Foodarama Supermarkets Inc. v. American Insurance

43 Pa. D. & C.4th 467, 2000 Pa. Dist. & Cnty. Dec. LEXIS 372
CourtPennsylvania Court of Common Pleas, Philadelphia County
DecidedJanuary 10, 2000
Docketno. 9802-1138
StatusPublished
Cited by2 cases

This text of 43 Pa. D. & C.4th 467 (Foodarama Supermarkets Inc. v. American Insurance) is published on Counsel Stack Legal Research, covering Pennsylvania Court of Common Pleas, Philadelphia County primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Foodarama Supermarkets Inc. v. American Insurance, 43 Pa. D. & C.4th 467, 2000 Pa. Dist. & Cnty. Dec. LEXIS 372 (Pa. Super. Ct. 2000).

Opinion

LEVIN, J.,

Before this court are plaintiffs’ motion for class certification, defendants’ memorandum of law in opposition to plaintiffs’ motion for class certification and all responses thereto. For the reasons stated below we deny plaintiffs’ motion.

INTRODUCTION

This class action litigation pits workers’ compensation insurance purchasers against workers’ compensation insurers. Plaintiffs define their class as “all employers in the Commonwealth of Pennsylvania that have purchased or renewed retrospectively-rated or adjusted policies or other similarly loss-sensitive policies in the voluntary market since 1985.” 1 Defendants are all workers’ compensation insurers who not only sold policies to the 11 named plaintiffs but also who are alleged to have written or sold workers’ compensation insurance to employers doing business in the Commonwealth.2 Plaintiffs allege that the defendant insurers engaged in a “fraudulent scheme and [470]*470conspiracy ... to bolster their profits in the face of substantial losses they began incurring in the mid-1980s in connection with the residual market for workers’ compensation insurance in Pennsylvania3 and many other states.” (Pis.’ second am. compl. ¶2.)

To understand plaintiffs’ complaint, a brief explanation about loss-sensitive policies and the residual market is required. Under loss-sensitive policies an employer’s premium depends upon the amount of actual losses the employer incurs.4 The premiums and charges are adjusted annually to reflect the employer’s losses. Plaintiffs contend that the yearly adjustment “afford the defendant carriers the opportunity to layer illegal charge upon illegal charge.” (Pis.’ second am. compl. at^28.) A retrospectively-rated policy is a type of loss-sensitive policy that uses four elements to calculate the premium.5 [471]*471Plaintiffs assert that these elements along with rates, fees, factors, charges, loads and assessments are filed with the Commonwealth’s Insurance Commissioner and cannot be changed unless approved by the commissioner.

Broadly speaking, plaintiffs’ claim asserts that defendants charged more in premiums than the law or their insurance contracts allowed in order to recoup losses the insurers were sustaining in the residual market. The residual market comprises employers who do not choose their insurer but are assigned to certain insurers. Thus, residual market employers obtain their insurance involuntarily because their insurers are assigned and not chosen. The plaintiffs are voluntary market participants and the defendants sell on both the voluntary and involuntary market. Plaintiffs contend that it is unlawful for insurance companies to overcharge voluntary market policyholders to recoup losses incurred by the insurers in the residual market.

Plaintiffs allege that “defendants, individually and acting in concert, schemed to bilk the named plaintiffs and other insureds in the voluntary market in Pennsylvania and other states out of more than $1 billion.” (Second am. compl. ¶4.) Defendants allegedly carried out their scheme in five ways: (1) misrepresenting and inflating the applicable tax multiplier used in calculating the final premium; (2) imposing illegal and unauthorized residual market assessments against voluntary market carriers; (3) using an illegally inflated loss conversion factor; (4) [472]*472misrepresenting and illegally inflating the basic premium amounts; and (5) requiring insurers to purchase coverage that was unrequested and unnecessary. (Pis.’ second am. compl. at^38(a)-(e).)

Based in part on these allegations, plaintiffs assert five causes of action against defendants6 and also allege that defendants fraudulently concealed their allegedly unlawful actions.

FINDINGS OF FACT

(1) Plaintiffs seek certification of a class consisting of:

“All employers in the Commonwealth of Pennsylvania that purchased or renewed multi-state policies issued by the insurer defendants covering risks within the Commonwealth of Pennsylvania during the period from January 1,1985 to the present (the “class period”). Excluded from the class are defendants and members of the NCCI; each of their parents, subsidiaries, and affiliates; any person controlled by any excluded person; and the legal representatives, heirs, successors, and assigns of any excluded person.” Pis.’ motion at 1.

(2) Policies are defined in the complaint to include retrospectively-rated, retrospectively-adjusted, or other loss-sensitive workers’ compensation insurance policies purchased in the voluntary market. Compl. ¶55.

[473]*473(3) Plaintiff Foodarama Supermarkets Inc. is a New Jersey corporation that purchased a policy issued by defendant Insurance Company of North America, a member of the CIGNA Group, covering Foodarama’s Pennsylvania employees for the policy year ending June 1, 1992. Compl. ¶12; INA’s answer ¶12.

(4) Plaintiff Andrew Corporation is a Delaware corporation that purchased a policy issued by defendant INA, among other things,.covering Andrew’s Pennsylvania employees for the policy year ending December 1,1992. Andrew also purchased a policy issued by defendant Liberty Mutual Fire Insurance Company, a member of the Liberty Group, covering Andrew’s Pennsylvania employees for the policy year ending December 1,1991. Compl. ¶13; Liberty Mutual’s answer ¶13.

(5) Plainntiff The ERM Group Inc. is a Pennsylvania corporation that purchased policies issued by defendant Old Republic Insurance Company, a member of the Old Republic Group, covering ERM’s Pennsylvania employees for the policy years ending October 15,1990 through October 15, 1994. Compl. ¶15; Old Republic’s answer ¶15.

(6) Plaintiff Matria Healthcare Inc., the successor in interest to Healthdyne Inc., is a Delaware corporation that purchased policies issued by defendant Sentry Insurance, a Mutual company, a member of the Sentry Group, covering Matria’s Pennsylvania employees for the policy periods ending June 1,1991 through March 8, 1996. Matria also purchased a policy issued by defendant Commerce and Industry Company, a member of the AIG Group, covering Matria’s Pennsylvania employees [474]*474for the policy year ending June 1, 1990. Compl. ¶16; Commerce and Industry’s answer ¶16.

(7) Plaintiff Melvin Simon & Associates Inc. is an Indiana corporation that purchased policies issued by defendant Standard Fire Insurance Company, a member of the Travelers Group, covering Melvin Simon’s Pennsylvania employees for the policy years ending July 1, 1990 and July 1, 1991. Compl. ¶17; Standard Fire’s answer ¶17.

(8) Plaintiff Specialty Restaurants Corporation d/b/a Baby Doe’s is a California corporation that purchased policies issued by defendants United Pacific Insurance Company, a member of the Reliance Group, covering Specialty Restaurants’ Pennsylvania employees for the policy years ending December 1,1990 and December 1, 1991. Compl. ¶18; United Pacific’s answer ¶18.

(9) Plaintiff Alumax Inc. is a Delaware corporation that purchased policies issued by defendant Pacific Employers Insurance Company, a member of the CIGNA Group, covering Alumax’s Pennsylvania employees for the policy years ending January 1,1986 through April 1, 1990. Compl. ¶19; Pacific Employers’ answer ¶19.

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43 Pa. D. & C.4th 467, 2000 Pa. Dist. & Cnty. Dec. LEXIS 372, Counsel Stack Legal Research, https://law.counselstack.com/opinion/foodarama-supermarkets-inc-v-american-insurance-pactcomplphilad-2000.