Holroyd v. Requa

603 S.E.2d 417, 361 S.C. 43, 2004 S.C. App. LEXIS 275
CourtCourt of Appeals of South Carolina
DecidedSeptember 24, 2004
Docket3852
StatusPublished
Cited by17 cases

This text of 603 S.E.2d 417 (Holroyd v. Requa) is published on Counsel Stack Legal Research, covering Court of Appeals of South Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Holroyd v. Requa, 603 S.E.2d 417, 361 S.C. 43, 2004 S.C. App. LEXIS 275 (S.C. Ct. App. 2004).

Opinion

CURETON, A.J.:

Christopher Holroyd, Gillian Holroyd, and American AVK Company (collectively “Respondents”) brought this action against their insurance agent, Michael Requa, alleging various causes of action for misrepresentation, fraud, and negligence stemming from Requa’s solicitation and sale of a health insurance policy to Respondents. Requa denied these allegations and claimed Respondents’ state law causes of action were preempted and barred by the federal Employee Retirement Income Security Act, 29 U.S.C. §§ 1001 to -1461 (Supp.2003) (“ERISA”). The jury rendered a verdict in favor of Respondents. The trial court subsequently denied Requa’s post-trial motions for judgment notwithstanding the verdict and new trial. Requa now appeals. We affirm.

BACKGROUND

Requa was an insurance agent doing business in Moncks Comer, South Carolina. At the center of this case is a health insurance plan administered by Fidelity Group, Inc., that Requa marketed to American AVK Company for its employees. At issue was whether Requa was liable for Fidelity’s failure to pay legitimate medical expense claims filed by Holroyd, one of American AVK’s employees.

Fidelity’s Health Insurance Plan

The program administered by Fidelity was not a typical insurance plan. Rather than being developed and sold by a traditional insurance company, the Fidelity plan was the product of an association of several distinct entities.

Around 1995, a purported employee union called the International Workers Guild (IWG) (also known as the Intemation *50 al Workers Association) entered into a collective bargaining agreement with a purported employer’s association, the National Association of Business Owners and Professionals (NA-BOP). 1 Under this agreement, employees joining IWG would be provided healthcare benefits through a third-party-trust called the International Guild Health and Welfare Trust Fund (IWG Fund). The arrangement provided in part that employers would join the collectively bargained agreement prepared by the organizers of the arrangement with IWG and NABOP. Employees paid membership dues to IWG, and the employers made monthly contributions on behalf of their enrolled employees. The IWG Fund managed the plan, and Fidelity marketed it and administered claims.

Requa was recruited to market the Fidelity plan to his customers by John Branham and Marty Geitler, the exclusive general agents for the Plan. Over the course of two meetings, Branham and Geitler explained the structure and benefits of the Plan and provided Requa with marketing materials prepared by Fidelity. Several months later, Requa executed a marketing agreement to act as agent for the Fidelity Plan.

Requa’s Solicitation of American AVK

In late 1996, Requa sent a letter to American AVK Company, a subsidiary of an international company with offices in California and South Carolina, soliciting interest in a group health insurance program from Fidelity Group, Inc.

The letter described the pricing, benefits, and network of care providers that were included in the Fidelity plan. Requa made various claims in the letter about the quality of the Fidelity plan. He wrote that it offered “great benefits with reasonable prices,” had “[a] history of low rate increases and an A+ rate,” was “# 1 in benefits compared to other carriers,” and was “[l]ocally strong with reciprocal access nationwide.” In addition to these more subjective claims, Requa specifically noted that “[t]he Fidelity Group has an average annual rate increase of only 3.4% over the last 8 years.” The letter further claimed Fidelity was reinsured through “Reli *51 anee [Reinsurance Company], rated A+ by A.M. Best.” 2 The Fidelity plan was the only product promoted in the letter.

Shortly after receiving Requa’s letter, American AVK decided to enroll in the Fidelity Plan. American AVK paid monthly premiums for the coverage and the participating employees made monthly contributions.

Failure of the Fidelity Plan

Within months of American AVK’s enrollment in the Plan, Fidelity began having problems paying claims in a timely manner. No later than July 1997, Requa was aware Fidelity was experiencing problems — specifically advising one of his clients that “[t]he Fidelity Group has apparently experienced rapid growth — too soon — -without the capacity to handle it.”

Also in July 1997, Requa received a letter from the South Carolina Department of Insurance notifying him that the Fidelity Group’s insurance plan and Requa’s involvement in marketing that plan were the subject of an investigation as to whether Fidelity had complied with state law regulating the sale of insurance. The letter instructed Requa to immediately cease the marketing and sale of the Plan until the Department of Insurance was able to make a final determination.

It is undisputed that Requa did not advise American AVK or its employees of the difficulties experienced by the Fidelity Plan or the ongoing investigation when he learned of the problems. In May 1998, Requa claimed he sent a letter to all of his clients enrolled in the Fidelity Plan, including American AVK, advising them that “your health insurer, The Fidelity Group, has some serious problems and that it may be time to move to another, more competent carrier.” Respondents, however, deny ever having received this letter.

Holroyd’s Unpaid Claims

This action arises from unpaid medical claims submitted to Fidelity by one of American AVK’s enrolled employees, Christopher Holroyd. Holroyd suffered severe heart attacks in July and October 1998. He incurred approximately $65,000 in medical costs, which Fidelity did not pay. Because Requa *52 failed to inform them of Fidelity’s problems, Holroyd, his wife, Gillian, and American AVK filed the underlying action against Requa. The jury returned a verdict in favor of Respondents on the charges of negligence, negligent misrepresentation, and breach of fiduciary duty. Respondents were awarded $365,000 in actual damages and $180,000 in punitive damages.

Requa moved for judgment notwithstanding the verdict (JNOV), a new trial absolute, and a new trial nisi remittitur, which were denied. Requa appeals.

STANDARD OF REVIEW

“In ruling on directed verdict or JNOV motions, the trial court is required to view the evidence and the inferences that reasonably can be drawn therefrom in the light most favorable to the party opposing the motions.” Sabb v. South Carolina State Univ., 350 S.C. 416, 427, 567 S.E.2d 231, 236 (2002). The motions must be denied by the trial court when the evidence yields more than one inference or its inference is in doubt. Steinke v. South Carolina Dep’t of Labor, Licensing & Regulation, 336 S.C. 373, 386, 520 S.E.2d 142, 149 (1999). On appeal from the denial of a motion for a directed verdict or JNOV, this Court will reverse the trial court only where there is no evidence to support the ruling below.

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Bluebook (online)
603 S.E.2d 417, 361 S.C. 43, 2004 S.C. App. LEXIS 275, Counsel Stack Legal Research, https://law.counselstack.com/opinion/holroyd-v-requa-scctapp-2004.