Lincoln General Insurance v. U.S. Auto Insurance Services, Inc.

787 F.3d 716, 2015 U.S. App. LEXIS 8172, 2015 WL 2383693
CourtCourt of Appeals for the Fifth Circuit
DecidedMay 18, 2015
Docket13-10589
StatusPublished
Cited by28 cases

This text of 787 F.3d 716 (Lincoln General Insurance v. U.S. Auto Insurance Services, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lincoln General Insurance v. U.S. Auto Insurance Services, Inc., 787 F.3d 716, 2015 U.S. App. LEXIS 8172, 2015 WL 2383693 (5th Cir. 2015).

Opinion

GREGG COSTA, Circuit Judge:

A party that obtains a multimillion dollar judgment at trial usually leaves the courthouse happy. The Plaintiff in this case, Lincoln General Insurance Company, is an exception. After a bench trial, the district court awarded Lincoln $16.5 million on its tortious interference claims against CSi Agency Services, Inc. and Alpha Partners, Limited. The conduct that led to that judgment involved the diversion of funds from a reinsurance arrangement involving insurer Lincoln and a claims administrator named U.S. Auto Insurance Services Company.

Despite being awarded a large judgment, it is Lincoln who raises the vast majority of ostensible errors in this cross appeal. Lincoln contends that the district court erred in dismissing other claims and Defendants before trial. The other claims are for breach of contract, breach of fiduciary duty, conversion, and derivative liability based on theories of alter ego and aiding and abetting. The Defendants are U.S. Auto, a number of affiliated companies, and Doug and Jim Maxwell, the father-son team associated with these entities.

The only error asserted by the parties who lost at trial, CSi and Alpha, is that the *719 tortious interference claims are time barred.

I.

This case arises from a complicated series of transactions often called “fronting arrangements” in the insurance industry. 1 A nonparty to this lawsuit, State and County Insurance Co. (S & C), fronted auto insurance policies. That means the policies were issued in S & C’s name but it bore no risk. Lincoln was the party incurring the insurance risk as it reinsured 100% of S & C’s liabilities under policies issued from 2003 through 2007. This departed from a previous agreement Lincoln signed with S & C in 2002, which allocated just 45% of the liabilities to Lincoln and the remainder to another reinsurer who is not involved in the current dispute.

U.S. Auto, a company entirely owned and operated by Doug Maxwell, served as the managing general agent for S & C pursuant to a General Agency Agreement. As managing general agent, U.S. Auto’s responsibilities included issuing policies in S & C’s name; collecting and handling the premiums paid by the insureds; and investigating, adjusting, and paying any claims. The General Agency Agreement required U.S. Auto to set up a “Premium Trust Account” to manage the money from these various transactions, although U.S. Auto had the “privilege of retaining [its] commission! ]” prior to depositing any collected money into the trust account. U.S. Auto hired Gamma Group, Inc., another entity owned by Doug Maxwell, to assist with handling the claims. During the relevant time period, U.S. Auto’s only business involved the auto policies issued by S & C and reinsured by Lincoln.

The agreements between the parties provided for the following. As the nominal issuer of the policies, S & C would receive a small percentage off the top of the premiums collected. U.S. Auto would receive 20.6% of what remained as compensation for its administrative work. The parties anticipated that actual payouts on claims to the insureds — labelled “incurred losses” — would amount to 69.4% of the remaining collected premiums. This percentage is the “target loss ratio.” As an incentive, U.S. Auto could receive an additional commission based on any amount the target loss ratio exceeded actual losses. In other words, if claims paid on the policies ended up being less than the anticipated 69.4% of premiums, U.S. Auto as the claims handler would receive that difference. The remaining 10% of premiums was expected to go to Lincoln as its profit for bearing the risk. Lincoln’s actual receipt of its 10% margin thus depended on paid claims not exceeding the expected 69.4% figure; if claims paid exceeded that target loss .ratio, the additional amount needed to pay claims would come out of the 10% otherwise owed to Lincoln.

Because the profit of the parties depended so heavily on the target loss ratio and the amount of incurred losses, the agreements detailed the accounting techniques used to compute those numbers. One difficulty they addressed was the uncertainty in calculating incurred losses, which may be paid even after a policy has expired so long as the event triggering the claim occurred during the policy period. The formula to calculate incurred losses thus included an adjustment based on projected “incurred but not reported” losses. By making an adjustment for IBNR, the accounts would more accurately reflect the *720 amount ultimately paid out for claims, and thus how much profit the parties would make.

As things turned out, actual losses for all relevant years fell below the target loss ratio of 69.4%. This should have resulted in all parties making money. Instead, Lincoln lost millions. The reasons why gave rise to this lawsuit.

During the first four years it acted as managing general agent, U.S. Auto transferred approximately $50 million to CSi Agency Services and Alpha Partners, two companies owned by Doug Maxwell and his father, Jim Maxwell. The transfers to CSi were purportedly made pursuant to a contract for the purchase of information technology and management services. No contract exists to support the transfers between U.S. Auto and Alpha. After receiving inflated management fees, Alpha and CSi distributed the money to Doug Maxwell and Jim Maxwell. All told, roughly $30 million flowed to Jim Maxwell and $20 million to Doug Maxwell.

Transfers of these vast sums would obviously lead to a shortfall at some point in the future. Doug Maxwell recognized this. But in reasoning reminiscent of a Ponzi scheme, he hoped that U.S. Auto would obtain funds through future business with other reinsurers that would allow it to replenish the depleted accounts needed to cover Lincoln’s liabilities under the auto policies.

That future business never materialized and, by 2006, the Premium Trust Account ran out of funds to pay the claims for which Lincoln was liable. This required Lincoln to fund a zero balance account, which is so named because it automatically receives funds from another account when a check is presented for payment but does not otherwise receive funds (thus, the balance is always zero). U.S. Auto misused this zero balance account to pay 100% of the claims due under the 2002 agreement, even though Lincoln was only responsible for 45% of those liabilities.

In April 2007, U.S. Auto stopped issuing policies under the S & C name. It transferred all new business to Santa Fe Auto, another entity operated by Doug and Jim . Maxwell. Around this same time, U.S. Auto “ran out of money” and “unilaterally” changed the formula used to calculate its commissions on the S & C policies for which Lincoln was on the hook. ROA 4566. As discussed previously, those additional commissions would be earned by U.S. Auto only if incurred losses fell below the 69.4% target loss ratio, and the agreements adjusted incurred losses upwards to accommodate for incurred but not reported losses. U.S. Auto removed incurred but not reported losses from the commission calculations, thereby creating the illusion of smaller incurred losses. This benefited U.S. Auto because it made the incurred loss ratio fall further below the target loss ratio, thereby inflating U.S. Auto’s commission.

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Bluebook (online)
787 F.3d 716, 2015 U.S. App. LEXIS 8172, 2015 WL 2383693, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lincoln-general-insurance-v-us-auto-insurance-services-inc-ca5-2015.