Untd Tchr Assoc Ins v. Un Labor Life Ins Co

CourtCourt of Appeals for the Fifth Circuit
DecidedAugust 8, 2005
Docket04-50531
StatusPublished

This text of Untd Tchr Assoc Ins v. Un Labor Life Ins Co (Untd Tchr Assoc Ins v. Un Labor Life Ins Co) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Untd Tchr Assoc Ins v. Un Labor Life Ins Co, (5th Cir. 2005).

Opinion

United States Court of Appeals Fifth Circuit F I L E D REVISED AUGUST 8, 2005 June 24, 2005 IN THE UNITED STATES COURT OF APPEALS Charles R. Fulbruge III FOR THE FIFTH CIRCUIT Clerk

____________________

No. 04-50531 ____________________

UNITED TEACHER ASSOCIATES INSURANCE CO

Plaintiff - Appellant v.

UNION LABOR LIFE INSURANCE COMPANY; UNION STANDARD OF AMERICA LIFE INSURANCE CO

Defendants - Appellees ___________________________________________________________________ ____________________

No. 04-50852 ____________________

Plaintiff - Counter Defendant - Appellees

v.

UNION LABOR LIFE INSURANCE COMPANY; UNION STANDARD OF AMERICA LIFE INSURANCE CO

Defendants - Counter Claimants - Appellants _________________________________________________________________

Appeals from the United States District Court for the Western District of Texas, Austin _________________________________________________________________

Before KING, Chief Judge, and BARKSDALE and STEWART, Circuit Judges.

KING, Chief Judge: Plaintiff-Appellant United Teacher Associates Insurance

Company sued Defendants-Appellees Union Labor Life Insurance

Company and Union Standard of America Life Insurance Company for

fraud, alleging that they failed to disclose material information

during the course of a business transaction. The Defendants-

Appellees responded by filing a counterclaim seeking both a

declaration that certain acquisition agreements between the

parties were valid and binding and an order of specific

performance and injunctive relief. After a bench trial, the

district court ruled in favor of the Defendants-Appellees,

granted the relief requested in their counterclaim, and awarded

them costs. Subsequently, however, the district court denied a

motion for further relief pursuant to 28 U.S.C. § 2202 filed by

them.

Plaintiff-Appellant United Teacher Life Insurance Company

now appeals the judgment of the district court, claiming that the

district court erred by: (1) holding that no duty to disclose

exists in Texas absent a confidential or fiduciary relationship;

(2) refusing to certify to the Texas Supreme Court the question

of when a duty to disclose exists in Texas; and (3) improperly

awarding certain costs to the Defendants-Appellees. Union Labor

Life Insurance Company and Union Standard of America Life

Insurance Company also appeal, arguing that the district court

erred when it denied their motion for further relief. The

parties’ appeals have been consolidated. For the following

2 reasons, we AFFIRM in part, VACATE in part, and REMAND to the

district court for further proceedings consistent with this

opinion.

I. FACTUAL AND PROCEDURAL BACKGROUND

In November 1999, Union Labor Life Insurance Company (“Union

Labor”) and its subsidiary, Union Standard of America Life

Insurance Company (“USA Life”) (collectively “Union/USA”), agreed

to sell their Medicare Supplement and Medicare Select insurance

policies (the “Medicare Block”) to United Teacher Associates

Insurance Company (“United Teacher”).

Prior to putting the Medicare Block up for sale, Union/USA

had entered into two consent orders with the Florida Department

of Insurance (“FDI”) that restricted future premium rate

increases on the Medicare Block. First, on May 27, 1997,

Union/USA entered into a consent order restricting premium rate

increases to trend on the Florida Medicare Select policies for a

two-year period, followed by a reevaluation of the anticipated

lifetime loss ratio at the end of this period.1 Second, on June

18, 1999, Union/USA entered into a consent order with the FDI

that allowed for a 12% premium rate increase on the Medicare

Supplement policies in force prior to the effective date of the

1 “Trend” increases are increases based solely on the growth in claims from year to year because of medical inflation, the increased utilization of medical services, and general inflation. They do not take into account the actual experience of a line of business.

3 consent order, but restricted future increases to trend unless

Union Labor had “credible experience” on new issues.2 According

to United Teacher, the 1997 and 1999 consent orders significantly

affected the profitability of the Medicare Select and Medicare

Supplement policies.

After Union Labor put the Medicare Block up for sale,3 it

assembled a due diligence team, led by Union Labor associate

actuary Jennifer Lazio, to respond to requests for information

from prospective purchasers. When Larry Doze, the president of

United Teacher, learned that the Medicare Block was up for bid

through a broker, he requested information about it. Lazio

responded by sending him the 1998 rate-filing information for the

Medicare Supplement policies and an actuarial memorandum about

the Medicare Select policies. Lazio did not, however, mention

the consent orders. Doze subsequently requested, as part of his

due diligence investigation, other documents and information to

assess the profitability of the Medicare Block. He did not

specifically request information about consent orders or

impediments to future rate increases, and he received no such

2 In Florida, an insurer must issue at least 500 new policies to get “partial credibility,” and at least 2,000 new policies to get “full credibility,” in order to obtain future rate increases based on the actual experience of a line of business. 3 Union Labor was authorized to act as agent for USA Life in connection with the sale and transfer of the USA Life Medicare Supplement lines of business included in the Medicare Block.

4 information. United Teacher also conducted an on-site visit to

the offices of Union Labor’s third-party administrator, the

American Insurance Administration Group (“AIAG”), but did not

learn of the consent orders from this visit. At one point in the

negotiations, Lazio told Doze that the FDI had recently approved

a 12% increase in the Medicare Supplement premiums and an 8%

increase in the Medicare Select premiums, but she did not tell

him that these increases were pursuant to the consent orders.

United Teacher now claims that Union/USA was fraudulently hiding

the consent orders from it.

In November 1999, United Teacher decided to purchase the

Medicare Block, and it entered into a letter agreement to that

effect with Union/USA, with a formal written agreement to follow.

In August 2000, United Teacher decided not to follow through with

the purchase. Accordingly, on December 6, 2000, Union/USA sued

United Teacher in the U.S. District Court for the District of

Columbia for relief arising out of United Teacher’s failure to

consummate the transaction. On October 4, 2001, the parties

settled the litigation, and Union/USA agreed to pay United

Teacher $2.5 million for United Teacher to acquire the Medicare

Block from it. At the time of settlement, United Teacher still

did not know about the consent orders.

During the settlement negotiations, United Teacher concluded

that it would need to seek rate increases aggressively on the

Medicare Block to make it profitable. Accordingly, it asked

5 Union/USA to permit it to do the 2001 rate increase filings for

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