Intertel, Inc. v. Sedgwick Claims Management Services, Inc.

204 S.W.3d 183, 2006 Mo. App. LEXIS 984, 2006 WL 1867907
CourtMissouri Court of Appeals
DecidedJune 30, 2006
DocketED 85163, ED 85201
StatusPublished
Cited by36 cases

This text of 204 S.W.3d 183 (Intertel, Inc. v. Sedgwick Claims Management Services, Inc.) is published on Counsel Stack Legal Research, covering Missouri Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Intertel, Inc. v. Sedgwick Claims Management Services, Inc., 204 S.W.3d 183, 2006 Mo. App. LEXIS 984, 2006 WL 1867907 (Mo. Ct. App. 2006).

Opinion

NANNETTE A. BAKER, Presiding Judge.

Introduction

Intertel, Inc. (“Intertel”) appeals from a judgment entered after a jury returned a unanimous verdict in favor of Intertel on its breach of contract claim against Sedg-wick Claims Management Services, Inc. (“SCMS”) in the amount of $31,000.00 and verdicts in favor of Intertel on all of SCMS’s counterclaims. Intertel claims eight points on appeal and SCMS claims one point on cross-appeal. We affirm in part and reverse and remand for new trial.

Factual Background and Proceedings Below

SCMS, a third-party claims administrator, handles insurance claims in the insurance industry. Large corporations that choose to self-fund their own insurance losses hire companies like SCMS to review and evaluate claims. These self-funded corporations then provide money to third-party administrators to process submitted claims.

Many states have enacted legislation requiring companies like SCMS to utilize Special Investigative Units (“SIUs”) for investigating claims. SIUs not only investigate claims, but also create fraud plans and educational programs for employees regarding the proper method of conducting investigations. Under this system, a claim is submitted to SCMS and if an SCMS examiner suspects fraud, the claim is sent to a SIU firm. Upon receiving the claim, the SIU assigns the claim to a local investigation firm (“vendor”) to conduct the investigation that SCMS requested. *190 The vendor ultimately sends its field report to SCMS. To get paid, the vendor must submit a bill to the SIU who then adds in overhead charge and sends the bill to SCMS for payment. Using funds from the client’s bank account, SCMS sends a check to the SIU for the total amount so that the SIU can pay the vendor its share.

SCMS and Intertel entered into a service agreement (“Service Agreement”) whereby Intertel became SCMS’s SIU as of October 1999. The Service Agreement had no fixed term of months or years. Instead, it continued until either party terminated it upon sixty days’ written notice or if breached, upon written notice by the non-breaching party. Under the agreement, Intertel’s responsibilities were limited to claims that SCMS “specifically referred” to it per “Exhibit A.” Exhibit A states that parties would follow the referral procedures outlined in SCMS’s SIU Manual (“SIU Manual”).

Soon after Intertel signed the Service Agreement, Intertel began experiencing both performance and financial problems as the SIU. In 2000, SCMS customers began complaining about Intertel’s SIU services. Intertel’s employee Lori Morgan (“Morgan”), the National Account Manager for the SCMS account at the time, ran the SIU program and handled Intertel’s SIU performance problems.

As of September 2000, Intertel’s liabilities exceeded its assets by over $230,000.00. After one year as the SIU, Intertel posted an annual loss of $27,559.00. In December 2000, Intertel told SCMS that it needed $300,000.00 to continue its business and asked SCMS to invest capital in Intertel for that amount. A week later, Intertel requested an additional $58,000.00 from SCMS because In-tertel was unable to satisfy its current payroll and rent obligations. SCMS told Intertel that SCMS would have to conduct due diligence prior to making such an investment decision. In January 2001, SCMS sent a team to Intertel to review Intertel’s financial records. After reviewing the records, on February 6, 2001, SCMS declined Intertel’s investment request.

SCMS decided instead to assist Intertel by providing $5,000.00 per month and waiving the revenue-sharing provision of the Service Agreement. The revenue-sharing provision required Intertel to pay SCMS 15% of business referred to Intertel by SCMS. A month later, Intertel asked SCMS to provide it with an additional $30,000.00 to cover its payroll.

SCMS continued receiving complaints from its clients about Intertel’s performance as the SIU. Vendors complained that they did not receive payment from Intertel for services rendered. In May 2001, SCMS terminated the SIU relationship with Intertel over the phone. On June 4, 2001, SCMS sent a letter to Intertel entitled “Partial ' Termination of Service Agreement” notifying Intertel that as of August 3, 2001, it would no longer be SCMS’s SIU. Yet, SCMS did not terminate the entire business relationship. SCMS continued to use Intertel for select investigative services, namely its 3-in-l Claims Intelligence Program (“3-CIP”) 1 and certain hospital investigative checks. SCMS selected MJM Investigations, Inc. (“MJM”), one of Intertel’s vendors, to be the new SIU after August 3, 2001.

Shortly after SCMS terminated Intertel as the SIU, SCMS and Intertel began discussing Morgan’s employment with In- *191 tertel, since she would no longer manage the SIU for Intertel. Intertel could benefit in allowing Morgan to work for SCMS because she would be in a position to refer investigative business back to Intertel. Intertel offered her a bonus for any business she referred to Intertel. Intertel waived her non-compete clause, allowing Morgan to leave Intertel’s employment and commence employment with SCMS on June 15, 2001.

In August 2001, SCMS learned that the vendors had not received $801,977.40 that SCMS had paid Intertel to pay the vendors for services they provided SCMS clients. On September 24, 2001, SCMS terminated all remaining business relationships with Intertel by letter, effective November 20, 2001.

In February 2002, Intertel filed suit against SCMS, Morgan and MJM (collectively “Defendants”). In its Count I (“Count I”), Intertel alleged that Defendants entered into a civil conspiracy to drive Intertel out of business. Specifically, Intertel alleged that SCMS embarked on a campaign to take over Intertel’s business activities after utilizing purported sensitive information SCMS received from its due diligence in January 2001.

Intertel also brought breach of contract claims against SCMS (“Count II”), Morgan (“Count III”) and MJM (“Count IV”). In Count II, Intertel alleged that under the Service Agreement SCMS was obligated to refer all claims to Intertel and breached the agreement by failing to do so. In Count III, Intertel claimed that Morgan breached her employment contract by leaving Intertel, joining SCMS, and wrongfully disclosing Intertel’s purported confidential information and trade secrets to SCMS. In Count IV, Intertel alleged that when MJM contracted with Intertel to become a vendor for SCMS, MJM breached that contract by wrongfully disclosing Intertel’s confidential information and trade secrets to SCMS.

Intertel also claimed that SCMS induced Morgan to breach her contract with Inter-tel (“Count V”) and induced MJM to breach its contract with Intertel (“Count VI”). Intertel claimed SCMS induced both Morgan and MJM to breach their respective contracts to deprive Intertel of its business opportunities and rights. In-tertel sought punitive damages on Counts I, V, and VI.

In its Answer, SCMS denied all of Inter-tel’s claims and raised six counterclaims against Intertel: (1) fraud; (2) breach of fiduciary duty; (3) tortious interference; (4) breach of contract; (5) conversion; and (6) unjust enrichment.

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Bluebook (online)
204 S.W.3d 183, 2006 Mo. App. LEXIS 984, 2006 WL 1867907, Counsel Stack Legal Research, https://law.counselstack.com/opinion/intertel-inc-v-sedgwick-claims-management-services-inc-moctapp-2006.