United States ex rel. Sonnier v. Standard Fire Insurance

84 F. Supp. 3d 575, 2015 U.S. Dist. LEXIS 10006
CourtDistrict Court, S.D. Texas
DecidedJanuary 29, 2015
DocketCivil Action No. H-12-1065
StatusPublished

This text of 84 F. Supp. 3d 575 (United States ex rel. Sonnier v. Standard Fire 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
United States ex rel. Sonnier v. Standard Fire Insurance, 84 F. Supp. 3d 575, 2015 U.S. Dist. LEXIS 10006 (S.D. Tex. 2015).

Opinion

MEMORANDUM AND OPINION

LEE H. ROSENTHAL, District Judge.

This is the latest in a series of qui tam actions alleging that insurers and adjusters committed fraud in responding to hurricane damage claims. The relator, Ker-mith Sonnier, alleges that the defendants prepared and submitted inflated claims on flood-insurance policies backed by the Federal Insurance Administration’s (“FIA”) National Flood Insurance Program (“NFIP”), while reducing claims paid on privately backed wind-insurance policies, in violation of the False Claims Act (“FCA”), 31 U.S.C. §§ 3729-32. The United States declined to intervene. (Docket Entry No. 10).

The defendants have moved to dismiss Sonnier’s claims. They argue that the court lacks subject-matter jurisdiction because: the claims were the subject of prior disclosures and Sonnier is not an original source; Sonnier was not the first to file claims against the defendants; and Sonnier did not plead his fraud claims with sufficient particularity. (Docket Entry No. 82). Allstate Insurance Company; Pilot Catastrophe Services, Inc.; Fidelity National Financial, Inc.; Fidelity National Indemnity Insurance Company; Colonial Claims Corporation 1; and Brown & [580]*580Brown, Inc. also filed supplemental memo-randa asserting additional grounds for dismissing the claims against them. (Docket Entry Nos. 84, 85, 86, 88). Sonnier filed a consolidated response, (Docket Entry No. 106), and the defendants replied, (Docket Entry Nos. 107, 108, 110, 111, 112). The court held a hearing on April 7, 2014, at which the parties presented oral argument. (Docket Entry No. 120). At the court’s request, the parties submitted supplemental briefs on the effect of the Supreme Court’s grant of certiorari in United States ex rel. Carter v. Halliburton Company, 710 F.3d 171 (4th Cir.2013), cert. granted, — U.S. ---, 134 S.Ct. 2899, 189 L.Ed.2d 853 (2014). (Docket Entry Nos. 124, 125).

Based on the pleadings; the motions, responses, and replies; the record; and the applicable law, the court grants the defendants’ motion to dismiss Sonnier’s claims. (Docket Entry No. 82). The reasons are explained in detail below.

1. Background2

A. The WYO Insurance Program

The federal government administers a Write Your Own (“WYO”) insurance program through the NFIP to provide flood-insurance policies to individuals. Under the WYO program, private insurers issue NFIP-backed flood-insurance policies to individuals, who pay the federal government the premium through the issuing private insurer. These private insurers are called “WYO insurers” when they administer NFIP-backed flood policies. After a flood event, the WYO insurers receive and adjust claims and submit them to the federal government for payment. In exchange, the WYO insurers receive part of the policy premiums, a fee for processing claims, and an adjuster fee based on the amount of each settled claim. (Docket Entry No. 1, Complaint, ¶¶ 19-20).

Private insurance companies hire adjusters to inspect each insured property, determine whether and how much damage the policy covers, and prepare - a formal written loss estimate. Adjusters frequently use a. pricing program to estimate the cost to repair covered damage. The pricing program contains information on per-unit costs for supplies and labor in the area. (Id. at ¶ 23). After preparing the estimates, the adjuster submits it, with the claim, to the WYO insurer. If the WYO insurer approves the estimate, the amount is submitted to the policyholder as a “final settlement.” The policyholder may accept the final settlement or object to it. Once the policyholder and the WYO insurer agree on a final settlement for a claim under an NFIP-backed policy, the insurer submits it to the NFIP for payment. The NFIP reviews the claim and, if the claim is accepted, sends payment to the WYO insurer. (Id. atY 24).

The NFIP does not back wind-insurance policies. A property owner typically purchases wind insurance from the same private insurer that administers the owner’s NFIP flood policy. The result is that when a home is damaged, the WYO insurer is responsible for evaluating claims under both policies, determining whether to attribute the damage to water or to wind, and providing an estimated value for each type of claim and damage. The federal government pays for covered damage caused by flooding, and the private insurance companies pay for covered damage caused by wind. Higher flood claims benefit WYO insurers because the adjuster fee the NFIP pays the insurer is based on the value of the claim, and attributing more [581]*581damage to the flood policy may lower the amounts claimed under the privately backed wind-insurance policy. Improperly classifying wind damage as flood damage or inflating flood-damage claims to minimize wind-damage claims is referred to as “wind/water fraud.”

B. Kermith Sonnier

Sonnier is an independent adjuster who has worked for several insurance companies, including some of the defendants. He prepared property-damage estimates after Hurricane Katrina in 2006 and Hurricane Ike in 2008. Sonnier reviewed an estimate Allstate had prepared in 2006 that assigned higher margins for overhead and profit on the flood claim under an NFIP-backed policy than on the wind claim under an Allstate-backed policy. (Complaint, ¶¶ 66-67). That led Sonnier to investigate other claims he had worked on after Hurricane Ike. He alleges that this investigation revealed that the defendant insurers routinely used higher per-unit prices to calculate flood claims than to calculate wind claims. (Id. at ¶ 67).

In 2009, Sonnier filed a qui tam action against Allstate in the United States District Court for the Middle District of Louisiana, alleging wind/water fraud. See United States ex rel. Sonnier v. Allstate Ins. Co., No. 09-1038-JJB, 2012 WL 75041 (M.D.La. Jan. 10, 2012) (“Sonnier I”). The court dismissed that lawsuit in January 2013 under the FCA’s flrst-to-file rule, 31 U.S.C. § 3730(b)(5), because a similar qui tam action was pending when Sonnier sued. Id. When the first case was disposed of, Sonnier filed this second qui tam suit, again alleging wind/water fraud.

C. The Defendants

Fourteen of 23 defendants have settled and been dismissed. The remaining defendants are:

• Allstate Insurance Company,
• Brown & Brown,
• Colonial Claims,
• Fidelity National Financial, '
• Fidelity National Indemnity Insurance Company,
• Louisiana Farm Bureau Casualty Insurance Company,
• Pilot Catastrophe Services,
• Southern Farm Bureau Casualty Insurance Company, and
• WRM America Holding Company.
1. The Insurers

The corporate relationships among the defendant insurers are as follows:

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Little v. Liquid Air Corp.
37 F.3d 1069 (Fifth Circuit, 1994)
Boudreaux v. Swift Transportation Co.
402 F.3d 536 (Fifth Circuit, 2005)
Triple Tee Golf, Inc. v. Nike, Inc.
485 F.3d 253 (Fifth Circuit, 2007)
Baranowski v. Hart
486 F.3d 112 (Fifth Circuit, 2007)
Connors v. Graves
538 F.3d 373 (Fifth Circuit, 2008)
United States Ex Rel. Grubbs v. Kanneganti
565 F.3d 180 (Fifth Circuit, 2009)
Bell Atlantic Corp. v. Twombly
550 U.S. 544 (Supreme Court, 2007)
Rockwell International Corp. v. United States
549 U.S. 457 (Supreme Court, 2007)
Ashcroft v. Iqbal
556 U.S. 662 (Supreme Court, 2009)
In Re Natural Gas Royalties
562 F.3d 1032 (Tenth Circuit, 2009)

Cite This Page — Counsel Stack

Bluebook (online)
84 F. Supp. 3d 575, 2015 U.S. Dist. LEXIS 10006, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-ex-rel-sonnier-v-standard-fire-insurance-txsd-2015.