Health Plans, Inc. v. New York Life Insurance

898 F. Supp. 941, 1995 U.S. Dist. LEXIS 13783, 1995 WL 559075
CourtDistrict Court, D. Massachusetts
DecidedSeptember 18, 1995
DocketCiv. A. 91-40022-NMG
StatusPublished
Cited by6 cases

This text of 898 F. Supp. 941 (Health Plans, Inc. v. New York Life Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Massachusetts primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Health Plans, Inc. v. New York Life Insurance, 898 F. Supp. 941, 1995 U.S. Dist. LEXIS 13783, 1995 WL 559075 (D. Mass. 1995).

Opinion

MEMORANDUM AND ORDER

GORTON, District Judge.

The plaintiffs, Health Plans, Inc. (“Health Plans”) and Freedom Care, Inc. (“Freedom Care”), bring this action against the defendant, New York Life Insurance Company (“New York”), claiming breach of contract, breach of implied covenants of fair dealing, fraud and violations of M.G.L. c. 93A. New York has counterclaimed against Health Plans for breach of contract, violations of M.G.L. e. 93A and libel.

New York also filed a separate action (No. 91-40047) against Sentry Life Insurance Co. (“Sentry”) alleging tortious interference of contract, misappropriation of confidential business information, unfair competition and violations of M.G.L. c. 93A. Sentry, in turn, counterclaimed against New York, asserting tortious interference with advantageous business relationships and violations of M.G.L. c. 93A. The Court (per Young, J.) consolidated the lawsuit initiated by New York, No. 91-40047, with this case, No. 91-40022, on June 24, 1991.

Pending before the Court are the following motions:

1) motion of New York for summary judgment on all claims asserted against it by plaintiffs, Health Plans and Freedom Care,
2) motion of New York for summary judgment on the counterclaims brought by Sentry, and
3) motion of Sentry for summary judgment on the claims brought by New York.

For the reasons stated below, the Court will allow the motions of New York for summary judgment and the motion of Sentry for summary judgment with respect to Count 5 of New York’s complaint. Sentry’s motion for summary judgment with respect to Counts 1-4 will be denied.

I. BACKGROUND

The relevant facts are recited in the light most favorable to the non-moving parties. O’Connor v. Steeves, 994 F.2d 905, 907 (1st Cir.1993).

Health Plans, a Worcester, Massachusetts, corporation, created and administered a multiple employer trust (“MET”) called the Employers Group Insurance System (“EGIS”). The underlying purpose of the EGIS was to allow small employers to join together to obtain group health insurance. As the third-party administrator of the EGIS, Health Plans marketed the plan, collected the premiums and processed the claims. Health Plans did not, however, provide the actual insurance coverage for the EGIS.

In the early-to-mid 1980s, Health Plans retained Sentry to provide the insurance coverage for the EGIS. In 1987, though, Health Plans became concerned with Sentry’s premium rate, increases, and, as a result, switched to New York Life on July 1, 1987.

*944 When New York first agreed to provide the coverage for the EGIS, the EGIS had a total of approximately $5 million in annualized premiums. In 1988, as other METs failed, New York agreed to bring more insureds into the EGIS. Consequently, by the end of 1988, the EGIS had annualized premiums in excess of $30 million.

Although the EGIS was growing, New York nevertheless claimed that it was losing money. New York, therefore, negotiated a new deal with Health Plans in February, 1989. Under the new contract, New York agreed to provide the insurance coverage for the EGIS through 1989, and both parties agreed to 1) implement more restrictivé underwriting criteria, 2) increase premiums, and 3) impose expense controls.

Later that same year, Health Plans became concerned that New York’s new premiums were too high. As a result, Health Plans entered into renewed negotiations with both Sentry and New York. At the end of those negotiations, Health Plans decided to keep New York as the insurance carrier for the EGIS for the ensuing year. Accordingly, on October 26, 1989, Health Plans and New York signed a “letter agreement” to continue their relationship through at least December 31, 1990. They further agreed that: 1) New York would advance $200,000 to Health Plans as a marketing allowance for 1990, and 2) if Health Plans did not make a minimum of $6 million in sales during 1990, it would refund the $200,000.

By June, 1990, Health Plans had sales in the amount of only $1.15 million, and the total EGIS premium had decreased to approximately $15 million. Those poor results led to New York’s decision, in July, 1990, to abandon the MET marketplace. Accordingly, New York advised Health Plans to find another insurance carrier for the EGIS as soon as possible, but nevertheless agreed to continue insuring the EGIS for up to a year if Health Plans could not secure another carrier before then.

Health Plans immediately began its search for a new carrier for the EGIS and entered into negotiations with Sentry. Health Plans and Sentry eventually reached an agreement in November, 1990. Under that agreement, they offered to the 87% lowest-risk insureds the opportunity to transfer to a new EGIS trust (“EGIS II”) covered by Sentry, effective January 1, 1991.

New York objected to the Sentry/Health Plans agreement, because it transferred less than the entire EGIS block. The remaining 13% of the highest-risk insureds remained with New York. New York claims that, by “cherry-picking” the lowest-risk insureds, Sentry and Health Plans 1) violated the exclusive marketing provision of New York’s contract with Health Plans, 2) misused New York’s proprietary information, and 3) breached Health Plan’s duty to conserve the EGIS block of business.

New York continued to insure the 13% high-risk participants of the EGIS until May, 1991, at which time the number of EGIS insureds had dwindled to a point that entitled New York to terminate the policy. New York claims that it lost more than $1 million as a result of the partial transfer.

II. DISCUSSION

A. Summary Judgment Standard

Summary Judgment shall be rendered where the pleadings, discovery on file and affidavits, if any, show “there is no genuine issue as to any material fact and ... the moving party is entitled to a judgment as a matter of law.” Fed.R.Civ.P. 56(c). The Court must view the entire record in the light most favorable to the nonmoving party and indulge all reasonable inferences in its favor. O’Connor, 994 F.2d at 907.

With respect to a motion for summary judgment, the burden is on the moving party to show that “there is an absence of evidence to support the non-moving party’s case.” FDIC v. Municipality of Ponce, 904 F.2d 740, 742 (1st Cir.1990), quoting Celotex Corp. v. Catrett, 477 U.S. 317, 325, 106 S.Ct. 2548, 2553, 91 L.Ed.2d 265 (1986). If the movant satisfies that burden, it shifts to the non-moving party to establish the existence of a genuine material issue. Id.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

United Air Lines, Inc. v. Gregory
716 F. Supp. 2d 79 (D. Massachusetts, 2010)
Mazzitti v. Garden City Group, Inc., 06ap-850 (6-28-2007)
2007 Ohio 3285 (Ohio Court of Appeals, 2007)
Azar v. Prudential Insurance Co. of America
2003 NMCA 062 (New Mexico Court of Appeals, 2003)
Dunkin' Donuts Inc. v. Gav-Stra Donuts, Inc.
139 F. Supp. 2d 147 (D. Massachusetts, 2001)
Premier Technical Sales, Inc. v. Digital Equipment Corp.
11 F. Supp. 2d 1156 (N.D. California, 1998)
Dunkin' Donuts Inc. v. Panagakos
5 F. Supp. 2d 57 (D. Massachusetts, 1998)

Cite This Page — Counsel Stack

Bluebook (online)
898 F. Supp. 941, 1995 U.S. Dist. LEXIS 13783, 1995 WL 559075, Counsel Stack Legal Research, https://law.counselstack.com/opinion/health-plans-inc-v-new-york-life-insurance-mad-1995.