Pet Food Express Ltd. v. Applied Underwriters Inc.

CourtDistrict Court, E.D. California
DecidedSeptember 12, 2019
Docket2:16-cv-01211
StatusUnknown

This text of Pet Food Express Ltd. v. Applied Underwriters Inc. (Pet Food Express Ltd. v. Applied Underwriters Inc.) is published on Counsel Stack Legal Research, covering District Court, E.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pet Food Express Ltd. v. Applied Underwriters Inc., (E.D. Cal. 2019).

Opinion

1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 EASTERN DISTRICT OF CALIFORNIA 10 ----oo0oo---- 11 12 PET FOOD EXPRESS, LTD., No. 2:16-CV-01211 WBS AC 13 Plaintiff, 14 v. 15 APPLIED UNDERWRITERS, INC., MEMORANDUM AND ORDER RE: APPLIED UNDERWRITERS CAPTIVE CROSS MOTIONS FOR SUMMARY 16 RISK ASSURANCE COMPANY, INC., JUDGMENT CALIFORNIA INSURANCE COMPANY, 17 and APPLIED RISK SERVICES, 18 Defendant. 19 20 ----oo0oo---- 21 Plaintiff Pet Food Express, Ltd. (“Pet Food”) filed 22 this lawsuit against defendant Applied Underwriters, Inc. 23 (“Applied Underwriters”), Applied Underwriters Captive Risk 24 Assurance Company, Inc. (“Captive Risk Assurance”), and 25 California Insurance Company (“California Insurance”) 26 (collectively, “Applied”), alleging that defendants unlawfully 27 marketed and sold workers’ compensation insurance to California 28 employers in violation of California’s Unfair Competition Law. 1 Before the court is Defendants’ Motion for Summary Judgment, 2 (Defs.’ Mot. for Summ. J. (“DMSJ”) (Docket No. 139)), and 3 plaintiff’s Motion for Partial Summary Judgment, (Pl.’s Mot. for 4 Partial Summ. J. (“PMSJ”) (Docket No. 138-1)). 5 I. Factual and Procedural Background 6 California requires that all employers purchase 7 workers’ compensation insurance to cover employees’ work-related 8 injuries. Cal. Lab. Code § 3700. The state also requires that 9 all workers’ compensation insurance policy forms, rates, and 10 rating plans be filed for approval with the California Workers 11 Compensation Insurance Rating Bureau (“the Bureau”) and approved 12 by the California Department of Insurance (“CDI”). (Pl.’s First 13 Am. Compl. (“PFAC”) ¶ 3 (Docket No. 54); see also Cal. Ins. Code 14 §§ 11658, 11735.) 15 Defendants filed a workers’ compensation insurance 16 program known as EquityComp (“Program”) with the Bureau and 17 received approval from the Department of Insurance. (PFAC ¶ 31.) 18 Defendants thereafter marketed and sold the Program to plaintiff. 19 (PFAC ¶ 30.) After the Program’s policies took effect for the 20 plaintiff, defendants required the plaintiff to enter a 21 Reinsurance Participation Agreement (“RPA”). (PFAC ¶¶ 29, 44; 22 DMSJ at 4.) Importantly, the parties agree that the RPA is “not a 23 filed retrospective rating plan.” (Pl.’s Reply in Opp. to Defs.’ 24 Mot. for Summ. J. (“PRSJ”) at 4, ¶ 17.) 25 Captive Risk Assurance is structured as a segregated 26 cell reinsurance facility. (PRSJ at 3, ¶7.) Under this 27 structure, instead of pooling its risk, each Program participant 28 has a separate underwriting account (or “cell”). (PRSJ at 3, ¶ 1 7.) Under the RPA, the employer agrees to maintain a capital 2 account in its segregated cell. (PRSJ at 3, ¶8.) Each Program 3 participant also agrees to maintain reserves in its cell after 4 the RPA’s three-year active term expires. (PRSJ at 4, ¶11.) The 5 reserve amount is adjusted periodically as claims develop. (DMSJ 6 at 4.) Because the ultimate claims costs cannot be known in 7 advance, “loss development factors” or “LDF’s” (i.e., 8 multipliers) are applied to claims to estimate their final cost. 9 (PRSJ at 3, ¶ 9.) LDFs reduce over time until their effect on 10 the cost (and therefore the amount in the cell) reaches zero and 11 the cell is closed. (DMSJ at 4.) When the segregated cell is 12 closed, the employer’s ultimate cost is calculated using the 13 RPA’s formulas and, depending on the claims experience, the 14 employer could receive a profit sharing distribution under the 15 RPA, also called a “rebate.” (PRSJ at 4, ¶ 14.) Under the RPA, 16 Applied may, “in its sole discretion,” hold the money in the cell 17 account up to “7 years after the expiration of the policies.” 18 (PMSJ at 14.) 19 On June 20, 2016, in an administrative action 20 challenging Applied’s RPA, the California Insurance Commissioner 21 (“Commissioner”) issued a Decision and Order, holding that the 22 RPA must be filed and approved by the Commissioner pursuant to 23 Insurance Code § 11735. See Shasta Linen Supply, Inc. v. Applied 24 Underwriters, Inc., 2:16-158 WBS AC, 2016 WL 6094446, at *5 (E.D. 25 Cal. Oct. 17, 2016). Because defendants did not file the RPA 26 before it took effect, the Commissioner found that the “RPA is 27 void as a matter of law.” Id. at *2. 28 In the wake of that administrative proceeding, 1 defendants developed an agreement that could be sold and marketed 2 with the CDI’s approval. (DMSJ at 5.) While there are 3 differences between the unfiled and the filed RPAs, “none of them 4 changes the structure, material terms, or financial results to 5 the participant.” (Fein Decl., Defs.’ Mot. for Summ. J., Medlong 6 Decl. Ex. 5 (Docket No. 139-6).) 7 Pet Food filed a class action complaint against 8 defendants asserting claims for unfair competition, rescission, 9 declaratory relief, and fraud. On June 21, 2017, plaintiff filed 10 an amended complaint asserting additional claims under the 11 federal Racketeer Influenced and Corrupt Organizations (“RICO”) 12 Act, 18 U.S.C. § 1962; under the California Unfair Competition 13 Law (“UCL”), Cal. Bus. & Prof. Code § 17200, and for quasi- 14 contract. Defendants in turn filed a counterclaim to plaintiff’s 15 amended complaint alleging breach of contract. (Defs.’ Answer, 16 Countercl., at 30, ¶ 24 (Docket No. 76).) 17 Defendants subsequently moved to dismiss the amended 18 complaint. (Docket No. 61.) The court dismissed the RICO claims 19 and denied the motion to dismiss in all other respects. (Mem. 20 and Order Re: Defs.’ Mot. to Dismiss at 24 (Docket No. 65).) 21 With respect to plaintiff’s UCL claim based on Insurance Code § 22 11735, the court found that an unfiled rate is not unlawful per 23 se and determined that the Commissioner did not conduct the 24 requisite formal rate disapproval hearing. (Id. at 20-22.) 25 Plaintiff then moved to certify the class. (Docket No. 116.) 26 This court subsequently denied the motion to certify on 27 superiority grounds. (Id.) 28 The claims remaining are Pet Food’s UCL claims for 1 unfair competition and unjust enrichment, and defendant’s 2 counterclaim for breach of contract. Plaintiff relies on the 3 Commissioner’s administrative decision and two subsequent 4 California Courts of Appeal cases to argue that the RPA is an 5 illegal program. (PMSJ at 5.) According to plaintiff, 6 defendant’s sale of this allegedly illegal program violates UCL 7 Section 17200. (PMSJ at 3.) Pet Food seeks restitution in “the 8 amount of money left in its segregated cell” account. (Mem. in 9 Supp. of Mot. Partial Summ. J. at 2 (Docket No. 138-1).) This 10 money consists of funds that Pet Food “has paid Defendants for 11 the EquityComp plans.” (Witriol Decl., Decl. of Terri Witriol 12 Lim in Opp. to Defs.’ Mot. for Summ. J., at 2 (Docket No. 141- 13 1).) Plaintiff also seeks a return on investment of these funds. 14 Id. In contrast, defendants seek to enforce California 15 Insurance’s contract with Pet Food and allege that Pet Food 16 remains liable for premiums, taxes, and assessments under the 17 purchased policies. (Defs.’ Answer, Countercl., at 30, ¶ 24 18 (Docket No. 76).) 19 Defendants now seek summary judgment under Federal Rule 20 of Civil Procedure 56, on the grounds that plaintiff lacks 21 standing to sue under the UCL.

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Pet Food Express Ltd. v. Applied Underwriters Inc., Counsel Stack Legal Research, https://law.counselstack.com/opinion/pet-food-express-ltd-v-applied-underwriters-inc-caed-2019.