Keeley & Sons, Inc. v. Zurich American Insurance Company

CourtAppellate Court of Illinois
DecidedApril 13, 2011
Docket5-10-0382 Rel
StatusPublished

This text of Keeley & Sons, Inc. v. Zurich American Insurance Company (Keeley & Sons, Inc. v. Zurich American Insurance Company) is published on Counsel Stack Legal Research, covering Appellate Court of Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Keeley & Sons, Inc. v. Zurich American Insurance Company, (Ill. Ct. App. 2011).

Opinion

NO. 5-10-0382 NOTICE

Decision filed 04/13/11. The text of IN THE this decision may be changed or

corrected prior to the filing of a APPELLATE COURT OF ILLINOIS Peti tion for Rehearing or th e

disposition of the same. FIFTH DISTRICT

KEELEY & SONS, INC., ) Appeal from the ) Circuit Court of Plaintiff-Appellee, ) St. Clair County. ) v. ) No. 10-L-163 ) ZURICH AMERICAN INSURANCE COMPANY, ) Honorable ) Lloyd A. Cueto, Defendant-Appellant. ) Judge, presiding.

JUSTICE WEXSTTEN delivered the judgment of the court, with opinion. Presiding Justice Chapman and Justice Donovan concurred in the judgment and opinion.

OPINION

The plaintiff, Keeley & Sons, Inc., filed a lawsuit against the defendant Zurich

American Insurance Company, seeking to recover alleged overpayments of premiums in the

total amount of $274,270 under two separate workers' compensation insurance policies

issued by the defendant. According to the allegations in the plaintiff's complaint, it overpaid

on these two policies due to the defendant's improper calculations of the premiums. Before

us now is the defendant's interlocutory appeal challenging the trial court's denial of its

amended motion to dismiss the plaintiff's complaint and compel arbitration. For the reasons

discussed herein, we affirm.

BACKGROUND

The plaintiff is a construction company located in East St. Louis, Illinois. The

defendant, an insurance company, issued the plaintiff two separate workers' compensation

and employers' liability insurance policies (collectively, the Policies) for its operations. The

1 first policy, number WC 9308164-00 (the 00 Policy), provided coverage from December 31,

2002, through December 31, 2003. The second policy, number WC 9308164-01 (the 01

Policy), provided coverage from December 31, 2003, through December 31, 2004.

Pursuant to the Policies, all the premiums were to be determined by the defendant's

manuals of rules, rates, rating plans, and classifications. Stated within the Policies, the final

premium for each of the Policies was also to be determined by using "the actual, not the

estimated, premium basis and the proper classifications and rates that lawfully applied to the

business and work covered by [each of the Policies]."1 Attached to the 00 Policy is an

endorsement entitled "CONTINGENT EXPERIENCE RATING MODIFICATION FACTOR

ENDORSEMENT," which states as follows:

"The premium for this policy will be adjusted by an experience rating modification

factor. The factor shown in the schedule is a Contingent Experience Rating

Modification factor based on the appropriate experience data available and replaces

any prior experience modification factor. We will issue an endorsement to show a

revised factor if appropriate additional experience data becomes available. The

Contingent factor will apply unless a revised factor is subsequently used."

The schedule within the endorsement states that the applicable contingent experience rating

modification factor was 1.77. Another endorsement is also attached to the 00 Policy; it is

entitled "ILLINOIS MOD CHANGE" and reads as follows: "DUE TO THE ILLINOIS

CONTINGENT MOD RULES, THE ILLINOIS MOD EFFECTIVE 12-31-02 IS

AMENDED TO 1.00 FOR THIS POLICY. THE RETURN PREMIUM IS SUBJECT TO

1 The court notes that although the 00 Policy does not contain this standard form

language, the record reveals the plaintiff's assertion that this standard language is also a part

of the 00 Policy because of several endorsements which modified the standard form

language.

2 AUDIT AND DEFERRED TO THE RETRO CALCULATION."

The 01 Policy contains an endorsement somewhat similar to the two endorsements

attached to the 00 Policy. It is entitled "CHANGES" and reads, in pertinent part, as follows:

"THE POLICY HAS BEEN AMENDED AS FOLLOWS: ENDORSEMENT #1 HAS BEEN

AMENDED TO READ: THE ILLINOIS EXPERIENCE MOD IS AMENDED TO 1.00.

THE MISSOURI EXPERIENCE MOD IS AMENDED TO 1.82. RETURN PREMIUM

SUBJECT TO AUDIT."

However, according to the plaintiff's allegations, the defendant improperly applied an

experience rating modification factor of 1.77 for the 00 Policy with respect to the plaintiff's

Illinois portion of the risk, increasing its premium calculation by $315,402.2 Therefore, after

the retrospective calculation on the 00 Policy was made, the plaintiff's total premium for that

policy equaled $351,943. Thus, the plaintiff alleges that had the defendant applied the

correct experience rating modification factor of 1.00, its total premium for the 00 Policy after

the retrospective calculation was applied should have been $216,029, thereby resulting in an

excess paid premium of $147,794.

Similarly, the plaintiff also alleges that the defendant improperly applied an

experience rating modification factor of 1.75 to the 01 Policy, thereby increasing the total

premium by $248,734. Accordingly, after the application of the retrospective calculation,

the total premium for the 01 Policy was $295,110. Yet the plaintiff alleges that had the

defendant applied the correct experience rating modification factor of 1.00, the total premium

due for the 01 Policy after the retrospective calculation should only have been $168,634,

2 In its complaint, the plaintiff states that the classification schedule attached to the 00

Policy and the 01 Policy actually shows the defendant's application of the incorrect

experience modification factor used to calculate the total premium due on each of the

Policies.

3 thereby resulting in an excess paid premium of $126,476. That alleged overcharge and the

retention of the plaintiff's overpayments give rise to the plaintiff's causes of action for a

breach of contract on each of the Policies.3

As the defendant points out on appeal, the allegations in the plaintiff's complaint refer

to the "retrospective calculation" applied to the total premiums for each of the Policies.

Explaining, the defendant states that the Policies were retrospectively rated, meaning that the

plaintiff's actual premiums on the Policies were to be determined based on actual losses that

may develop over time. According to the defendant, the reason for doing so was that, during

the effective period of coverage for each of the Policies, the actual attributable experience

was not yet known. Therefore, during the period of coverage applicable to each of the

Policies, the plaintiff paid what was called a "standard premium" (previously referred to in

this opinion as "premium" or "total premium"), which, the defendant asserts, is essentially

an estimate of the actual final retrospective premium. At the end of the coverage period and

periodically thereafter, the defendant was to calculate the actual retrospective premium

attributable to the program year according to a formula that took into account the actual

claims made and paid on the Policies. Thus, if the standard premium already paid by the

plaintiff was less than the actual final retrospective premium (i.e., if the actual claims

experience had been underestimated), then the plaintiff was to pay the difference to the

defendant. Conversely, if the standard premium turned out to be greater than the actual final

retrospective premium (i.e., if the parties had overestimated what the actual claims

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