Fogel v. Farmers Group, Inc.

74 Cal. Rptr. 3d 61, 160 Cal. App. 4th 1403
CourtCalifornia Court of Appeal
DecidedApril 7, 2008
DocketB182156
StatusPublished
Cited by22 cases

This text of 74 Cal. Rptr. 3d 61 (Fogel v. Farmers Group, Inc.) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Fogel v. Farmers Group, Inc., 74 Cal. Rptr. 3d 61, 160 Cal. App. 4th 1403 (Cal. Ct. App. 2008).

Opinion

Opinion

WILLHITE, Acting P. J.

The issue presented in this appeal is whether the attomeys-in-fact for subscribers of reciprocal insurance exchanges may be sued by the subscribers to recover alleged excessive fees the attorneys-in-fact collected in breach of their fiduciary duty to the subscribers. The fees were collected from premiums the subscribers paid to the exchanges. The premiums were based upon rates approved by the Commissioner of the Department of Insurance (the Commissioner). The attomeys-in-fact contend the attorney-in-fact fees (the AIF fees) are a component of that approved rate and, therefore, the subscribers’ lawsuit is barred under Walker v. Allstate Indemnity Co. (2000) 77 Cal.App.4th 750 [92 Cal.Rptr.2d 132] (Walker)—which held that Insurance Code 1 section 1860.1 precludes claims challenging an approved rate—and the filed rate doctrine, because the lawsuit improperly seeks to recoup premiums charged in accordance with an approved rate. We hold that neither Walker, nor section 1860.1, nor the filed rate doctrine applies to this lawsuit against the attomeys-in-fact, because the attomeys-in-fact are entities distinct from the exchanges, with fiduciary relationships with each of the subscribers. Accordingly, we reverse the summary judgment in favor of the attomeys-in-fact and direct the trial court to enter an order denying defendants’ motion and granting plaintiff’s motion to summarily adjudicate defendants’ exhaustion of administrative remedies affirmative defense.

BACKGROUND

Before discussing the allegations of the complaint and the procedural aspects of this case, we must first provide some background on reciprocal insurance exchanges and insurance rate regulation.

A. Reciprocal Insurance Exchanges

A reciprocal insurance exchange (also called an interinsurance exchange) “ ‘is an unincorporated business organization of a special character in *1407 which the participants, called subscribers ... are both insurers and insureds; for their mutual protection, they exchange insurance contracts through the medium of an attorney-in-fact.’ ” (Delos v. Farmers Group, Inc. (1979) 93 Cal.App.3d 642, 652 [155 Cal.Rptr. 843], quoting Industrial Indem. Co. v. Golden State Co. (1953) 117 Cal.App.2d 519, 522 [256 P.2d 677]; see also §§ 1300, 1301, 1305.) By statute, the reciprocal insurance exchange is deemed the insurer and each subscriber is deemed an insured. (§ 1303.)

The interinsurance exchange is managed by the attomey-in-fact, which may be a corporation, and which is appointed by the subscribers through powers of attorney. {Lee v. Interinsurance Exchange (1996) 50 Cal.App.4th 694, 704 [57 Cal.Rptr.2d 798]; see also § 1305.) For its services, the attomey-in-fact typically receives a percentage of the premiums the subscribers pay to the interinsurance exchange. {Delos v. Farmers Group, Inc., supra, 93 Cal.App.3d at p. 652; Industrial Indem. Co. v. Golden State Co., supra, 117 Cal.App.2d at p. 523.) The attomey-in-fact’s relationship with each subscriber is that of a fiduciary. 2 {Tran v. Farmers Group, Inc., supra, 104 Cal.App.4th at p. 1213.)

B. Insurance Rate Regulation in California

Before 1988, insurance regulation in California operated under the “open competition” system, “under which ‘rates [were] set by insurers without prior or subsequent approval by the Insurance Commissioner.’ ” {20th Century Ins. Co. v. Garamendi (1994) 8 Cal.4th 216, 240 [32 Cal.Rptr.2d 807, 878 P.2d 566] {20th Century).) That changed after the General Election in November 1988, when the voters of California approved an initiative that was designated Proposition 103. Proposition 103 required insurers to reduce their rates immediately, and instituted a “prior approval” system, which requires insurers to submit a rate application to the Commissioner for approval before changing any rates. {20th Century, at pp. 242-243; §§ 1861.01, 1861.05, subd. (b).) Under the new system, insurers may charge only approved rates (§ 1861.01, subd. (c)), although they are permitted to return savings or unabsorbed premiums to policyholders (§ I860; see also § 1402; Lee v. Interinsurance Exchange, supra, 50 Cal.App.4th at p. 705 [directors of interinsurance exchanges “may, but are not required to, return savings or credits to the subscribers”]; Delos v. Farmers Group, Inc., supra, 93 Cal.App.3d at p. 652 [“ ‘If the amount of premiums deposited is not fully required for the purposes *1408 mentioned [i.e., to pay losses and costs, and to maintain reserves and surpluses], the excess, called savings, is returned in whole or in part as dividends’ ”]).

Among other things, Proposition 103 enacted a statutory scheme governing the rate approval process, which provides for hearings before an administrative law judge in certain circumstances and allows for consumer participation. 3 (See, e.g., §§ 1861.05-1861.10.) The key provision is found in subdivision (a) of section 1861.05. That provision states that rates cannot be approved or remain in effect if they are “excessive, inadequate, unfairly discriminatory or otherwise in violation of’ chapter 9 of division 1, part 2 of the Insurance Code, governing rates and rating organizations (hereafter Chapter 9). (§ 1861.05, subd. (a).)

To implement the rate-setting component of Proposition 103, the Commissioner adopted regulations establishing the process and policies to be employed to determine whether rates are excessive or inadequate. (Cal. Code Regs., tit. 10, § 2641.1 et seq.) “The rate regulations define as ‘excessive’ a rate that is ‘expected to yield the reasonably efficient insurer a profit that exceeds a fair return on the investment used to provide the insurance’ in light of the ‘competing interests of consumers in lower prices and of investors in prices that yield high returns’ and the ‘fact that insurance is imbued with the public interest and is sometimes legally required.’ (Cal. Code Regs., tit. 10, § 2642.1.) They define as ‘inadequate’ a rate ‘under which a reasonably efficient insurer is not expected to have the opportunity to earn a fair return on the investment that is used to provide the insurance’ in light of the considerations identified above. (Id., tit. 10, § 2642.3.) Lastly, they define a ‘fair return’ as the ‘profit that an investor can reasonably expect to earn from an investment in a business other than insurance subject to regulation [thereunder] presenting investment risks comparable to the risks presented by insurance subject’ thereto. (Id., tit. 10, § 2642.2.)” (20th Century, supra, 8 Cal.4th at p. 253.)

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Cite This Page — Counsel Stack

Bluebook (online)
74 Cal. Rptr. 3d 61, 160 Cal. App. 4th 1403, Counsel Stack Legal Research, https://law.counselstack.com/opinion/fogel-v-farmers-group-inc-calctapp-2008.