As Sampson Ogunloye saw it, he was a newcomer to Washington with the dream of building a health insurance company.
But to several employes of foreign embassies, Ogunloye's company was the one that didn't pay their health insurance claims, causing some of them to receive dunning letters from their doctors.
Yesterday a D.C. administrative law judge ruled that Ogunloye operated an unlicensed health insurance company that sold policies to several Washington embassies, used a plagiarized Blue Cross policy in an unsuccessful attempt to solicit business and paid only 20 percent of its claims.
The judge, Sharon T. Nelson, ordered the now-defunct Washington Diplomat Insurance Company and its president, Ogunloye, to repay $5,313 plus interest to the Embassy of the State of Qatar and to give the city all the money it had collected since its creation in December 1981 that it had not paid out in claims.
The embassies have presented city officials with claims totaling $36,837 against Ogunloye's company. It is unclear how many of these claims might have been paid by the company. Some of the employes paid the bills themselves.
"This is a case I think is unjust," said Ogunloye, 36, of the 1600 block of Park Road NW. "I am licensed as a person to sell insurance in the District of Columbia and I intend to prove that in court." He would not comment when asked if he would appeal the decision.
The D.C. corporation counsel has also filed a criminal complaint in D.C. Superior Court charging Ogunloye with a series of violations arising from his operation of the unlicensed insurance company. A preliminary hearing in that case is scheduled for Monday.
In a January hearing before the administrative law judge, Ogunloye said his firm did not require a license because it qualified under a city exemption for nonprofit firms that deal solely with one organization. But city investigations found that Ogunloye was operating a profit-making company that solicited business from different organizations.
The civil action, which was brought by the D.C. Department of Consumer and Regulatory Affairs, found that the firm misrepresented itself as a "large, respectable established insurance company."
The city found that before 1981, Ogunloye had been licensed by three different insurance companies to sell policies as an individual salesman, but all withdrew their sponsorship because he did not sell enough insurance, according to the judge's order.
According to the city's investigation, in 1982 the Nigerian and Qatar embassies as well as the Bolivian Mission to the Organization of American States signed contracts with Ogunloye for health insurance for their employes. The Nigerian Embassy paid Ogunloye's firm a lump sum of $100,000 for a year of coverage.
Employes of these embassies later complained to the D.C. Department of Insurance that the firm refused to pay their claims.
According to the judge's order, the department also was contacted by a representative of BlueCross/Blue Shield. That representative said an official of another foreign mission told him that the Washington Diplomat company was soliciting insurance at the mission using material "plagiarized from Blue Cross, some of which still included Blue Cross/Blue Shield's name, according to the city's investigative report.
Ogunloye said it was only coincidence that his firm and Blue Cross offered the same coverage and that he did not adopt a Blue Cross policy as his own.
As a result of the city's investigation, the Department of Insurance ordered Ogunloye's firm in August 1983 to stop soliciting customers until it became licensed.
When the company applied to the D.C. Department of Consumer and Regulatory Affairs for a license, the accompanying documents said the firm had received premiums of $295,000 for 1982. But the judge noted that bank records showed that the firm had deposits of $336,456 for one month in 1982, "raising questions about the veracity of the income claimed" on the firm's financial statement.
City investigators found that the firm paid less than 20 percent of the claims that the embassy personnel submitted during that year.
Ogunloye said his firm has not done anything illegal and that the firm's bills exceeded its budget.
"You have to start somewhere," he said. "It is true that we had a dream that one day we would become an insurance company . . . .That's just the way John Hancock started. That's the way Mutual of Omaha started. They started small . . . . We didn't do this underground . . . . We did not defraud the public."