National Convention Services, L.L.C. v. Applied Underwriters Captive Risk Assurance Co.

239 F. Supp. 3d 761, 2017 WL 945189, 2017 U.S. Dist. LEXIS 34760
CourtDistrict Court, S.D. New York
DecidedMarch 9, 2017
Docket15-cv-07063 (JGK)
StatusPublished
Cited by42 cases

This text of 239 F. Supp. 3d 761 (National Convention Services, L.L.C. v. Applied Underwriters Captive Risk Assurance Co.) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
National Convention Services, L.L.C. v. Applied Underwriters Captive Risk Assurance Co., 239 F. Supp. 3d 761, 2017 WL 945189, 2017 U.S. Dist. LEXIS 34760 (S.D.N.Y. 2017).

Opinion

OPINION AND ORDER

JOHN G. KOELTL, District Judge:

This dispute arises out of a complicated insurance scheme executed by several affiliated insurance carriers, and their other affiliates, that was allegedly designed to circumvent the insurance laws of, among other states, New York. It involves three allegedly interconnected contracts that, according to the plaintiffs, should be treated as one interdependent transaction: First, a workers’ compensation insurance contract between a licensed insurer and an insured; second, a “reinsurance” contract between the licensed insurer and an affiliated “reinsurer”; and third, a “reinsurance and profit sharing” contract between the reinsurer and the insured. The plaintiffs allege that the “reinsurance and profit sharing” contract is not actually a separate contract for reinsurance and profit sharing, but instead is an illegal contract of insurance that modifies the material terms of the workers’ compensation insurance contract issued by the licensed insurer. The plaintiffs also claim that the “reinsurance and profit sharing” contract is materially misleading, and leads insureds unwittingly to buy back the very risk that they had yielded to the licensed insurer.

The defendants’ insurance scheme was so inventive and novel that it has been patented. In spite of the patent, the scheme has drawn the scrutiny of the insurance regulators of at least three states — California, Wisconsin, and Vermont — which have each found that the scheme did in fact violate the insurance laws of those states.

The defendants are Applied Underwriters Inc. (“Applied Underwriters”), Applied Underwriters Captive Risk Assurance Company, Inc. (“AUCRA”), Applied Risk Services Inc. (“ARS”), Applied Risk Services of New York Inc. (“ARSNY”), Continental Indemnity Company (“Continental Insurance”), and California Insurance Company (“California Insurance”). The plaintiffs, on behalf of a purported class, are National Convention Services, LLC, and Exserv, Inc. (the “NCS plaintiffs”); and Madjek Construction, Inc., R.D.D., Inc., and R.D.D. Management, Inc. (the “RDD plaintiffs”). The plaintiffs have brought claims against Continental Insurance and California Insurance for breach of contract (Count III); and against all of the defendants for rescission (Count II), violation of N.Y. Gen. Bus. L. § 349 (Count IV)) and unjust enrichment (Count V).1

The NCS plaintiffs brought this action in the New York State Supreme Court, [768]*768New York County. After the defendants removed the action to this Court pursuant to 28 U.S.C. §§ 1332 and 1441, the NCS plaintiffs filed an amended - class action complaint, in which the RDD plaintiffs joined. The RDD plaintiffs had previously filed their own action against the defendants in the New York State Supreme Court, New York County.

The defendants have moved to dismiss the Second Amended Complaint pursuant to Rule- 12(b)(6) of the Federal Rules of Civil Procedure. For the following reasons, the defendants’ motion to dismiss is granted in part and denied in part.

I.

In deciding a motion to dismiss pursuant to Rule 12(b)(6), the allegations in the complaint are accepted as true, and all reasonable inferences must be drawn in the plaintiffs favor. McCarthy v. Dun & Bradstreet Corp., 482 F.3d 184, 191 (2d Cir. 2007). The Court’s function on a motion to dismiss is “not to weigh the evidence that might be presented at a trial but merely to determine whether the complaint itself is legally sufficient.” Goldman v. Belden, 754 F.2d 1059, 1067 (2d Cir. 1985). The Court should not dismiss the complaint if the plaintiff has stated “enough facts' to state a claim to relief that is plausible on its face.” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007). “A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Ashcroft v. Iqbal, 556 U.S. 662, 678, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009).

While the Court should construe the factual allegations in the light most favorable to the plaintiff, “the tenet that a court must accept as true all of the allegations contained in the complaint is inapplicable to legal conclusions.” Id.; see also Springer v. U.S. Bank Nat’l Ass’n, No. 15-cv-1107 (JGK); 2015 WL 9462083, at *1 (S.D.N.Y. Dec. 23, 2015). When presented with a motion to dismiss pursuant to Rule 12(b)(6), the Court may consider documents that are referenced in the complaint, documents that the plaintiff relied on in bringing suit and that are either in the plaintiffs possession or that the plaintiff knew of when bringing suit, or matters of which judicial notice may be taken. Chambers v. Time Warner, Inc., 282 F.3d 147, 153 (2d Cir. 2002); see also Springer, 2015 WL 9462083, at *1.

II.

The allegations in the Second Amended Complaint are accepted as true for the purposes of this motion to dismiss.

A.

Workers’ compensation is a form of insurance that provides wage replacement and medical benefits to employees injured during the course of their employment. SAC ¶ 30. New York has enacted a comprehensive regulatory scheme for workers’ compensation that shifts the risk of on-the-job injuries from employees to employers. SAC ¶ 30. In turn, under the New York scheme, employers may purchase workers’ compensation insurance from insurance carriers that are licensed to market and sell insurance in New York. SAC ¶35.

Pursuant to the Workers’ Compensation Law (“WCL”) §§ 10 and 50, all employers must secure the payment' of workers’ compensation benefits for their employees, SAC ¶ 30. The WCL provides that employers may secure the payment of workers’ compensation for their employees by purchasing a workers’ compensation policy from any insurance carrier authorized to [769]*769transact, such business in New York. SAC ¶31 (citing WCL § 50(2)). An insurance carrier must be licensed by the New York Department of Financial Services (the “DFS”) in order to issue workers’ compensation insurance in New York.2 SAC ¶¶ 9, 35.

The New York Insurance Law (“NYIL”) regulates the provision of workers’ compensation insurance. SAC ¶ 3. For example, under the NYIL, all workers’ compensation insurance policy forms, rates, rating plans, rating rules, and-rate manuals must be filed with and approved by the DFS. SAC ¶2. An insurance carrier may not vary an already approved rate or policy form without prior approval from the DFS. SAC ¶¶ 3-4, 33-34.

Insurance carriers offer two main types of workers’ compensation policies: guaranteed cost (“GC”) policies, and retrospective rating plan (“RRP”) policies. A GC policy essentially fixes insurance premiums at the outset, meaning that the actual cost of the claims against the policy will not cause premiums to fluctuate during the life of the policy. SAC ¶¶ 35-38, 40-41.

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239 F. Supp. 3d 761, 2017 WL 945189, 2017 U.S. Dist. LEXIS 34760, Counsel Stack Legal Research, https://law.counselstack.com/opinion/national-convention-services-llc-v-applied-underwriters-captive-risk-nysd-2017.