Enfield v. Old Line Life Insurance Co. of America

2004 NMCA 115, 98 P.3d 1048, 136 N.M. 398
CourtNew Mexico Court of Appeals
DecidedJuly 23, 2004
Docket23,239
StatusPublished
Cited by5 cases

This text of 2004 NMCA 115 (Enfield v. Old Line Life Insurance Co. of America) is published on Counsel Stack Legal Research, covering New Mexico Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Enfield v. Old Line Life Insurance Co. of America, 2004 NMCA 115, 98 P.3d 1048, 136 N.M. 398 (N.M. Ct. App. 2004).

Opinion

OPINION

BUSTAMANTE, Judge.

{1} This is another nationwide class action involving modal premiums. The district court certified a class potentially numbering 700,000 “holders of Old Line insurance policies who purchased their policies at any time between January 1, 1980, and the date of class certification and who have paid modal premiums ... to Old Line.” In line with our opinion in Berry v. Federal Kemper Assurance Co., 2004-NMCA-116, 136 N.M. 454, 99 P.3d 1166 (No. 23,186) (July 23, 2004), we affirm in part, reverse in part, and remand for further consideration.

FACTS AND PROCEDURES

{2} The pleadings in this case follow a familiar pattern. Plaintiff Lisa Enfield alleges that, because she pays quarterly, she is being charged a higher premium by Defendant Old Line Life Insurance Company (Old Line) than is provided for in her policy. Plaintiff Enfield’s policy provides for a quarterly “Billing Frequency” and a “Mode Premium” of $179.14. Plaintiff contrasts these provisions with the “Policy Specifications” page which reflects an annual premium of $676 and a general statement that “premiums other than annual are a percentage of the annual premium.” Plaintiff also relies on premium tables that reflect “Maximum Annual Life Insurance Premium” of $676 for the first twenty years of the policy. Plaintiff also alleges that “Old Line knowingly failed to state or disclose material facts regarding ... payment options under the policy.” Specifically, Plaintiff alleges Old Line did not disclose the dollar difference between the various payment modes available, and, further, did not translate the dollar differential into an “effective annual percentage [or] interest rate.”

{3} Relying on these basic factual allegations, Plaintiff asserted six causes of action: (1) breach of contract (Count I); (2) failure to disclose material facts (Count II); (3) breach of the implied covenant of good faith and fair dealing (Count III); (4) violation of the Unfair Practices Act, NMSA 1978, §§ 57-12-1 to -22 (1978, as amended through 1999) (Count TV); (5) a request for injunctive relief (Count V); and (6) a request for declaratory relief (Count VI).

{4} Plaintiff requested nationwide certification for Counts I, II, and III, and a fifteen-state subclass for the Unfair Practices Act claim. After briefing and an evidentiary hearing, the district court refused to certify the subclass but granted the rest of the request. The parties did not file any dispositive motions before dealing with the class issues. Thus, the district court has not considered the merits of any of the claims.

{5} At the certification hearing, the parties stipulated to all of the documentary evidence, except Defendant’s Exhibit CH, which the district court admitted after argument. Exhibit CH is a copy of the file created by Plaintiffs insurance agent during the sale process. The documentary record parallels the pattern found and discussed in our opinion in Berry. The term life policy forms used by Old Line during the class period were essentially identical. The application forms were essentially identical for the class period. The agency agreements and independent marketing organization agreements through which Old Line allowed sale of its policies were essentially uniform throughout the class period. These form agreements all purport to limit the sales person’s ability to modify policies and prohibit the conveyance of any material about Old Line’s policies without its permission.

{6} None of the documentary material designed to reach policy holders contains any information describing Old Line’s modal premium factors and none provides any explicit statement concerning the dollar cost differential inherent in paying more than once a year. Old Line agrees it has never translated the cost differential into an interest rate or APR figure, though it asserts it does not do so because there is no loan involved in the premium structure. None of Old Line’s documentary material specifically forbade agents from disclosing the comparative costs of the various modes of payment, though its Compliance Manual places strict requirements for pre-approval of any “sales material” proposed to be used by selling agents.

{7} At the hearing, the district court heard testimony from Plaintiff, her insurance broker, an expert on insurance regulation as it affects consumers who testified for Plaintiff, a marketing consultant employed by Old Line, an expert in life insurance marketing who testified for Old Line, and an expert in insurance regulation who testified for Old Line.

{8} The facts specific to Plaintiffs case are straightforward. She contacted an independent insurance broker inquiring about term life, disability, and medical insurance. The broker secured a policy for Plaintiff with Old Line. Plaintiff asserts that the broker never told her there was a different premium depending on the mode or frequency of payment she chose. Plaintiff also admitted that, until just prior to filing this suit, she did not do the arithmetic to determine if her premium she was paying exceeded the “maximum” premium reflected on the face of the policy.

{9} Plaintiffs insurance broker testified generally that it was his practice to explain the dollar difference between an annual premium and the mode chosen by his clients. He could not recall specifically if he had that conversation with Plaintiff, or whether he reviewed the actual policy with her after it was issued. He agreed he did not give comparisons for all payments and that he did not disclose modal factors as such. The sales brochure describing premium calculations was not to be distributed to the public. The insurance agent agreed he never gave Plaintiff the modal factors for her policy, and in fact he didn’t know the modal factors and didn’t care about them. His focus was on periodic cost. The agent agreed he did not disclose modal premiums in terms of an APR or interest rate. The agent said “I’d confuse her and myself.”

{10} Old Line’s marketing consultant— who has never actually sold life insurance— testified generally that Old Line does not provide a script to be used during sales and it does not try to teach agencies “how to actually sell life insurance.” She also testified that agents are not required to get prior approval of oral statements to prospective policyholders. The marketing consultant agreed that Old Line’s training materials are standard across the country and include rate quotation software that does not disclose dollar differential between modes and does not give modal factors. The marketing consultant also agreed that there was nothing in Old Line’s training materials telling agents they should disclose modal factors, dollar differences between payment modes, or interest rate calculations.

{11} Old Line’s marketing and sales expert opined that Old Line’s life insurance products are sold in unique, individual transactions. He likened life insurance sales to a financial transaction where people’s “wants and needs and affordability and sophistication” differ. In his opinion it would be necessary to “interview” both the agent and the buyer to find out what happened in each transaction. He saw nothing in the standard agent’s agreement that limited what an agent could tell a policyholder concerning premiums.

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Cite This Page — Counsel Stack

Bluebook (online)
2004 NMCA 115, 98 P.3d 1048, 136 N.M. 398, Counsel Stack Legal Research, https://law.counselstack.com/opinion/enfield-v-old-line-life-insurance-co-of-america-nmctapp-2004.