Individual Healthcare Specialists, Inc. v. BlueCross BlueShield Of Tennessee, Inc.

CourtCourt of Appeals of Tennessee
DecidedMay 15, 2017
DocketM2015-02524-COA-R3-CV
StatusPublished

This text of Individual Healthcare Specialists, Inc. v. BlueCross BlueShield Of Tennessee, Inc. (Individual Healthcare Specialists, Inc. v. BlueCross BlueShield Of Tennessee, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals of Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Individual Healthcare Specialists, Inc. v. BlueCross BlueShield Of Tennessee, Inc., (Tenn. Ct. App. 2017).

Opinion

05/15/2017

IN THE COURT OF APPEALS OF TENNESSEE AT NASHVILLE February 21, 2017 Session

INDIVIDUAL HEALTHCARE SPECIALISTS, INC. V. BLUECROSS BLUESHIELD OF TENNESSEE, INC.

Appeal from the Chancery Court for Davidson County No. 111042III Ellen H. Lyle, Chancellor

No. M2015-02524-COA-R3-CV

This is a breach of contract action in which the issues hinge on the meaning of several provisions in the agreement. In 1999 and again in 2009, BlueCross BlueShield of Tennessee, Inc. (“BlueCross”) and Individual Healthcare Specialists, Inc. (“IHS”) entered into a general agency agreement that authorized IHS to solicit applications for individual insurance policies through IHS’s in-house agents and outside “subagents.” The commission rates to be paid were stated in a schedule, which was subject to modification by BlueCross. During the first eleven years, BlueCross modified the commission schedule several times and each modification was prospective only. In 2011, BlueCross modified the commission schedule and, for the first time, applied the commission schedule retrospectively. At the same time, IHS determined that BlueCross had been underpaying commissions since 1999. As a consequence, it commenced this action asserting claims for, inter alia, breach of contract and damages, while also claiming it was entitled to recover its attorney’s fees based on the contract’s indemnification provision. BlueCross denied any breach of contract. It also asserted the statute of limitations defense as a bar to recovering any commissions that accrued more than six years earlier, and asserted that IHS was not entitled to recover its attorney’s fees because the indemnification provision did not apply to disputes between the contracting parties. Shortly thereafter, BlueCross terminated the general agency agreement and began paying renewal commissions directly to IHS’s subagents instead of paying them to IHS as it had done since 1999. IHS then amended its complaint to assert a claim that BlueCross also breached the agreement by failing to pay commissions directly to IHS. Following a bench trial, the court denied BlueCross’s statute of limitations defense on the ground that IHS’s claims were “inherently undiscoverable.” The court also determined that BlueCross breached the contract by underpaying commissions, by applying the 2011 commission rates for renewals to existing policies, and by failing to pay all renewal commissions to IHS after termination of the general agency agreement. As for damages, the court awarded IHS some of the damages it claimed but denied others on the ground the evidence was speculative. As for IHS’s attorney’s fees, the trial court considered parol evidence to ascertain the intent of the parties and held that the indemnification provision authorized the recovery of attorney’s fees in a dispute between the contracting parties. Accordingly, it held that IHS, as the prevailing party, was entitled to recover its attorney’s fees. Both parties appeal. We affirm the trial court in all respects but one, that being the award of attorney’s fees. We have determined the trial court erred by considering parol evidence to determine the meaning of the indemnification provision. We also find that the indemnification provision does not apply to contractual disputes between the parties. Accordingly, IHS is not entitled to recover its attorney’s fees in this action.

Tenn. R. App. P. 3 Appeal as of Right; Judgment of the Chancery Court Affirmed in Part and Reversed in Part

FRANK G. CLEMENT, JR., P.J., M.S., delivered the opinion of the Court, in which ANDY D. BENNETT and RICHARD H. DINKINS, JJ., joined.

E. Todd Presnell, Joel D. Eckert, Edmund S. Sauer, and Junaid A. Odubeko, Nashville, Tennessee, for the appellant, BlueCross BlueShield of Tennessee, Inc.

Jay S. Bowen and Will Parsons, Nashville, Tennessee, for the appellee, Individual Healthcare Specialists, Inc.

OPINION

In 1999, BlueCross and IHS negotiated and executed a General Agency Agreement (“the 1999 agreement”). This agreement authorized IHS to solicit applications for BlueCross’s individual hospital, surgical, medical, and supplemental insurance policies through a network of in-house agents and outside brokers, known as “subagents” or “producing agents.” In 2009, BlueCross and IHS renewed their contractual relationship by executing a second agency agreement (“the 2009 agreement”) that was substantially similar to the 1999 agreement.

Pursuant to each of the agreements, BlueCross agreed to compensate IHS and its subagents by paying a commission on sales. BlueCross paid two types of commissions: first year commissions, based on premiums paid in the insurance policy’s first year; and renewal commissions, based on renewal premiums paid in subsequent years. Attached to, and incorporated by reference within, the 1999 agreement was a “Commission Schedule,” which set the specific commission rates for first year and renewal commissions for each of BlueCross’s insurance products. The commission schedule expressly provided that it “shall be subject to change by BlueCross,” and BlueCross exercised its right to modify the commission schedule under the 1999 agreement on

-2- several occasions.1 Each modified commission schedule contained the following language:

3. This Commission Schedule supplements any previous Commission Schedule you may have received; commissions for products previously sold are governed by the Commission Schedule in place at the time the sale was made.

...

[BlueCross] reserve[s] the right to modify or change the commission and payment schedules with appropriate notification.

(Emphasis added).

When the parties entered into their 2009 agreement, they continued to provide for compensation pursuant to a commission schedule which was attached to the contract and incorporated by reference therein. As before, and in pertinent part, the commission schedule included within the 2009 agreement provided that it “supplements any previous Commission Schedule . . . ,” and that “commissions for products previously sold are governed by the Commission Schedule in place at the time the sale was made.” The 2009 commission schedule also reserved BlueCross’s right to modify or change the commission and payment schedules with appropriate notice.

Further, the 2009 agreement provided that BlueCross would pay all commissions, whether for policies sold by IHS’s in-house agents or its subagents, directly to IHS. With respect to policies sold by subagents, IHS would retain a portion of the commission and remit the remainder to the subagent. The agreement stated that “in the event [IHS] is no longer able, entitled or available to receive Commissions, [BlueCross] shall use its best efforts to contract individually with the [subagents] . . . .”

The 2009 agreement also authorized either party to cancel the agreement “at any time and for any reason . . . upon ninety (90) days prior written notice.” Upon termination,

Neither party and no Producing Agent shall have any claim against the other for any alleged loss of prospective profits or commissions . . . , with

1 The record indicates that BlueCross modified the commission schedule under the 1999 agreement on the following occasions: April 2004, June 2005, October 2005, January 2006, December 2006, June 2008, and November 2008.

-3- the exception that renewal commissions for policies with effective dates prior to termination will continue to be paid by [BlueCross].

Further, the agreement contained an indemnity provision requiring BlueCross to,

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