Sandwich Chef of Texas, Inc. v. Reliance National Indemnity Insurance

111 F. Supp. 2d 867, 2000 U.S. Dist. LEXIS 17556
CourtDistrict Court, S.D. Texas
DecidedAugust 28, 2000
DocketNo. CIV.A.H-98-1484
StatusPublished
Cited by3 cases

This text of 111 F. Supp. 2d 867 (Sandwich Chef of Texas, Inc. v. Reliance National Indemnity Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Sandwich Chef of Texas, Inc. v. Reliance National Indemnity Insurance, 111 F. Supp. 2d 867, 2000 U.S. Dist. LEXIS 17556 (S.D. Tex. 2000).

Opinion

ORDER

HITTNER, District Judge.

Pending before the Court is the Supplemental Motion for Summary Judgment (Document #282) filed by Defendants. Having considered the motion, submissions, and application of law, together with the arguments of counsel at a hearing conducted by the Court on August 15, 2000, the Court determines that the motion for summary judgment should be denied.

Plaintiff Sandwich Chef of Texas, Inc. d/b/a Wall Street Deli (“Wall Street”) filed a class action complaint against numerous defendants. Plaintiff alleges it and the proposed class have been defrauded by the concerted acts of the defendants and have been required to pay excessive workers’ compensation premiums during the last decade. Wall'Street and members of the putative class are employers that purchased retrospectively rated workers’ compensation insurance. Retrospectively rated workers’ compensation insurance combines expense factors and loss experience together in varied ways, such that the amount of the premium at the end of the policy period is affected by the amount of the insured’s covered losses. When the loss experience is less than anticipated, refunds or credits are issued; when the loss experience is greater than anticipated, additional premiums are required.

Most employers purchase workers’ compensation coverage in the voluntary market. Employers that are unable to secure coverage in the voluntary market may obtain it through legislatively established involuntary markets, which are sometimes called “residual markets,” “assigned risk markets,” or “assigned risk pools.” In order to obtain authorization to write worker’s compensation insurance in some states, insurers must agree to reinsure the “residual markets” of those states. As reinsurers of residual markets in some jurisdictions, insurance companies are often required to pay assessments necessary to fund deficits that result when workers’ compensation losses incurred by employers insured through such residual markets exceed premiums paid by those employers.

Beginning in the late 1980s, residual-market assessments began to increase dramatically. Insurance companies responded to the increases in residual market assessments by factoring the expenses associated with paying these assessments in the pricing of voluntary-market insurance programs. Insurance program documents disclosed the factoring of these expenses in pricing by explicitly identifying these “residual market charges” (also known as “residual market loads” or “RMLs”).

Wall Street alleges that from May 5, 1988 through January 4, 1990, approximately 150 insurance carriers charged excessive premiums for workers’ compensation insurance sold to a putative class consisting of thousands of employers in 44 states and in the District of Columbia. Wall Street contends that the defendant insurers employed the National Council on Compensation Insurance, Inc. (“NCCI”), an insurance trade organization, which includes as members persons employed by the defendant insurers, as a racketeering enterprise to defraud a putative class of insureds through a common scheme of mail and wire fraud, in violation of 18 U.S.C. §§ 1962(c)-(d).

Defendants have filed a motion for summary judgment on several grounds. First, defendants argue that Wall Street’s “in[872]*872voice theory” fails to allege indictable acts of racketeering. According to defendants, to establish mail or wire fraud after Neder v. United States, 527 U.S. 1, 119 S.Ct. 1827, 144 L.Ed.2d 35 (1999), Wall Street must prove a material misrepresentation that would support a claim for common-law fraud. At most, the defendants contend, Wall Street’s “invoice theory” alleges that one defendant insurer, Reliance, sent invoices to Wall Street that constitute misrepresentations of law in the performance of contractual duties, which are not actionable in fraud.

Second, defendants argue that summary judgment is proper because Wall Street fails to allege a viable basis for finding that it suffered its alleged injuries “by reason of’ the alleged misrepresentations in Reliance’s invoices. To prove an injury “by reason of’ mail and wire fraud within the meaning of 18 U.S.C. § 1964(c), a RICO plaintiff must plead and prove that it relied on the misrepresentations constituting the predicate acts of mail and wire fraud. According to the defendants, state and federal law conclusively presumes that policy holders know the contents and effects of applicable filed rates, and this “presumption of knowledge” precludes a finding that Wall Street relied on Reliance’s alleged misrepresentations concerning the conformity of Wall Street’s negotiated rates with allegedly applicable filed rates.

Third, according to the defendants, the summary judgment evidence establishes that Reliance never lied to Wall Street about the legality of Wall Street’s premiums or the conformity of those premiums to state filed rates. Rather, contend the defendants, Wall Street always knew that Reliance would adjust (and did adjust) Wall Street’s premiums using the unfiled and unapproved “tax multipliers” and “residual market loads” that Wall Street is challenging.

Fourth, according to the defendants, Wall Street cannot prove that Reliance or any other entity made any misrepresentations to any state regulators regarding any of the insurance programs upon which Wall Street is basing this case. Also, defendants argue that Wall Street cannot prove that it relied upon any misrepresentation made to any regulator regarding any policies issued to policy holders.

Fifth, the defendants assert that the McCarran-Ferguson Act entitles them to summary judgment on Wall Street’s claims. Specifically, the defendants argue that awarding Wall Street treble damages under the RICO statute for allegedly fraudulent departures from the filed rates would frustrate non-discrimination policies declared in state insurance laws requiring insurers to collect the full amount of any applicable filed rate and preclude any remedy that would effectively grant any policy holder a refund of any portion of a filed rate.

Sixth, the defendants argue that they are entitled to summary judgment on Wall Street’s conspiracy claim under section 1962(d). A claim under section 1962(d) based on an alleged conspiracy to violate section 1962(c) through a pattern of racketeering necessarily fails as a matter of law where the plaintiff cannot prove that the defendants committed predicate acts of racketeering or that the plaintiff suffered an injury to its business or property “by reason of’ those acts.

Summary judgment is mandated “against a party who fails to make a showing sufficient to establish the existence of an element essential to that party’s case, and on which that party will bear the burden of proof at trial.” Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). Initially, the mov-ant bears the burden of demonstrating to the Court that there is an absence of a genuine issue of any material fact. Id. at 323, 106 S.Ct. 2548. The burden then shifts to the party who bears the burden of proof on the claims on which summary judgment is sought to present evidence beyond the pleadings to show there is a genuine issue for trial. Id.

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111 F. Supp. 2d 867, 2000 U.S. Dist. LEXIS 17556, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sandwich-chef-of-texas-inc-v-reliance-national-indemnity-insurance-txsd-2000.