Woodford, M., Aplts. v. PA Insurance Dept.

Supreme Court of Pennsylvania·Decided December 22, 2020·No. 65 MAP 2019·Published

Opinion

[J-12-2020]

IN THE SUPREME COURT OF PENNSYLVANIA MIDDLE DISTRICT

SAYLOR, C.J., BAER, TODD, DONOHUE, DOUGHERTY, WECHT, MUNDY, JJ.

MICHAEL WILLIAM WOODFORD AND : No. 65 MAP 2019 OPTIONS INSURANCE AGENCY, :

: Appeal from the Order of the Appellants : Commonwealth Court at No. 1005 : CD 2018 dated January 4, 2019, : Reconsideration Denied February v. : 15, 2019, Affirming in Part and : Reversing in Part the Decision of the : PA Insurance Department at No.

COMMONWEALTH OF PENNSYLVANIA : SC16-11-001 dated June 21, 2018. INSURANCE DEPARTMENT, :

: ARGUED: March 11, 2020 Appellee :

OPINION

JUSTICE DOUGHERTY DECIDED: December 22, 2020 We granted discretionary review to consider, as a matter of first impression,

whether Section 310.74(a) of the Insurance Department Act of 1921 (the Act), 40 P.S. §§1-326.7, prohibits a licensed insurance producer from charging fees in addition to commissions in non-commercial, i.e. personal, insurance transactions.

I. Background

Appellant Options Insurance Agency is owned by appellant Michael Woodford and both are licensed insurance producers that facilitate motor vehicle insurance contracts between insurance consumers and insurance carriers. Adjudication and Order, 6/21/2018 at ¶¶1-5, 8; see 40 P.S. §310.1 (insurance producer is a “person that sells, solicits or negotiates contracts of insurance”). In June 2015, the Pennsylvania Insurance Department (the Department) began investigating appellants following a market conduct

examination of a different insurance agency, and receipt of a consumer complaint concerning appellants’ fee practices. During its investigation, the Department discovered that, between March 2011 and October 2015, appellants charged a non-refundable $60- $70 fee to customers seeking to purchase personal insurance products.1 Id. at ¶6. These fees were collected from the customers before appellants prepared the insurance policy applications. Id. at ¶7. One consumer complaint indicated appellants kept an “un- refundable broker application fee” when the consumer declined to buy a policy. N.T., 11/15/2017 at 300-01, 309. The Department’s investigation also revealed appellants paid a “one-time” $50 referral fee to car dealership sales personnel when they referred their customers in need of insurance. Adjudication and Order, 6/21/2018 at ¶¶9-10.

The Department concluded appellants’ fee practices included improper fees charged to consumers “for the completion of an application for a contract of insurance” and prohibited referral payments to the car dealerships. See 40 P.S. §310.74(b) (“no insurance producer shall charge a fee for the completion of an application for a contract of insurance”); §310.72(b)(2) (authorizing payment of certain limited referral fees).2 Accordingly, on November 2, 2016, the Department filed an Order to Show Cause with the Insurance Commissioner (the Commissioner) alleging appellants violated the Act when they paid referral fees to non-licensed individuals contingent on the sale of

1 Neither the Act nor the parties provide specific definitions of “personal” insurance, but it is apparent in this case that the subject personal insurance transactions involved individual drivers who sought insurance for their personal vehicles, rather than business consumers seeking insurance for a commercial vehicle. 2 Section 310.72(b)(2) of the Act allows producers to pay: “a fee to a person that is not a licensee for referring to a licensee persons that are interested in purchasing insurance if the referring person does not discuss specific terms and conditions of a contract of insurance and, in the case of referrals for insurance that is primarily for personal, family or household use, the referring person receives no more than a one-time, nominal fee of a fixed dollar amount for each referral that does not depend on whether the referral results in a sale.” 40 P.S. §310.72(b)(2).

insurance, charged consumers a fee for completing insurance applications, and demonstrated unworthiness of licensure, acted unfairly and used fraudulent practices. Order to Show Cause, 11/2/2016, ¶¶10-29; see 40 P.S. § 310.11(20) (relating to general lack of fitness, competency or reliability); §310.11(7) (prohibiting fraudulent, coercive or dishonest practices); §310.11(6) (prohibiting “unfair insurance practice or fraud”). The Department requested that the Commissioner revoke appellants’ insurance producer licenses, bar them from future licensure, or from applying to renew any license previously held in this Commonwealth, impose a civil penalty of $5,000 per violation, order appellants to cease and desist from violating the Act, order restitution for each of the illegal fees charged to insurance consumers, and impose any other conditions deemed appropriate, including supervision for a minimum five-year period should appellants become relicensed. Id., citing 40 P.S. §310.91(d) (penalty provision).

In an Answer and New Matter, appellants admitted they paid referral fees to automobile dealerships and charged “broker fees” to their customers, but maintained those fees did not violate the Act. Appellants also filed a Motion to Dismiss the Order to Show Cause, and provided an affidavit from Michael Woodford as evidentiary support. Woodford averred, with respect to fees paid to car dealerships, to his knowledge none of the salesmen ever “discuss specific terms or conditions of any insurance policy[,]” and appellants pay the referral fee “irrespective of whether a sale is consummated[.]” Affidavit of Michael William Woodford, 12/2/2016 at ¶¶8-10. Woodford further stated in his affidavit that appellants “charge[d] customers a broker’s fee, which is also perfectly common throughout the Commonwealth[;]” the “fee is always fully disclosed in writing to and signed off on by all of our consumers, and rightfully earned for valuable insurance services rendered by Options[,]” specifically because appellants “work[ ] to identify carriers to best serve its customers’ automobile insurance needs based on the individual circumstances

presented with each account[;]” and that the fee “has nothing to do with the preparation or completion of any application for auto insurance[,] in fact, that task is handled by the insurance carriers that ultimately write the business.” Id. at ¶¶12-14.

A. The Insurance Commissioner’s Adjudication Efforts to resolve the dispute amicably failed and, during a February 16, 2017 prehearing conference, the parties agreed to treat appellants’ Motion to Dismiss as a Motion for Summary Judgment. On April 11, 2017, the Department finally filed an Answer to appellants’ December 2016 Motion to Dismiss, supported by three affidavits from automobile dealer sales representatives who asserted appellants paid them improper referral fees. Appellants filed a Motion to Strike the Department’s Answer as untimely. Following oral argument, the Commissioner granted appellants’ Motion to Strike but denied summary judgment in their favor. The Commissioner reasoned appellants’ motion was supported only by Woodford’s affidavit and although his averments about the fees were uncontradicted, an evidentiary hearing was necessary to test the affiant’s credibility. See Order Denying Motion for Summary Judgment, 7/31/2017 at 11, citing Borough of Nanty-Glo v. American Surety Co. of New York, 163 A. 523 (Pa. 1932).

Prior to the hearing before the Commissioner, the Department amended its Order to Show Cause to include an allegation that the $60-$70 fees appellants charged consumers in non-commercial personal insurance transactions also violated Section 310.74(a) which permits a “fee in addition to a commission” only in commercial transactions.3 See Amendment to Order to Show Cause, 8/25/17 at 2. In response, appellants again admitted charging what they deemed “broker” fees, but asserted they

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

Woodford, M., Aplts. v. PA Insurance Dept., (Pa. 2020).

Woodford, M., Aplts. v. PA Insurance Dept. (Woodford, M., Aplts. v. PA Insurance Dept.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

Taylor v. United States
44 U.S. 197 (Supreme Court, 1845)
Edelman v. Lynchburg College
535 U.S. 106 (Supreme Court, 2002)
Commonwealth v. Monumental Properties, Inc.
329 A.2d 812 (Supreme Court of Pennsylvania, 1974)
Summers v. CERTAINTEED CORP.
997 A.2d 1152 (Supreme Court of Pennsylvania, 2010)
United Healthcare Benefits Trust v. Insurance Commissioner
620 A.2d 81 (Commonwealth Court of Pennsylvania, 1993)
Penn Center House, Inc. v. Hoffman
553 A.2d 900 (Supreme Court of Pennsylvania, 1989)
Curran v. Philadelphia Newspapers, Inc.
439 A.2d 652 (Supreme Court of Pennsylvania, 1981)
Grimaud v. Pennsylvania Insurance Department
995 A.2d 391 (Commonwealth Court of Pennsylvania, 2010)
Kmonk-Sullivan v. State Farm Mutual Automobile Insurance
788 A.2d 955 (Supreme Court of Pennsylvania, 2001)
Peoples Natural Gas Co. v. Pennsylvania Public Utility Commission
554 A.2d 585 (Commonwealth Court of Pennsylvania, 1989)
Snyder v. Department of Environmental Resources
588 A.2d 1001 (Commonwealth Court of Pennsylvania, 1991)
Bremmer v. Protected Home Mutual Life Insurance
260 A.2d 785 (Supreme Court of Pennsylvania, 1970)
Tincher, T. v. Omega Flex, Inc., Aplt.
104 A.3d 328 (Supreme Court of Pennsylvania, 2014)
Bailets v. Pennsylvania Turnpike Commission
123 A.3d 300 (Supreme Court of Pennsylvania, 2015)
Nanty-Glo Boro. v. American Surety Co.
163 A. 523 (Supreme Court of Pennsylvania, 1932)
Verona v. Schenley Farms Co.
167 A. 317 (Supreme Court of Pennsylvania, 1933)
A.S. v. Pennsylvania State Police
143 A.3d 896 (Supreme Court of Pennsylvania, 2016)
McGrath v. Bureau of Prof'l & Occupational Affairs
146 A.3d 310 (Commonwealth Court of Pennsylvania, 2016)
Snyder Brothers, Inc. v. PA PUC PA Independent Oil & Gas Association v. PA PUC
157 A.3d 1018 (Commonwealth Court of Pennsylvania, 2017)
Trust Agrmt. of E. Taylor Appeal of: Wells Fargo
164 A.3d 1147 (Supreme Court of Pennsylvania, 2017)