Pomeroy v. Schwartz

2013 Ohio 4920
Ohio Court of Appeals·Decided November 7, 2013·No. 99638·Published·Cited by 8 cases

Opinion

Court of Appeals of Ohio

EIGHTH APPELLATE DISTRICT COUNTY OF CUYAHOGA

JOURNAL ENTRY AND OPINION No. 99638

JACQUES C. POMEROY, ET AL.

PLAINTIFFS-APPELLANTS

vs.

MARK SCHWARTZ, ET AL.

DEFENDANTS-APPELLEES

JUDGMENT:

AFFIRMED

Civil Appeal from the

Cuyahoga County Court of Common Pleas Case No. CV-769361

BEFORE: McCormack, J., Jones, P.J., and E.T. Gallagher, J.

RELEASED AND JOURNALIZED: November 7, 2013

ATTORNEY FOR APPELLANTS

Timothy P. Whitford Waldheger - Coyne 1991 Crocker Road Suite 550 Westlake, OH 44145

ATTORNEYS FOR APPELLEES

Eric Larson Zalud Matthew D. Gurbach Benesch, Friedlander, Coplan, & Aronoff L.L.P. 200 Public Square Suite 2300 Cleveland, OH 44114

TIM McCORMACK, J.:

{¶1} Appellants, Jacques C. Pomeroy (“Pomeroy”) and J.P. Agency, Inc. (“JP”), appeal from a judgment of the Cuyahoga County Common Pleas Court that granted summary judgment in favor of appellees, Mark Schwartz (“Schwartz”), G&S Metal Products Co., Inc. (“G&S”), and G&S Metal Products Employee Benefit Plan. The trial court ruled that the statute of limitations barred appellants’ claims of breach of contract, unjust enrichment, and conversion. After a careful review of the record and pertinent law, we find no merit to the appeal and affirm the judgment of the trial court.

{¶2} The plaintiffs in this case are Jacques C. Pomeroy and his solely-owned insurance agency, JP. The defendants are Pomeroy’s long-term client Schwartz and his company G&S. The subject matter of this litigation is medical insurance claims totaling $362,614.04, which were incurred by G&S employees in 2001-2002 but were not covered under G&S’s health insurance policy.

Substantive Facts and Procedural History

{¶3} The parties had a long and intricate business relationship spanning 40 years.

Pomeroy was originally in the business of office equipment sales. He started his insurance business when he sold his first insurance policy in 1963 to Mark Schwartz’s father, founder of G&S. A long and extensive business relationship ensued. Over the years, Pomeroy provided many services to G&S, including human resources, 401(K) administration, investment management, employment benefits, group life and disability insurance polices, and health insurance policies, among others.

{¶4} This case concerns a health insurance policy. For over 40 years, Pomeroy helped G&S select suitable health insurance plans for its employees. Pomeroy would obtain quotes from health insurance coverage providers and prepare spreadsheets for comparisons of prices and coverage. After G&S selected a plan, Pomeroy would prepare the application and collect checks for the insurance premiums.

{¶5} G&S had always maintained a “self-insured,” as opposed to “fully insured,”

health insurance plan, including the period from November 2001 to November 2002, the pertinent period of time for the instant litigation. During this time, employees of G&S were covered under a “self-insured” policy issued by Humana, Inc. However, G&S decided to switched to a “fully-insured” plan in November 2002. From November 2002 to November 2003, G&S’s employees were covered under a “fully-insured” policy, also issued by Humana.

{¶6} Apparently when there is a change of policy from “self-insured” to “fully insured,” the claims that are incurred during the prior period but not made until the subsequent period — so called “trail claims” — are not covered by either policy. Separate coverage for the “trail claims” has to be purchased.1

Pomeroy explained in his deposition that, under a self-insured plan, the claims are 1

paid out of the self-insured plan regardless of when the claims are made or incurred, and therefore, there would be no need for “trail claim” coverage. However, when a self-insured plan is switched to a “fully insured” plan, a separate “trail claim” coverage is required to make it the responsibility of the insurance company to pay the “trail claims.”

{¶7} G&S did not purchase the additional “trail claims” coverage when it switched its policy from “self-insured” to “fully insured.” Beginning in November 2002, after the switch, G&S employees began to find that their claims that were incurred during the November 2001 – November 2002 period but were not made until after November 2002 were rejected by the insurance company.

{¶8} Not wanting to lose his valuable client, Pomeroy tried to resolve the issues.

Beginning in February 2003, JP itself started to pay these unpaid claims. As Pomeroy testified later in his deposition, JP made the payments because he felt “a moral obligation to make them.” When he told Schwartz about the problem, Schwartz told him to “take care of it,” and he did. Also in his own words, he made the payments because he felt “in order for J.P. Agency to retain G&S and the Schwartz business, that this should be paid.” He wanted to “silence the complaints until [he] resolved the issue.”

{¶9} Pomeroy also testified in his deposition that “he was sure” he would get reimbursed later, either by Humana or by G&S, stating “I thought somebody was going to reimburse me” and “[i]t may have been Humana.” He emphasized that “I knew that if there was a problem that I would be reimbursed for my expenses.” When asked how he knew, he answered “[j]ust because of the relationship.”

{¶10} Pomeroy testified in his deposition that he did not recall if he had discussed thoroughly with Schwartz the need for a separate “trail claims” when the policy was switched to “fully-insured.” According to Schwartz, he did not know G&S did not have the necessary coverage for the “trail claims” and was never actually offered such a coverage by Pomeroy.

{¶11} JP made the last of these “trail claim” payments on September 11, 2003.

Nothing was brought up about these payments until three years later, in 2006, around the time when the relationship between Pomeroy and Schwarz went sour.

{¶12} The deterioration of their relationship began when Pomeroy tried to sell Schwartz a “loss of income” policy, which turned out to be a fraudulent investment vehicle, peddled by a third individual. Pomeroy’s involvement in selling this fraudulent product led to a criminal investigation of him, and Pomeroy was eventually convicted of filing a false tax return over his involvement in the scheme in 2006. This is the same year Pomeroy, for the first time, demanded G&S’s reimbursement for the funds G&S had advanced to cover the “trail claims.”

{¶13} Pomeroy alleges that he demanded the payment at that time because, during an annual audit, the auditor discovered G&S had not paid back the advanced funds for the “trail claims.” As a result of the “discovery,” Pomeroy’s son, who also worked at JP, sent a correspondence to Schwartz on April 20, 2006, demanding payment. The correspondence stated: “During a current outside audit it has been determined that several items paid by the J.P. Agency, Inc. have not been reimbursed by G&S Metal Products Company.” The correspondence demanded $362,614.04, referring to the money as “funds advanced.”

{¶14} In a subsequent correspondence dated May 25, 2006, Pomeroy again demanded payment, stating that JP was never reimbursed by Humana for the payments made by JP regarding the “trail claims.” When Pomeroy was asked later in a deposition about this May 25, 2006 correspondence, he testified that “my indication was to go to Humana first and go to G&S second * * *.” He stated he was sure he would get paid “by someone.”

{¶15} According to Schwartz, Pomeroy never raised this issue with him before these correspondences. Schwartz alleged Pomeroy demanded payment at this time because of his diminishing cash flow.

{¶16} On November 16, 2011, eight years after JP made the last “trail claims”

payment, Pomeroy and JP (collectively “appellants”) filed the instant complaint against Schwartz and G&S (collectively “appellees”) to recover the funds, asserting breach of oral contract, unjust enrichment, and conversion. Extensive discovery was exchanged, and depositions were taken of Pomeroy and Schwartz.2

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