V. Anne Talton v. American Family Life Insurance Company

Court of Appeals for the Eleventh Circuit·Decided March 8, 2022·No. 21-12668·Unpublished

Opinion

[DO NOT PUBLISH]

In the

United States Court of Appeals For the Eleventh Circuit

No. 21-12668

Non-Argument Calendar

V. ANNE TALTON, Plaintiff-Appellant,

versus AMERICAN FAMILY INSURANCE COMPANY,

Defendant,

AMERICAN FAMILY LIFE INSURANCE COMPANY, AMERICAN STANDARD INSURANCE COMPANY OF WISCONSIN, 2 Opinion of the Court 21-12668

Defendants-Appellees.

Appeal from the United States District Court for the Northern District of Georgia D.C. Docket No. 1:19-cv-02571-MHC

Before WILSON, JORDAN, and NEWSOM, Circuit Judges. PER CURIAM:

In this breach of contract action, Anne Talton sued American Family Life Insurance Company and American Standard Insurance Company of Wisconsin (collectively, AFI) for terminating her Agent Agreement without notice. AFI says that it was entitled to terminate Talton’s Agent Agreement without notice because Talton engaged in dishonest and disloyal conduct when she provided coverage on an insurance claim by backdating a lapsed policy. The district court granted summary judgment to AFI, finding no genuine issue of material fact as to whether Talton engaged in dishonest and disloyal conduct by backdating the policy. After careful review , we affirm.

I.

In October 2008, Talton signed an Agent Agreement with AFI, an insurance company offering auto, property, commercial, and life insurance. The Agent Agreement provided that Talton 21-12668 Opinion of the Court 3

would be an independent contractor for AFI. In Section 4 of the Agent Agreement, Talton agreed to the following provisions:

That you shall not have the authority to extend the time of payment of any premium or alter, waive or forfeit any of the Company’s rights, requirements or conditions in any policy of insurance or otherwise obligate the Company in any way except as stated in this agreement or expressly authorized under the rules and regulations of the Company or previously authorized in writing by the Company. ....

To maintain a good reputation in your community and to direct your efforts toward advancing the interests and business of the Company to the best of your ability, to refrain from any practices competitive with or prejudicial to the Company and to abide by and comply with all applicable insurance laws and regulations. Section 6.h.2 outlined the conditions under which AFI could terminate the Agent Agreement. AFI was to provide six months’ written notice before termination unless Talton engaged in “dishonest , disloyal or unlawful conduct.” In that scenario, AFI could terminate the Agreement without notice. Talton was also subject to AFI’s Code of Conduct, which required agents to “fully cooperate ” with internal company investigations, and stated that 4 Opinion of the Court 21-12668

violations of the Code “may result in disciplinary action up to and including termination of the agent agreement.”

The events giving rise to this lawsuit stem from a client of Talton’s named T.B. On March 19, 2013, T.B. reached out to Talton and explained that he had called AFI to report hail damage to one of his cars, but had been told that his auto policies were cancelled . According to T.B.’s Statement of Account History, he had three active auto policies, all of which were “cancelled due to nonpayment of premium” on March 15, 2013. Talton set up a conference call between herself, T.B., and a billing representative to discuss T.B.’s policy. During that call, Talton stated that she would reinstate his policy and “backdate” it to March 15th to ensure that his claim would be covered. A transcript of the call—the accuracy of which Talton does not dispute—records the following exchange:

Talton: I’m just going to reinstate [T.B.’s policy] from the day it went out of force on the 14th so he won't have a break in coverage. . . . Sanchez: Okay. Then you would need to do the 15th because he canceled the 15th. Talton: Okay. So we could do it as of the 15th. And if I reinstate it as of the 15th, then he won’t have a break in coverage? [Billing Representative]: Correct. Talton: And the reason why is because he’s had a— he’s got a claim and he’s not going to get it covered 21-12668 Opinion of the Court 5

because his policy’s out of force if I don’t backdate it to the 15th. [Billing Representative]: Okay. I—I can’t advise that one, Anne, that would be something you would have to speak with the underwriter. Talton: But up until this point his policy hasn’t canceled , so and it’s only, it’s less than five days so I’m comfortable with him going back to that and just using his current premium. . . . Okay. T.B., if you could make a payment of $252.82, that’ll take you up until April 16th. T.B.: Thank you. T.B. paid the requested balance over the phone. His Statement of Account History shows that his three auto policies were then reinstated for coverage from March 15, 2013 through April 16, 2013.

The day after the conference call, AFI’s Compliance and Ethics Department (Compliance) contacted Michael Marlin, Talton’s sales district leader, and Michael Riggs, Talton’s state sales director. Compliance explained to Marlin and Riggs that it would be investigating whether Talton had backdated an insurance policy to provide coverage during the period a policy was in cancellation for nonpayment. As part of the investigation, Compliance asked Talton why she had reinstated T.B.’s policy effective March 15th when 6 Opinion of the Court 21-12668

T.B. had not paid until March 19th. Talton responded that she had “reinstated [the policy] with no lapse in coverage as a courtesy.”

Compliance requested additional documents from Talton and asked questions related to the reinstatement of T.B.’s policy, but Talton did not respond to these requests and interrogatories. In an email, she apologized for not having responded and stated that she “had some staffing challenges.” When Compliance completed its investigation in late April, it concluded that Talton had improperly backdated T.B.’s policy. The investigation found that AFI paid $2,487.30 to cover T.B.’s claim as a result of Talton’s backdating the policy. Compliance also flagged eleven other policies that Talton appeared to have backdated.

A few weeks later, on May 9, 2013, Marlin met with Talton to discuss the investigative findings. During the meeting, Marlin took contemporaneous notes which he shared with Talton afterward . According to Marlin’s notes, he informed Talton that backdating insurance policies undermined AFI’s profitability and was prejudicial to the company. Talton responded that she was busy and multitasking during the conference call with T.B. and the billing representative. She said that she was uncertain “how billing rules and regulations work and what would cause [T.B.’s] policy to be active or not at the time of the loss.” She insisted that she had not attempted to do anything fraudulent.

On May 17, Riggs signed an approval of Talton’s termination , stating that Talton “had several compliance violations,” and had failed to comply with company rules and guidelines. The 21-12668 Opinion of the Court 7

approval form had a line item asking “Did the company terminate the agent for violation of their agent agreement?” The answer “No” was marked on the form. Later that day, Riggs and Marlin met with Talton. Again, Marlin took notes which Talton agrees were accurate. Riggs explained to Talton that AFI was terminating her Agent Agreement effective immediately for backdating T.B.’s policy. Talton stated that any issues with backdating coverage were attributable to gaps in training. Nevertheless, Riggs provided Talton with a termination letter stating that AFI had decided to terminate her contract for the reasons discussed in the meeting.

With respect to Talton’s handling of T.B.’s insurance policy, AFI also referred a complaint to Georgia’s Office of Insurance and Safety Fire Commissioner (Georgia DOI). Georgia DOI issued Talton a warning letter on August 8, 2013, stating that:

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