated to be within 2 to 9 months.”

The Letter then explained that, because of a “misrepresentation of

material facts submitted to the Marketplace at the time of enrollment,” MMO was

exercising its “right to rescind.” The Letter stated that recission meant to “cancel or

discontinue coverage back to the original effective date of [the] policy as if the

coverage never existed.” On March 31, 2017, “coverage [would] be terminated with

a retroactive date of February 1, 2017, the date of your enrollment.”

3. Social Worker’s Note

Of particular relevance to MMO’s decision to rescind coverage is a

note, dated January 11, 2017, which summarized a social worker’s psychosocial

evaluation of Ajit (“Social Worker’s Note” or “the Note”). This evaluation was part

of the Cleveland Clinic’s assessment of Ajit as a candidate for a lung transplant. The Social Worker’s Note included information about Ajit’s relocation to the country,

immigration status, and plans.

Per the Note, Ajit “came to US with his wife, their 9 yo daughter and

his sister and uncle are staying here for the next two months.” The Note also said

that Ajit was “prepared that he may have to be here for 9 months” and that he

demonstrated “commitment to transplant time frame they expected was 9 months

. . . .” As to Ajit’s “Resident Status,” the Note classified him as a “Non-U.S.

Citizen/Non-U.S. Resident, Traveled to U.S. for Transplant.” As to what Ajit

expected to do after treatment, the Note stated, “Any moves planned: no.”

4. B-2 Visa Extension Applications

Several documents provided by MMO show that, after entering the

United States, Ajit twice requested that United States Citizenship and Immigration

Services (“USCIS”) extend his B-2 visa. Ajit’s visa was originally set to expire on

June 22, 2017. The Tolanis submitted to USCIS an “Application to Extend / Change

Nonimmigrant Status,” dated June 12, 2017. Another extension request, dated

December 20, 2017, notes that USCIS granted the Tolanis’ first request until

December 22, 2017.

5. HHS Notice

MMO also provided the court a notice from the United States

Department of Health and Human Services (“HHS Notice”) that HHS appears to

have sent to Ajit on December 27, 2016. The HHS Notice purports to approve Ajit

to purchase health insurance using the ACA Exchange. The HHS Notice stated that Ajit was “[e]ligible to purchase health coverage through the Marketplace” and

provided “Next Steps,” including to “[c]hoose a health plan and make first month’s

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2025 Ohio 5624, Counsel Stack Legal Research, https://law.counselstack.com/opinion/tolani-v-med-mut-of-ohio-ohioctapp-2025.