JEFFERSON PARISH CLERK OF COURT HEALTH INSURANCE TRUST FUND EX. REL. MOULEDOUX v. Fidelity & Deposit Co.

673 So. 2d 1238
CourtLouisiana Court of Appeal
DecidedApril 30, 1996
Docket95-CA-951 to 95-CA-957
StatusPublished
Cited by18 cases

This text of 673 So. 2d 1238 (JEFFERSON PARISH CLERK OF COURT HEALTH INSURANCE TRUST FUND EX. REL. MOULEDOUX v. Fidelity & Deposit Co.) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
JEFFERSON PARISH CLERK OF COURT HEALTH INSURANCE TRUST FUND EX. REL. MOULEDOUX v. Fidelity & Deposit Co., 673 So. 2d 1238 (La. Ct. App. 1996).

Opinion

673 So.2d 1238 (1996)

JEFFERSON PARISH CLERK OF COURT HEALTH INSURANCE TRUST FUND Through its Trustee, Warren E. MOULEDOUX, Jr.
v.
FIDELITY AND DEPOSIT COMPANY OF MARYLAND, et al.
Marilyn McKINNIE
v.
CLERK OF COURT, JEFFERSON PARISH and Benefit Management Services.
Vic A. PITRE, Sr., et al
v.
OFFICE OF the CLERK OF COURT In and For the PARISH OF JEFFERSON, et al.
Karen NOLAN, Wife of/and James J. LeBLANC
v.
OFFICE OF the CLERK OF COURT In and For the PARISH OF JEFFERSON, et al.
Charlene ATTARDO, Wife of/and Frank J. Attardo, Jr.
v.
BENEFIT MANAGEMENT SERVICES, et al.
Jon A. GEGENHEIMER, Clerk of Court For the Parish of Jefferson
v.
JEFFERSON PARISH CLERK OF COURT HEALTH INSURANCE TRUST FUND.
Janos I. VOROS, M.D.
v.
Yvette O'NEILL.

Nos. 95-CA-951 to 95-CA-957.

Court of Appeal of Louisiana, Fifth Circuit.

April 30, 1996.
Rehearing Denied May 31, 1996.

*1239 Maura Z. Pelleteri, Eugene R. Preaus, New Orleans, for Plaintiff/Appellant Fidelity & Deposit Company of Maryland.

Jacob J. Amato, Jr., Stephen C. Grefer, Gretna, for Plaintiff/Appellee/Appellant Marilyn McKinnie.

*1240 Melvin Ripp, Jr., Gretna, for Plaintiffs/Appellees/Appellants Vic Pitre and Karen LeBlanc.

S. Guy deLaup, Metairie, for Plaintiff/Appellee/Appellant Jefferson Parish Clerk of Court Health Insurance Trust Fund through its trustee, Warren E. Mouledoux, Jr.

Before GOTHARD, CANNELLA and DALEY, JJ.

DALEY, Judge.

This appeal is comprised of seven consolidated suits[1] that arose out of the Jefferson Parish Clerk of Court Health Insurance Trust Fund's failure to pay health insurance benefits on behalf of a group of insured employees of the Jefferson Parish Clerk of Court under former Clerk of Court, Raoul A. "Skip" Galan, Jr.'s tenure. After a three day trial the trial court rendered judgment in favor of the Jefferson Parish Clerk of Court Health Insurance Trust Fund (Trust Fund) and against defendant Fidelity & Deposit Company of Maryland (F & D), the insurer of the Trust Fund pursuant to a Commercial Crime Policy, in the sum of $50,000.00, together with legal interest from the date of judicial demand, and all costs of the proceedings. The judgment dismissed all of the claims of the Trust Fund, Vic Pitre, Sr., Octavia Clark Pitre, Karen Nolan, wife of/ and James LeBlanc, and Marilyn McKinnie against the office of the Clerk of Court for the Parish of Jefferson.

The Trust Fund appeals the judgment in favor of the Clerk of Court and also appeals the limiting of the amount of F & D's liability to $50,000.00. In addition, the Trust Fund claims that the trial court erred in failing to hold that F & D forfeited the $50,000.00 penal sum under its policy when F & D deposited the $50,000.00 with the registry of the court pursuant to a concursus proceeding initiated by F & D.

F & D appeals, asserting as error the trial court's finding that the Trust Fund sustained covered losses and the trial court's finding of "employee dishonesty" as per the definition under F & D's Commercial Crime Policy. F *1241 & D also appeals claiming error by the trial court in admitting certain documentary evidence concerning criminal activity of Raoul A. Galan.

Individual plaintiffs, Marilyn McKinnie, Vic Pitre, and Karen LeBlanc also appeal the judgment which dismissed their claims against the Clerk of Court's office.

We affirm that portion of the trial court's judgment finding Galan liable in his capacity as Trustee of the Trust Fund. We affirm the trial court's finding of employee dishonesty and thus coverage under F & D's Commercial Crime policy. We also affirm that portion of the judgment which found only one "occurrence" or scheme of employee dishonesty. We reverse that portion of the judgment that found no liability against the office of Clerk of Court or Raoul A. Galan in his official capacity.

The history of events leading to this litigation began in July of 1987 when Galan, the duly elected Clerk of Court for the Parish of Jefferson, decided to cancel his office's health insurance policy through the Louisiana Clerks of Court Association with Equitable Life Insurance Company and establish a self-insurance plan.[2] Galan learned from Equitable that for the past year claims had greatly exceeded premiums paid, and that a premium increase (as much as 42%) and a benefit reduction was probable. Galan felt that a self-insurance program would result in a substantial savings for the Clerk of Court and his employees.

In July of 1987, the Trust Fund was established. The Plan's enabling document is entitled "Welfare Plan Trust Agreement for Employees of Jefferson Parish Clerk of Court Self Insured Fund". Galan signed as Sponsor. Galan hired Richard Camus[3] and Camus and Associates, d/b/a/ Benefit Management Services (BMS), a Camus company, to set up and administer the plan. Galan testified that Camus was an actuary whom he had met in the early 1970's in connection with other business. The Trust Fund Plan operated under the same premium and benefit schedule as had Equitable. Three trustees were appointed by Galan: himself; Gary Aspiazu, the Chief Deputy Clerk of Court; and Donald F. Crist, the Personnel Director for the Clerk of Court's Office. Two bank accounts were established in connection with the Trust Fund: the Trust Account and the Claims Account. Employees' share of premiums[4] were deducted from their paychecks and paid into the Clerk of Court Fee Fund, the operating account for the Clerk's office. Retirees who were participating in this plan paid one half their premium, the Clerk of Court the other half. Retirees' contributions were supposed to be deposited directly into the Trust Account rather than the Fee Fund. The premiums, including the Clerk's portions, were paid from the Clerk's Fee Fund into the Trust Fund's Trust Account. Administrative and management fees were paid out of the Trust Account. Claims were processed and adjusted by Camus/BMS. When claims were adjusted money would be transferred from the Trust Account into the Claims Account, whereupon checks would be issued to claimants. Only Galan had the authority to approve, issue, and sign checks from the Trust and Claims accounts.

Despite having a surplus of approximately $2 million when Galan took office in July 1984, by 1987 the Clerk's Office was experiencing severe financial constraints, which Galan attributed to a decrease in filings and the downturn in the real estate market. Almost from the Plan's inception, the Clerk's Office was nearly always late in paying the premiums from the Clerk's Fee Fund to the Trust Fund's Trust Account. Many of these late payments were made in installments instead of a lump sum per month as billed. In turn, *1242 the Trust Fund experienced difficulty in paying its claims timely or at all. Often, checks made out to beneficiaries and/or providers would accumulate awaiting the injection of money into the Claims Account from the Clerk's Fee Fund. Other claimants were not paid at all, which resulted in the instant suits. In hindsight, the record shows that the Trust Fund was inadequately funded from the beginning. Despite numerous notices to Galan by employees that the Trust Fund did not have enough money to pay its claims, premiums were never raised nor benefits adjusted during the year of the Trust Fund's existence.[5]

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Bluebook (online)
673 So. 2d 1238, Counsel Stack Legal Research, https://law.counselstack.com/opinion/jefferson-parish-clerk-of-court-health-insurance-trust-fund-ex-rel-lactapp-1996.