Munich Reinsurance America, Inc. v. American National Insurance

999 F. Supp. 2d 690, 2014 U.S. Dist. LEXIS 25078, 2014 WL 793129
CourtDistrict Court, D. New Jersey
DecidedFebruary 27, 2014
DocketCivil No. 09-6435 (FLW)
StatusPublished
Cited by7 cases

This text of 999 F. Supp. 2d 690 (Munich Reinsurance America, Inc. v. American National Insurance) is published on Counsel Stack Legal Research, covering District Court, D. New Jersey primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Munich Reinsurance America, Inc. v. American National Insurance, 999 F. Supp. 2d 690, 2014 U.S. Dist. LEXIS 25078, 2014 WL 793129 (D.N.J. 2014).

Opinion

OPINION

WOLFSON, District Judge:

This case involves complex retrocessional agreements between Plaintiff Munich Reinsurance America Inc. (“Munich”) and Defendant American National Insurance Company (“ANICO”). Munich filed a Complaint alleging breach of contract for ANICO’s refusal to pay certain claims submitted for payment by Munich under the parties’ agreements, and in response, ANI-CO filed a counterclaim for rescission of the agreements. Following motion prac[697]*697tice, the Court conducted a nine-day bench trial with numerous experts and witnesses testifying as to each party’s obligations under the agreements as well as their respective business practices.

In light of the evidence presented at trial, the Court concludes that ANICO is not entitled to rescission of the agreements. The Court further finds that Munich satisfied its reporting obligations under the agreements in part, and thus ANICO breached its respective payment obligations for those claims that were properly ceded and reported. To wit, those claims to which Munich is entitled to payment include all claims that were properly ceded to ANICO via IOA Re before the expiration of the Sunset Provision deadlines, including claims that arise from underlying primary policies of workers’ compensation written by either Everest or Everest Re, but they do not include claims arising from injuries sustained by a roofing contractor or subcontractor. Further, Munich is not entitled to payment on those claims that were only first noticed on a spreadsheet Munich provided to IOA Re in August 2008, as that document did not satisfy the reporting requirements of Article XVI of the parties’ agreements.

I. OVERVIEW

A. Reinsurance

Before proceeding to the specifics of this case, the Court sets forth a brief overview of the reinsurance industry. As I noted in my previous opinion resolving the parties’ summary judgment motions, this overview of an issue as complex as reinsurance must be taken with a grain of salt; I merely seek to provide a basic primer to help orient the reader.

In Pacific Employers Ins. Co. v. Global Reins. Corp. of America, 693 F.3d 417 (3d Cir.2012), the Third Circuit described reinsurance as

insurance for insurance companies. A reinsurer agrees to indemnify a reinsured for certain payments the latter makes under one or more of its issued policies. In return, the reinsurer receives a share of the underlying premiums. Ceding a portion of an insured risk prevents a single catastrophic loss from hurling the reinsured into insolvency. It also allows the reinsured to invest more capital or to insure more risks.

Id. at 421. Reinsurance is comparable to “a contract of indemnity.” Christiania Gen. Ins. Corp. of N.Y. v. Great Am. Ins. Co., 979 F.2d 268, 271 (2d Cir.1992).

“The reinsurance of reinsurance is called a retrocession, and the reinsurers of reinsurers — that is, reinsurers who assume retrocession risk through retrocessional agreements — are called retrocessionaires.” Century Indem. Co. v. Certain Underwriters at Lloyd’s, London, subscribing to Retrocessional Agreement Nos. 950518, 950519, 950616, 584 F.3d 513, 519 (3d Cir.2009). Such retrocession agreements present considerably more complex legal and factual scenarios because “there is another layer of coverage created and another party thrown into the mix.” Plitt, et al., 1A COUCH ON INSURANCE § 9:3.

There are two overarching categories of reinsurance and retrocession — treaty and facultative; the agreements here are the former. Through treaty reinsurance, [698]*698Pac. Employers, 693 F.3d at 421. As with primary insurance, reinsurance comes in several basic types, including proportion and “excess of loss” policies. The instant agreements are excess of loss policies, which obligate the retrocessionaire to pay up to its “retention” amount, ie., the amount of “cover” the retrocessionaire agreed to provide the reinsurer, once the total claim amount has surpassed a set monetary limit or “layer” that the reinsurer must first pay. See Hartford Acc. and Indem. Co. v. Ace Am. Reins. Co., 284 Conn. 744, 750 n. 5, 936 A.2d 224 (2007). Excess of loss policies come in three forms: “per risk,” “annual aggregate,” or “per occurrence.” See Orpett, et al., 3 LAW AND PRAC. OF INS. COVERAGE LITIG. § 41:10 (2012). These three methods differ in the manner in which risks “attach” to the reinsurance agreement. Under a per occurrence policy, like those at issue here, the retrocessionaire’s obligation is triggered by a particular incident, such as a personal injury. Id.

[697]*697the reinsurer [or retrocessionaire] agrees to accept an entire block of business from the reinsured. Once a treaty is written, a reinsurer is bound to accept all of the policies under the block of business, including those as yet unwritten. Because a treaty reinsurer accepts an entire block of business, it does not assess the individual risks being reinsured; rather, it evaluates the overall risk pool.

[698]*698B. The Parties and the Agreements

For the purposes of the present case, Munich1 was the ceding reinsurer and ANICO was the retrocessionaire for two excess of loss retrocessional agreements of workers’ compensation reinsurance, on a per-oecurrence, or per-claim, basis, which cover the periods of November 1, 2000 through December 31, 2000 (referred to by the parties as the “2000 Year Agreement,” and also as the “Stub Year Agreement,” due to its short, two-month duration), and January 1, 2001 through December 31, 2001 (the “2001 Agreement”) (collectively, the “Retrocession Agreements”). The terms of the two agreements are identical except for the following differences: (1) their duration; (2) the relevant provision of Article X (Claims) is reflected in Endorsement No. 1 in the Stub Year Agreement, while the identical corresponding provision for the 2001 Year is in the body of that agreement; and (3) under the Stub Year Agreement, ANICO only took a 75% share of the retrocession. Pl.’s 1 at MRAM-01-0304 to -0305 (Stub Year Agreement); PL’s 2 at MRAM-01-0034, - 0040 (2001 Agreement).2

As detailed more fully infra, the Retro-cession Agreements provide that ANICO shall not be liable for any single loss until Munich’s loss exceeds $500,000, that ANI-CO is not liable for more than $500,000 per loss occurrence, and that for the 2001 Agreement ANICO is not liable beyond $20,000, 000. PL’s 1-2 (Art. IV). A “loss occurrence” is each and every accident or occurrence, or series of accidents or occurrences, arising out of one event. PL’s 1-2 (Art. VII).

The story behind the Retrocession Agreements, however, is considerably more complex.

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Bluebook (online)
999 F. Supp. 2d 690, 2014 U.S. Dist. LEXIS 25078, 2014 WL 793129, Counsel Stack Legal Research, https://law.counselstack.com/opinion/munich-reinsurance-america-inc-v-american-national-insurance-njd-2014.