Health Admin. Amer. v. American Med. Sec., Unpublished Decision (3-29-2001)

CourtOhio Court of Appeals
DecidedMarch 29, 2001
DocketCase No. 00CAE04009.
StatusUnpublished

This text of Health Admin. Amer. v. American Med. Sec., Unpublished Decision (3-29-2001) (Health Admin. Amer. v. American Med. Sec., Unpublished Decision (3-29-2001)) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Health Admin. Amer. v. American Med. Sec., Unpublished Decision (3-29-2001), (Ohio Ct. App. 2001).

Opinions

OPINION
Appellants American Medical Security, Inc. ("AMS"), et al., appeal a $5.4 million judgment, in the Delaware County Court of Common Pleas, in favor of Appellees Health Administrators of America, Inc. and Charles F. Booher ("Booher"), et al., in an extensive breach of contract and fraud action based upon certain insurance agency and sales commission contractual arrangements. The relevant facts leading to this appeal are as follows.

Appellee Charles F. Booher is an officer of Health Administrators of America, Inc., and a licensed insurance agent. Prior to May 1, 1992, Booher owned a block of insurance business, with annual premiums of approximately $23 million, with the American Benefit Life Insurance Company ("ABL"), a corporation he had created in 1991. In 1992, AMS entered into an option agreement to purchase all outstanding stock of ABL. As a result, on May 1, 1992, Booher and Health Administrators of America, Inc. entered into a commission agreement with AMS, United Wisconsin Life Insurance Company ("UWLIC"), and American Medical Security Insurance Company ("AMSIC") to pay Booher commissions for existing business and for renewals on policy premiums, utilizing a sliding scale based on the "loss ratio" of the ABL block of business. (On May 14, 1993, the parties modified the loss ratio renewal commission provision of the commission agreement, such that payment would be made to Booher at a rate of eight percent, except where three percent would be added for association plans.) On May 5, 1992, several days after the original commission agreement, Booher entered into a general agent contract with AMS, which controlled commission payments he would receive as an individual entity for new, additional business. From May 1, 1992 until approximately August 30, 1996, appellants paid Booher renewal commissions on the block of ABL accounts in existence as of May 1, 1992, pursuant to the terms of the commission agreement.

The chain of events leading to the eventual litigation in this matter commenced in the spring of 1996, when Booher attempted to enroll a group of employees from Clear Creek Valley of Ohio, a foster care agency in Fairfield County. The group was rated "substandard" for insurance purposes, forcing a withdrawal of the application. Booher then allegedly resubmitted the Clear Creek employees as employees of Chrysler-Plymouth East, an automobile dealership which had originally been in the ABL block of accounts. AMS contacted Booher about the matter, but nonetheless became suspicious of Booher's handling of other accounts. Upon further investigation, AMS discovered what it alleged were improper billing practices and overcharging of policyholders by Booher.

On August 30, 1996, appellants notified Booher via letter that the agency relationships between them were terminated for cause. At approximately the same time, AMS ceased further renewal commissions to be paid pursuant to the commission agreement.

On September 9, 1996, AMS filed a complaint against Booher with the Ohio Department of Insurance, resulting in an investigation lasting approximately ten months. The Department of Insurance did not officially render a finding as to any wrongdoing or violation of law by Booher, but he was ordered to pay a fine of $4000 via a consent agreement.

On October 25, 1996, appellees, including Booher, filed an amended five-count action for breach of contract and fraud against Appellants AMS, UWLIC, and AMSIC. The complaint alleged breach of the aforesaid 1992 commission agreement, fraudulent misrepresentation of rate quotes and premium charges, and breach of agency, oral, and commission contracts.1 Appellees prayed for compensatory damages of over $9 million, plus punitive damages. All three appellants jointly answered the complaint on November 12, 1996.

On December 24, 1996, Booher filed a motion for summary judgment, alleging that he was entitled to judgment as a matter of law regarding breach of the commission agreement, as further discussed in regard to appellant's First and Second Assignments of Error, infra. The trial court granted appellee's motion for partial summary judgment on August 26, 1997. The summary judgment entry read in part that "* * * it is clear from the terms of the Commission Agreement that the parties did not intend to create a right of unilateral revocation." Judgment Entry, August 26, 1997, at 9. The trial court thereupon found that AMS had violated an express contractual provision by unilaterally terminating and refusing to pay Booher his commissions on the ABL block of business.

None of the parties requested a jury trial. The trial court judge referred the remaining issues to a magistrate for evidence. The magistrate heard evidence for a total of twelve days, commencing on January 25, 1999 and concluding on February 18, 1999. The magistrate took the matter under advisement and issued a decision on February 7, 2000. The decision granted judgment for damages to Booher in the amount of $3,023,754 in regard to Count I of the complaint (breach of commission agreement) and $2,405,543 in regard to Count III (breach of agent contract). In total, the award to Booher amounted to $5,429,297, representing the value of future commissions due on the renewal of group health insurance policies for the next sixteen years. Among the findings of the magistrate was the following assessment:

Accordingly, while the Defendant [AMS] may be justifiably unhappy with Plaintiff's [Booher's] conduct, the contract * * * requires that termination for cause be supported by evidence that an agent engaged in fraudulent, illegal or dishonest activity adversely affecting the company; and violation of laws, regulations, or rules of the jurisdiction governing the agent's activity. The record simply does not support termination for cause under those terms.

Magistrate's Decision, February 7, 2000, at 8, emphasis sic.

Both parties filed objections to the magistrate's decision, but the trial judge overruled each and entered judgment on April 10, 2000. Appellants filed their notice of appeal on April 18, 2000. The appellees filed a notice of cross-appeal on May 4, 2000. Appellant's nine Assignments of Error are as follows:

I. THE TRIAL COURT ERRED IN GRANTING SUMMARY JUDGMENT AND FAILING TO REVISE ITS SUMMARY JUDGMENT IN LIGHT OF THE EVIDENCE CONCERNING BOOHER'S FRAUDULENT, ILLEGAL AND DISHONEST ACTS.

II. THE TRIAL COURT ERRED IN FAILING TO REVISE ITS SUMMARY JUDGMENT IN LIGHT OF THE EVIDENCE CONCERNING THE AMENDMENT TO THE COMMISSION AGREEMENT.

III. THE TRIAL COURT ERRED IN ITS CONSTRUCTION OF THE AGENT CONTRACT AND IN HOLDING THAT AMS COULD NOT TERMINATE THE CONTRACT "FOR CAUSE."

IV. THE TRIAL COURT ERRED BY FAILING TO CONSTRUE AND APPLY THE TERMINATION PROVISIONS IN THE AGENT AGREEMENT AND BY TREATING ALL COMMISSIONS FOR BUSINESS WRITTEN AFTER MAY 1, 1992 AS BEING PAYABLE PURSUANT TO THE AGENT CONTRACT.

V. THE TRIAL COURT ERRED BY GRANTING A JUDGMENT THAT IS INCONSISTENT WITH ITS EARLIER SUMMARY JUDGMENT AND THAT IS BASED ON AN ERRONEOUS CALCULATION.

VI. THE TRIAL COURT ERRED BY GRANTING A JUDGMENT THAT INCLUDES AN 80% "RENEWAL BONUS" NOT PROVIDED FOR IN THE COMMISSION AGREEMENT.

VII. THE TRIAL COURT ERRED BY GRANTING A JUDGMENT THAT INCLUDES A 7% COMMISSION ON THE UNION TEAMSTERS ACCOUNT AS TO WHICH THE COURT RULED AMS HAD NO FURTHER OBLIGATION.

VIII. THE TRIAL COURT ERRED BY FAILING TO SUBTRACT (SIC) BOOHER'S DAMAGES THE EXPENSES HE SAVED IN NOT HAVING TO CONTINUE TO SERVICE THE BUSINESS.

IX. THE TRIAL COURT'S JUDGMENT WAS CONTRARY TO THE MANIFEST WEIGHT OF THE EVIDENCE.

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Health Admin. Amer. v. American Med. Sec., Unpublished Decision (3-29-2001), Counsel Stack Legal Research, https://law.counselstack.com/opinion/health-admin-amer-v-american-med-sec-unpublished-decision-3-29-2001-ohioctapp-2001.