Gary C. Quintinsky v. Texas Mutual Insurance Company

Court of Appeals of Texas·Decided April 30, 2008·No. 03-07-00299-CV·Published

Opinion

TEXAS COURT OF APPEALS, THIRD DISTRICT, AT AUSTIN

NO. 03-07-00299-CV

Gary C. Quintinsky, Appellant v.

Texas Mutual Insurance Company, Appellee

FROM THE DISTRICT COURT OF TRAVIS COUNTY, 200TH JUDICIAL DISTRICT NO. D-1-GN-06-003093, HONORABLE ORLINDA NARANJO, JUDGE PRESIDING

MEMORANDUM OPINION

Gary C. Quintinsky appeals a judgment awarding Texas Mutual Insurance Company $5,077,390 in compensatory damages and $2,500,000 in exemplary damages. Texas Mutual’s central theory at trial was that Quintinsky fraudulently induced Texas Mutual into issuing insurance policies to companies that Quintinsky owned and operated by misrepresenting the companies’ payroll in order to evade Texas Mutual’s experience-rating system. In four issues on appeal, Quintinsky challenges the legal and factual sufficiency of the evidence supporting various jury findings, asserts that the district court erred when it denied his motion for judgment notwithstanding the verdict, and contends that Texas Mutual made an incurable jury argument regarding exemplary damages. We will affirm the judgment.

BACKGROUND

Since 2001, Texas Mutual has been the State of Texas’s worker’s compensation insurer of last resort. That is, if an applicant would be rejected for workers’ compensation insurance under Texas Mutual’s underwriting standards, the company may not reject the risk, but shall insure the risk at a higher premium as provided by the company’s requirements. Tex. Ins. Code Ann. art. 5.76-4(b) (West Supp. 2006-07) (current version at Tex. Ins. Code Ann. § 2054.351(b) (West Supp. 2007)).1 The insurance code further provides that a policyholder shall fully disclose to the policyholder’s insurance company information concerning the policyholder’s ownership, change of ownership, operations, or payroll. Id. art. 5.65B(a) (West Supp. 2006-07) (current version at Tex. Ins. Code Ann. § 2051.101(a)(1) (West Supp. 2007)).

At trial, Grace Turner, a supervisor in Texas Mutual’s Special Investigations Department, explained Texas Mutual’s insurance application process. In the application, the employer provides estimates of its payroll for the coming year. Based on this estimate, an estimated premium is charged. Then, an auditor “will go and get all of the payroll information and charge accordingly.” In other words, an estimated premium is paid up front, and, later, when the actual payroll is determined, there will result either a refund of a portion of the premium or an additional charge for more premium that is due.

1 In 2005, the legislature enacted a nonsubstantive revision of the insurance code, effective April 1, 2007. See Act of May 24, 2005, 79th Leg., R.S., ch. 727, § 18, 2005 Tex. Gen. Laws 1752, 2187. Because the revisions operate prospectively, we will cite to the code provisions in effect at the time Texas Mutual’s cause of action arose.

Turner explained that the premium is calculated based on a formula that includes a dollar amount of payroll and a rate based on the specific class code that is assigned to that payroll based on the workers’ risk of injury. For example, an office worker has a lower rate than a crane operator. These two factors determine the “base premium.” Once the base premium is determined, the next step is to apply an “experience modifier,” which is a multiplier based on the “loss history” of the company. According to Turner, all employers start out with a modifier of 1.0, which has no impact on the employer’s base premium. Over time, that modifier will increase or decrease depending on the amount of claims that the employer files. An experience modifier of less than 1.0 is assigned to employers who are perceived to be less of a risk than the average employer. An experience modifier of more than 1.0 is assigned to employers who are perceived to be a greater risk than the average employer. The higher the modifier, the higher the premium.

Texas Mutual alleged that Quintinsky was the true owner and operator of the United Crane Companies (United Crane, United Crane Sales and Leasing, International Holdings, Conroe United, Austin United, United Payroll Services, and United Fleet Maintenance), which rented telescopic boom cranes, with or without operators, to petrochemical and general building contractors throughout the State of Texas. Texas Mutual also alleged that in 1994, Quintinsky sold the assets of the United Crane Companies to Ellynn Ogilvie, an employee of the United Crane Companies (and Quintinsky’s alleged “live-in girlfriend”) but continued to exercise control over the business. The United Crane Companies were insured by Texas Mutual for the policy years 2000-2001, 2001-2002, 2002-2003, and 2003-2004.

Turner testified concerning how Texas Mutual conducted the audits on the United Crane Companies. The auditor looked at three types of documents: unemployment reports filed with the Texas Workforce Commission, federal income tax forms, and payroll journals. The United Crane Companies provided these documents to Texas Mutual, and Texas Mutual would compare the payroll information on the documents “to make sure they matched up.” According to Turner, the auditor does not normally go beyond the documents provided by the employer, and he usually accepts the truth of what the employer is telling him. Turner testified that Texas Mutual performed an audit on the United Crane Companies in the above manner for three of the four years in which it insured the companies.2 Turner recounted that Texas Mutual ran a query on its “high modifier accounts”

and noticed that the United Crane Companies had a modifier greater than 3.0. This meant that the United Crane Companies was paying premiums in an amount more than three times what a business would normally pay. Turner explained that a high modifier is a motivator for an insured to commit fraud. After the discovery of the high modifier, Texas Mutual “ran a check to see if there were any similar or other operations at the same location” as the United Crane Companies. This was done, Turner explained, because “when payroll is hidden, it’s usually hidden in a company that has a similar address as the insured that we cover.” Texas Mutual noticed that there were “a lot of the companies at the same location listed on the policy, but there was . . . one company that was not listed.” In response to this discovery, Texas Mutual obtained payroll information on the

2 An audit was not attempted during the fourth year because at that time, according to Turner, Texas Mutual had discovered that the United Crane Companies had not been truthful in their prior audits.

United Crane Companies directly from the Texas Workforce Commission. Turner testified that “when the numbers [from the Texas Workforce Commission] came back, they were not even close” to the payroll numbers that the United Crane Companies had reported to Texas Mutual. In fact, Texas Mutual discovered that there were “millions of dollars of difference between what was given to the auditor and given to [the] Texas Workforce Commission.” This discrepancy indicated to Turner that the reports shown to the auditor “weren’t the true and correct copies of the ones that were filed with the State” and had been falsified. Turner suspected that the payroll journals provided by the United Crane Companies to Texas Mutual were “probably altered as well.” However, she had “no idea” whether the federal income tax forms provided by the United Crane Companies to Texas Mutual had been altered.

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