Continental Casualty Co. v. First Financial Employee Leasing, Inc.

716 F. Supp. 2d 1176, 2010 U.S. Dist. LEXIS 55642
CourtDistrict Court, M.D. Florida
DecidedJune 3, 2010
DocketCase 8:08-CV-2372-T-27GW
StatusPublished
Cited by12 cases

This text of 716 F. Supp. 2d 1176 (Continental Casualty Co. v. First Financial Employee Leasing, Inc.) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Continental Casualty Co. v. First Financial Employee Leasing, Inc., 716 F. Supp. 2d 1176, 2010 U.S. Dist. LEXIS 55642 (M.D. Fla. 2010).

Opinion

ORDER

JAMES D. WHITTEMORE, District Judge.

BEFORE THE COURT are: (1) Defendant First Financial Employee Leasing, Inc.’s Motion for Partial Summary Judgment (Dkt. 64), to which Plaintiffs have responded (Dkt. 82); (2) Plaintiffs’ Motion for Partial Summary Judgment (Dkt. 67) and separate Memorandum of Law (Dkt. 69), 1 to which Defendant has responded (Dkt. 80); (3) Defendant’s Motion to Strike Plaintiffs’ Response Memorandum (Dkt. 84), to which Plaintiffs have responded (Dkt. 91); (4) Plaintiffs’ Cross-Motion to Strike Defendant’s Opposition and Defendant’s Motion for Summary Judgment (Dkt. 91), to which Defendant has responded (Dkt. 94); and (5) Defendant’s Motion to Strike Affidavit of Cynthia Goral and to Exclude Testimony at Trial (Dkt. 96), to which Plaintiffs have responded (Dkt. 107).

Plaintiffs brought this action to recover amounts owing under two policies of workers’ compensation and employers liability insurance issued to Defendant. Defendant counterclaimed and asserted (a) a claim for breach of contract (Count I) alleging that one or more Plaintiffs breached their claims management and settlement obligations under one of the policies; (b) a second claim for breach of contract (Count II) alleging that Plaintiffs overcharged Defendant by failing to apply a premium credit in accordance with the policies and as mandated by Florida law; and (c) a claim for equitable accounting (Count III).

As to Count II, Defendant contends that (1) in determining the amount of premium owed by Defendant, Plaintiff was required by Florida law and the insurance policies to apply a premium credit provided by the Florida Contracting Classification Premium Adjustment Program (“FCCPAP”), as promulgated by the National Council on Compensation Insurance, Inc. (“NCCI”) and (2) after being instructed to do so by NCCI, Plaintiff did initially apply the FCCPAP credit in its premium audit statements and thereby “endorsed” the policies to include the credit. In response, Plaintiffs argue that applying the FCCPAP to reduce Defendant’s premium was neither required by the policies nor consistent with Plaintiffs’ filed and approved rating plan. Additionally, Plaintiffs argue that, as Count II challenges a premium rate calculation and *1179 seeks a premium rate adjustment, Defendant was required to exhaust its administrative remedies under Section 627.371, Florida Statutes, before suing on Count II. As set forth below, the Court agrees that Defendant was required to exhaust its administrative remedies but failed to do so. Accordingly, Plaintiffs’ Motion for Partial Summary Judgment is GRANTED and Defendant’s Motion for Partial Summary Judgment is DENIED.

Background

Plaintiffs American Casualty Co. of Reading, Pennsylvania (“American”) and Continental Casualty Co. (“Continental”) are insurance carriers. (Pretrial Statement, Dkt. 86 ¶ 9(c)). Plaintiff CNA ClaimPlus, Inc. is a claims administration company. 2 Although the nature of their affiliation is not entirely clear, Plaintiffs state that they all operate under the CNA Insurance Companies trademark and they refer to themselves collectively as CNA. Sather Aff. I, ¶ 2. Defendant First Financial Employee Leasing, Inc. (“FFEL”) is an employee leasing company. (Dkt. 86 ¶ 9(c)).

Plaintiff American issued to FFEL a policy of workers’ compensation and employers liability insurance for the effective dates of February 4, 2001 to February 4, 2002 (the “2001 Policy [Dkt. 64-1]”) and a renewal policy for the effective dates of February 4, 2002 to February 4, 2003, (the “2002 Policy [Dkt. 64-2]”). (Dkt. 86 ¶ 9(d)-(e)). At FFEL’s request, the 2002 Policy was terminated early, on December 31, 2002. Id. ¶ 9(e); Sather Aff. ¶ 3.

The Policies were issued as part of large deductible insurance programs (the “Programs”) whose terms and conditions were outlined in the Policies and in (1) a Deductible Reimbursement Agreement between Plaintiff Continental and FFEL effective February 4, 2001; (2) a Claim Service Agreement between FFEL and RSKCo Claims Services, Inc., Plaintiff CNA ClaimPlus, Inc.’s predecessor in interest, effective February 4, 2001; and (3) confirmation letters sent by CNA to FFEL. See Sather Aff. I ¶ 5 and Exs. B, C, D & E (Dkt. 82-1 at 35-55 and Dkt. 82-2 at 1^14); see also Dkt. 86, ¶ 9(f)-(g).

Under Florida law, as to workers’ compensation and employers liability insurance, every insurer must file with the Department of Financial Services (f/k/a the Department of Insurance) “every manual of classifications, rules, and rates, every rating plan, and every modification of any of the foregoing which it proposes to use.” Fla. Stat. § 627.091(1). However, an insurer “may satisfy its obligation to make such filings by becoming a member of, or a subscriber to, a licensed rating organization which makes such filings and by authorizing the office to accept such filings in its behalf ...” Id. § 627.091(4). CNA states that NCCI has operated the only rating organization in the State of Florida for several decades. (Dkt. 82 at 21). NCCI has filed on behalf of its member carriers the Florida rates and rules contained in its Basic Manual for Workers Compensation and Employers Liability Insurance (the “NCCI Manual”). See Dkt. 110 at 4. Generally, an insurer may not issue a contract of insurance except in accordance with its filings, see Fla. Stat. § 627.191, and must “adhere to the filings made on its behalf’ by NCCI, Fla. Stat. § 627.211; see also Dkt. 110 at 4.

The Programs were issued pursuant to a Workers’ Compensation Loss Reimbursement Rating Plan approved by the Department of Insurance in January, 1996. See Sather Aff. I ¶ 8 and Ex. F (Dkt. 82-3 at 2-65); Dkt. 64-1 at 19-22; Dkt. 64-2 at *1180 20-24. 3 The Rating Plan provides for a premium calculated pursuant to actuarial formulas based, in part, on the amount of the deductible to be borne by the insured and the insured’s expected losses (ie., the estimated frequency and magnitude of claims based on the insured’s claims experience in prior years). Sather Aff. I ¶ 12.

The 2001 and 2002 Program’s premiums are based on formulas that contemplate FFEL’s deductible obligations (ie., risk retention) and loss experience. Sather Aff. I ¶ 13. The 2001 Policy and confirmation letters provide for a premium rate of $2.03 per $100 of payroll of covered employees. See id. ¶ 14; Dkt. 82-2 at 9, 13. Because the insured’s actual payroll over the course of the policy term cannot be determined in advance, the payroll (and hence the premium based thereon) is subject to an audit following expiration of the policy’s effective dates. Sather Aff. I ¶ 14.

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716 F. Supp. 2d 1176, 2010 U.S. Dist. LEXIS 55642, Counsel Stack Legal Research, https://law.counselstack.com/opinion/continental-casualty-co-v-first-financial-employee-leasing-inc-flmd-2010.