Gamma Group, Inc. v. Transatlantic Reinsurance Co.

242 S.W.3d 203, 2007 WL 4227081
CourtCourt of Appeals of Texas
DecidedJanuary 14, 2008
Docket05-06-00156-CV
StatusPublished
Cited by10 cases

This text of 242 S.W.3d 203 (Gamma Group, Inc. v. Transatlantic Reinsurance Co.) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Gamma Group, Inc. v. Transatlantic Reinsurance Co., 242 S.W.3d 203, 2007 WL 4227081 (Tex. Ct. App. 2008).

Opinion

OPINION

Opinion by Justice RICHTER.

This appeal involves a breach of contract claim asserted by Transatlantic Reinsurance Company (“TRC”), a reinsurer on non-standard automobile insurance policies, and intervenor Home State County Mutual Insurance Company (“Home State”), the ceding and fronting carrier, against Gamma Group, Inc. (“Gamma”), the agent responsible for binding and adjusting the policies. 1

In two issues, Gamma appeals the trial court’s judgment awarding TRC and Home State damages and attorney’s fees. Gamma first argues the trial court erred in awarding damages under the contract be *206 cause losses and loss adjustment expenses on run-off claims should not have been included in the commission adjustment after Home State transferred the claims adjusting responsibility to a third party. 2 In its second issue, Gamma asserts the trial court erred in awarding statutory attorney’s fees for breach of contract because the demand was unreasonable and the evidence was insufficient to establish the statutory prerequisites for recovery. In a cross-issue, TRC and Home State assert the contract provided for commission adjustments based on “incurred” rather than “reasonable” losses. As a result, TRC and Home State contend the trial court erred when it construed the contract to imply that only “reasonable” run-off payments were to be included in the commission adjustment calculation. We affirm the trial court’s judgment on the right to recover damages for breach of contract and attorney’s fees, but conclude the trial court erred when it reduced the damage award based on an implied term in the contract. Therefore, we reverse the trial court’s judgment with regard to the amount of damages awarded. Because the damages can not be calculated with mathematical certainty on this record, we remand the case to the trial court for calculation of damages based on the incurred loss.

I. FACTUAL AND PROCEDURAL BACKGROUND

The Home State Program

In May 1995, Home State and Gamma entered into an agency agreement (the “agency agreement”) under which non-standard automobile insurance policies were to be underwritten by Home State as the fronting carrier and bound and adjusted by Gamma. 3 The agency agreement provided Gamma would produce the policies, collect premiums, and adjust any resulting liability claims against Home State insureds. In addition to payment of insured’s claims, the collected premiums were to be used to make payments to the ceding carrier and reinsurer and for Gamma to pay commissions to itself. Initially, the agency agreement was subject to a reinsurance agreement between Home State and U.S. Capital Insurance Company. In 1996, TRC and Hartford Reinsurance Company (“HartRe”) began reinsur-ing the business produced under the Agency Agreement through a quota-share reinsurance treaty with Home State (the “treaty”). 4 The treaty was renewed in 1997 and 1998. By the time of the 1998 renewal, TRC had assumed 90% of the Home State liabilities in exchange for 90% of the premium.

The treaty provided for payment of a “provisional ceding commission” consisting of 21.5% of the collected premium. This commission was to be subsequently adjusted to an “actual ceding commission.” The adjustment was based on a ratio of incurred losses to premiums. The adjustments were to continue during the effective period of the treaty and after termination until all losses were set- *207 tied, including those incurred during runoff periods.

The agency agreement fully incorporated the reinsurance treaty and amendments, and required all business coming within the scope of the agreement to be reinsured under the reinsurance treaty. The agency agreement further stated the reinsurer had the right to act on all matters within the scope of the agreement as though the reinsurer were Home State. Any violation of the terms and conditions of the reinsurance treaty resulting in a diminution of the reinsurer’s liability to Home State was the sole responsibility of Gamma. The agency agreement also provided that the commission set forth in the reinsurance agreement was to be Gamma’s sole and full compensation for business placed with Home State.

Two years after the inception of the Home State program, Home State had disagreements with Gamma about its management of the program. During the same time frame, the Texas Department of Insurance alerted Home State to an “extraordinary” number of complaints made by insureds about Gamma. As a result, Home State decided to withdraw from the arrangement and terminated the Agency Agreement effective January 1, 1999. Although Gamma was not authorized to write new business on Home State policies after the termination date, Gamma was still responsible for adjusting run-off claims on policies placed during the effective period of the agreements.

The S &C Program

TRC subsequently joined in a new contractual relationship with State and County Mutual Insurance Company (S & C) as the ceding and fronting carrier and Gamma as the agent responsible for binding coverage and adjusting claims. To this end, in 1999, Gamma, S & C, and TRC executed an agency agreement (the “S & C Agency Agreement”) and a reinsurance agreement (the “S & C Treaty”). 5 The S & C Treaty was a 100% quota-share agreement under which TRC assumed 100% of the risks in exchange for 100% of the premiums, less commissions, fees, and taxes. Like the Home State treaty, commissions were subject to adjustment based on the ratio of losses to earned premium.

Claims Handling

In 2000, outside sources advised TRC of two lawsuits alleging Gamma engaged in improper claims handling practices. Although contractually obligated to do so, Gamma failed to notify TRC and Home State about these claims. One of the claims resulted in a default judgment and a claim for bad faith against Gamma and Home State. Home State also contacted TRC to express concern about Gamma’s handling of the run-off business. As a result, in June 2000, TRC conducted an extensive audit of Gamma. Previous audits of Gamma, a company in its infancy, had been conducted by the underwriting department. But the 2000 audit was conducted by the claims department. The claims department was critical of Gamma’s aggressive claims handling and was concerned such practices could result in extra-contractual liability. The audit also revealed problems with Gamma’s staffing and record-keeping. After the audit, TRC made several efforts to rehabilitate Gamma’s claims handling practices but ultimately concluded the efforts were futile. TRC terminated the S & C Treaty by endorsement with respect to all new and renewal business effective January 1, 2002. *208 Following termination, Gamma remained obligated to handle run-off claims made on S & C policies.

Despite the termination of the agreements with Gamma, the parties remained concerned about Gamma’s ability to handle run-off claims.

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242 S.W.3d 203, 2007 WL 4227081, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gamma-group-inc-v-transatlantic-reinsurance-co-texapp-2008.