Ahmed v. CIGNA Health Management, Inc.

Background

The parties agreed that the Certificate of Coverage attached to the complaint is the authentic insurance contract between Ahmed and Wellfleet. The certificate contains a contractual lawsuit deadline. It states that no action may be maintained until 60 days after a written claim is submitted as required by the certificate, and that any lawsuit under the certificate must be started within three years from the date the claim was required to be filed.

The certificate defines “Us” as Atlanta International Insurance Company and anyone to whom it legally delegates performance on its behalf. The complaint alleges that Cigna was “a subcontractor of the policy administrator.”

Questions Identified by the Court

The court directed Ahmed and Cigna to address whether the contractual three-year term also applies to Ahmed’s unjust-enrichment claim against Cigna. The court specifically asked whether the unjust-enrichment claim is subject to that term because it is based on the same allegations as the breach-of-contract claim. The court also asked whether Ahmed may seek disgorgement on an unjust-enrichment claim, citing authority stating that plaintiffs may not recover defendants’ profits when doing so would compensate them beyond their losses.

Order

Judge Arun Subramanian ordered Ahmed and Cigna to submit letters of no more than three single-spaced pages by June 20, 2024, at 5:00 p.m. The opinion does not resolve whether the three-year term applies to the unjust-enrichment claim or whether disgorgement is available.