Woodworker's Supply v. Principal Mutual, 170 F.3d 985, 10th Cir. (1999)
Woodworker's Supply v. Principal Mutual, 170 F.3d 985, 10th Cir. (1999)
Woodworker's Supply v. Principal Mutual, 170 F.3d 985, 10th Cir. (1999)
MAR 10 1999
PUBLISH
PATRICK FISHER
Clerk
UNITED STATES COURT OF APPEALS
TENTH CIRCUIT
Nos. 97-2226
97-2232
Defendant-Appellant/
Cross-Appellee,
Appeal from the United States District Court
for the District of New Mexico
(D.C. No. CIV 95-1583 BB/DJS)
Doug K. Butler (Bill E. Davidoff with him on the briefs) of Figari & Davenport,
L.L.P., Dallas, Texas, for Defendant-Appellant/Cross-Appellee.
William C. Madison and Gregory D. Steinman of Madison, Harbour, Mroz &
Brennan, P.A., Albuquerque, New Mexico, for Plaintiff-Appellee/CrossAppellant.
Before SEYMOUR, Chief Judge, BALDOCK and BRORBY, Circuit Judges.
SEYMOUR, Chief Judge.
I.
We review the evidence in the light most favorable to Woodworker
because the jury found in its favor. See Webb v. ABF Freight Sys. Inc., 155 F.3d
1230, 1234 n.1 (10th Cir. 1998). [W]e accept the jurys factual determinations
as long as they are reasonably based on some evidence or the inferences that may
reasonably be drawn from such evidence. Id. Under this standard of review, the
record establishes the following facts.
At the end of 1993, Woodworker, a manufacturer and supplier of
woodworking tools and equipment, was shopping for insurance coverage for its
employees. It was dissatisfied with its previous insurer, Washington National, for
processing claims inefficiently and inaccurately. Woodworker received bids from
several insurance companies, including Principal Mutual, through its insurance
broker, Nadyne Shimada.
Woodworker had previous experience with different types of insurance
contracts. Washington National had provided Woodworker with a contingent
premium contract, also known as a retrospective premium agreement. Under such
an agreement, the insurer sets two rates, the preliminary premium and the contract
premium. During the course of the year, the insured pays the preliminary
premium which is the lower of the two rates. At the end of the year, the insurer
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calculates the claims paid as well as certain other charges. If this calculation is
lower than the preliminary premium, the insured pays nothing further. If it is
higher, the insured pays the difference but never more than the contract rate. In
exchange for this flexibility, the maximum liability is somewhat higher than it
would be were only one rate set. Woodworkers experience with this arrangement
had been positive. Its claims had been 60-70% of the preliminary premium, and it
never had to make an additional payment at the end of the year.
When Ms. Shimada solicited bids for a new insurer on behalf of
Woodworker, she looked for a plan structured similarly to Washington Nationals.
Principal Mutual submitted a low bid, so low in fact that Ms. Shimada sent it back
for the company to revise its rates upwards. Rates that are too low may harm the
insured in several ways. They may indicate insufficient coverage. Or, in a
contingent funding agreement, inadequate preliminary premiums may subject the
insured to unexpected collections at the end of the year or significant rate
increases for the next year.
Principal Mutual resubmitted an increased bid and set the preliminary
rates 25% below the contract rate. According to Ms. Shimadas analysis, the rates
seemed reasonable and she recommended Principal Mutuals plan to Woodworker.
Principal Mutual began insuring Woodworker on March 1, 1994, although the
parties did not sign the retrospective premium agreement until late July 1994.
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disclose this to Woodworker until February 1995. In addition, while the contract
mentioned pooling charges, it did not indicate that such charges could equal up to
15% of the contract premium. Even though Woodworker paid $178,000 in
premiums in 1994, its claims would have to have been less than $50,000 to avoid
an end of the year surcharge. Had Woodworker known this prior to March 1,
1994, it would not have contracted with Principal Mutual.
As would be expected, Principal Mutuals omissions resulted in a
significant charge at the end of 1994 as well as a large rate increase for the
following year. Severe disagreements ensued between Principal Mutual and
Woodworker. Woodworker refused to pay the increase in the rates, as well as the
1994 surcharge. Principal Mutual demanded payments and unilaterally increased
the 1995 rates. Finally, Principal Mutual terminated Woodworkers coverage
effective midnight, August 31, 1995.
II.
A.
ERISA Preemption
The primary legal question in this case is whether, and to what extent,
ERISA preempts Woodworkers claims against Principal Mutual. 1 The trial court
1
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at 1065. While the scope of ERISA preemption may be broad, it is certainly not
boundless. See Monarch Cement Co. v. Lone Star Indus. Inc., 982 F.2d 1448,
1452 (10th Cir. 1992).
With these principles in mind we turn to the parties claims. Essentially
Principal Mutual argues that many courts, including this one, have held ERISA
preempts fraudulent inducement claims and we should follow that precedent here.
Principal Mutual concedes that courts have allowed employers fraudulent
inducement claims against insurance professionals, but contends those cases are
inapposite because Principal Mutual is an insurance company, not an insurance
professional. We disagree on both counts.
In the cases upon which Principal Mutual relies, the fraudulent
inducement claims arise in a context factually distinguishable from the instant
case. For example, several of the cases involve fraudulent inducement claims
affecting relations between primary ERISA entities. See, e.g., Dedeaux, 481 U.S.
41, 43-44 (1987) (employee sued plan fiduciary for failing to pay benefits);
DeBruyne v. Equitable Life Assurance Soc. of the United States, 920 F.2d 457,
460-62 (7th Cir. 1990) (beneficiaries sued plan fiduciary). Principal Mutuals
heavy reliance on Maez v. Mountain States Tel. & Tel., 54 F.3d 1488 (10th Cir.
1995), is also misplaced. In Maez, plan beneficiaries sued the employer to
recover benefits under the plan. Id. at 1492. As noted above, the allocation of
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benefits under an employee benefits plan goes to the core of ERISA, and so such
claims are usually preempted. See Airparts Co., 28 F.3d at 1064-65.
We find instructive those cases in which an employer sued an insurance
professional for misrepresentations that induced plan participation. At least four
circuits have held that ERISA does not preempt such claims. See Wilson v.
Zoellner, 114 F.3d 713, 721 (8th Cir. 1997) ([W]e hold that ERISA does not
preempt [plaintiffs] suit against [an insurance agent] for the Missouri state
common-law tort of negligent misrepresentation.); Coyne & Delaney Co. v.
Selman, 98 F.3d 1457, 1467 (4th Cir. 1996) (We hold that [plaintiffs]
malpractice claim [against the insurance professionals] is not preempted because
it does not relate to an employee benefit plan within the meaning of ERISAs
preemption provision); Morstein v. National Ins. Serv., Inc., 93 F.3d 715, 723
(11th Cir. 1996) (en banc) (When a state law claim involves the reliance on an
insurers promise that a particular treatment is fully covered under a policy, . . . a
claim of promissory estoppel is not related to the benefits plan.); Perkins v.
Time Ins. Co., 898 F.2d 470, 473 (5th Cir. 1990) ([W]e conclude that a claim
that an insurance agent fraudulently induced an insured to surrender coverage
under an existing policy, to participate in an ERISA plan which did not provide
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the promised coverage, relates to that plan only indirectly.). 2 The reasoning is
two-fold: first, by definition, the insurance professional cannot act as a plan
fiduciary before the plan exists; and second, allowing preemption would not
further Congress purpose in passing ERISA. See Coyne & Delaney Co., 98 F.3d
at 1466-71.
Coyne & Delaney Co. is particularly apposite to the instant case. There,
an employer sued insurance professionals under Virginias malpractice law. See
id. at 1464. The insurance professionals had misadvised the employer about
employee benefit plans and had designed an inadequate plan for it. See id. at
1461. Once the plan went into effect, the insurance professionals served as the
Plan Administrator and Plan Supervisor. See id. The Fourth Circuit rejected the
defendants claims that ERISA preempted the employers claims, noting:
Quite simply, Delanys claim is not aimed at a plan administrator at
all since the defendants are sued in their capacities as insurance
professionals for actions taken in that capacity. Indeed, defendants
malpractice, if any, took place before they began to act in their
capacities as Plan Administrator and Plan Supervisor.
Id. at 1471.
Two cases to the contrary relied on by Principal Mutual have
subsequently been disavowed in their respective circuits. Thus, in Wilson v.
Zoellner, 114 F.3d 713, 721 n.4 (8th Cir. 1997), the Eighth Circuit declined to
follow the dicta in Consolidated Beef Indus., Inc. v. New York Life Ins. Co., 949
F.2d 960, 964 (8th Cir. 1991). And in Morstein v. National Ins. Servs., Inc., 93
F.3d 715, 717-18, 722 (11th Cir. 1996), the Eleventh Circuit en banc court
overruled Farlow v. Union Cent. Life Ins. Co., 874 F.2d 791 (11th Cir. 1989).
2
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Similarly, Woodworker is suing Principal Mutual with respect to its preplan activity in its role as a seller of insurance, not as an administrator of an
employee benefits plan. Principal Mutual does not, and cannot, claim that it was
a principal ERISA entity before March 1, 1994. Of the four principal ERISA
entities, the employer, the plan, the beneficiaries, and the plan fiduciaries,
Principal Mutual could only claim to be the last. However, Congress quite
logically defined a plan fiduciary in relation to a plan. If no plan exists, by
definition plan fiduciaries cannot exist. Consequently, Woodworkers pre-March
1, 1994 claim is best characterized as a claim between an employer and an outside
party not affecting relations between ERISA entities, as such. See Airparts Co.,
28 F.3d at 1065. That Principal Mutual may have later acted as a plan fiduciary
does not alter its pre-plan status. Cf. Coyne & Delaney, 98 F.3d at 1471.
Allowing Woodworkers claims to proceed is consistent with Congress
purpose in enacting ERISA, that is, to protect the interests of employees and other
beneficiaries of benefit plans and establish uniform standards regulating such
plans. Holding insurers accountable for pre-plan fraud does not affect the
administration or calculation of benefits, nor does it alter the required duties of
plan fiduciaries. See Wilson, 114 F.3d at 719; Coyne & Delaney Co., 98 F.3d at
1471. Conversely, were ERISA to preempt such claims, employees, whom
Congress sought to protect, [would] find themselves unable to make informed
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defined by ERISA and citing cases). Moreover, one circuit has indicated that an
insurance company may suffer liability in a misrepresentation suit. See Wilson,
114 F.3d at 718 (If Prudential incurs any liability as a result of this suit, it will
do so only as the employer of a tortfeasor, and not as a plan fiduciary.). Quite
simply, we see no principled basis for distinguishing insurance companies from
insurance professionals in this type of action. We hold that ERISA does not
preempt Woodworkers pre-plan fraud claims against its insurer, and affirm the
district court on this point.
B.
damage theory prior to trial and that the district court should have excluded its
evidence of damages. Principal Mutual raises this claim under two theories:
arguing first, that Fed.R.Civ.P. 37(c) mandated exclusion, and second, the court
should have granted a new trial under Fed.R.Civ.P. 60(b)(3). We review
evidentiary rulings and the disposition of Rule 60(b) motions for an abuse of
discretion. See Howard v. Mail-Well Envelope Co., 150 F.3d 1227, 1231 (10th
Cir. 1998 ) (60(b) motions); Orjias v. Stevenson, 31 F.3d 995, 1005 (10th Cir.
1994) (evidentiary rulings under 37(c)). Under this standard, we will not reverse
unless the trial court has made an arbitrary, capricious, whimsical, or manifestly
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the same facts, and again assume arguendo that Woodworkers failure to disclose
was improper. [B]efore retrial is mandated under Rule 60(b)(3) in consequence
of discovery misconduct, the challenged behavior must substantially have
interfered with the aggrieved partys ability fully and fairly to prepare for and
proceed at trial. Anderson v. Cryovac, Inc., 862 F.2d 910, 924 (1st Cir. 1988)
(emphasis in original). Given Principal Mutuals opportunities to cure any
prejudice flowing from Mr. Wirths testimony, we cannot say with any certainty
that Woodworkers failure to disclose substantially interfered with Principal
Mutuals ability to proceed at trial. Accordingly, we hold that the district court
was within its discretion in denying Principal Mutuals Rule 60(b)(3) motion, and
we decline to grant a new trial on this basis.
C.
evidence to support the jurys finding on the claims for violations of the New
Mexico Unfair Practices Act, the Unfair Insurance Practices Act, fraudulent
inducement, and damages. We view the evidence in the light most favorable to
Woodworker, upholding the verdict if the record reveals sufficient evidence to
support it. See Acrey v. American Sheep Indus. Assn, 981 F.2d 1569, 1572 (10th
Cir. 1992). We discuss each claim in turn.
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1.
57-12-1 et. seq., and the New Mexico Unfair Insurance Practices Act (UIPA),
N.M. S TAT . A NN . 59A-16-1 et. seq., prohibit misleading or deceptive
communications to consumers. [U]sing exaggeration, innuendo or ambiguity as
to a material fact or failing to state a material fact if doing so deceives or tends to
deceive is unlawful under the UPA. N.M. S TAT . A NN . 57-12-2 (D) (14). The
UPA applies to all misleading or deceptive statements, whether intentionally or
unintentionally made. Ashlock v. Sunwest Bank of Roswell, 753 P.2d 346, 348
(N.M. 1988), overruled on other grounds by Gonzales v. Surgidev Corp., 899
P.2d 576, 583 (N.M. 1995).
The UIPA places similar restrictions on trade practices within the
insurance business. No person may misrepresent[] the benefits, advantages,
conditions or term of any policy, N.M. S TAT . A NN . 59A-16-4 (A) or fail[] to
disclose material facts reasonably necessary to prevent other statements made
from being misleading. N.M. S TAT . A NN . 59A-16-4 (G).
Woodworker presented evidence that Principal Mutual knew that the rates
were inadequate prior to the time the agreement went into effect, and that
Principal Mutual did not disclose its method for deciding whether to add a
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Fraudulent Inducement
Under New Mexico law, the elements for fraudulent inducement are 1) a
unusual calculation methods and the resultant hidden charges presumably led Ms.
Lorek to conclude the rates were inadequate. These underlying facts serve as the
basis for a fraud claim. In addition, a reasonable juror could infer that Principal
Mutual intentionally chose not to disclose the inadequacy of the proposed rates in
order to ensure it received Woodworkers business. Finally, Woodworker
presented evidence that it relied on Principal Mutuals concealment. We
therefore affirm the jurys finding of fraud. 4
3.
Damages
Principal Mutual contends that Woodworker did not suffer any damages
Because we uphold the jurys finding that the contract at issue was
procured by fraud, Principal Mutual has no right to collect under it. See
Rodriguez v. Horton, 622 P.2d 261, 265 (N.M. Ct. App. 1980). Consequently, we
deny Principal Mutuals counterclaim for $56,320, the surcharge on the 1994
preliminary premium.
4
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Punitive damages
Woodworker contends the district court erred in refusing to submit the
issue of punitive damages to the jury. After both parties rested, Woodworker
requested that evidence pertaining to punitive damages be admitted. The district
court denied the request, finding insufficient evidence to submit punitive damages
to the jury. Aplt. App. at 1144-1145. 5 We review this question of law de novo,
viewing the evidence in the light most favorable to Woodworker. See Oja v.
Howmedica, Inc., 111 F.3d 782, 792 (10th Cir. 1997).
Under New Mexico law, punitive damages may be awarded for conduct
Later, the district court noted the compensatory damage award alone was
sufficient to achieve the underlying policy rationale of awarding punitive
damages, that is, to encourage private citizens to undertake this type of litigation.
Aplt. App. at 201.
5
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support such a finding. Under these circumstances, New Mexico law requires an
instruction on punitive damages, if requested. See, e.g., Gilmore, 961 P.2d at
184. Because substantial evidence supports the jurys finding of fraudulent
inducement, we have no choice but to order a new trial on punitive damages.
B.
Treble damages
Woodworker argues that the district court also erred in refusing to treble
its damage award. The New Mexico Unfair Trade Practices Act provides that
[w]here the trier of fact finds that the party charged with an unfair or deceptive
trade practice . . . has willfully engaged in the trade practice, the court may award
up to three times actual damages. N.M. S TAT . A NN . 57-12-10 (B) (emphasis
added). The statute specifically makes the awarding of treble damages a
discretionary act. We therefore review the courts decision not to award treble
damages under an abuse of discretion standard. Cf. Lam, Inc. v. Johns-Manville
Corp., 668 F.2d 462, 476 (10th Cir. 1982) (reviewing for abuse of discretion an
award of treble damages and attorneys fees granted under statute providing the
court may award successful party such fees).
Here, the jury expressly found that Principal Mutuals conduct was
willful, so the district court had the option to grant treble damages. However,
[g]iven the record in the case and other remedies awarded, it declined to do so.
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Aplt. App. at 202. We are not persuaded the district court abused its discretion in
denying Woodworker treble damages.
C.
could only find liability for Principal Mutuals conduct occurring before the
commencement of the insurance plan on March 1, 1994, with respect to the
fraudulent inducement, the UPA, and the UIPA claims. On cross-appeal,
Woodworker asks us to reverse this decision in the event we order a new trial on
liability or damages. Woodworker provides no separate argument on this issue,
however, and we are at a loss to determine either from its briefs on appeal or from
the record below what alleged post-plan conduct of Principal Mutuals relates to
these three claims. Woodworker specifically disclaims any intent to appeal the
district courts dismissal of its claims for breach of contract, defamation, bad
faith, and prima facie tort, which claims primarily were based on conduct
occurring after March 1, 1994. See Br. of Aplee./Cross-Aplt. at 2. Under these
circumstances, we decline to address this argument.
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D.
appeal. The New Mexico Unfair Trade Practices Act mandates an award of costs
and attorneys fees to prevailing plaintiffs. N.M. S TAT . A NN . 57-12-10 (C).
The New Mexico Supreme Court has ruled that this provision applies to costs and
fees incurred on appeal as well as at trial. See Hale v. Basin Motor Co., 795 P.2d
1006, 1013-1014 (N.M. 1990). Woodworker is therefore entitled to such fees.
On remand, the district court should award Woodworker attorneys fees for
litigating this appeal.
IV.
We REVERSE the district courts denial of punitive damages and
REMAND this case for a new trial on that issue. We AFFIRM on all other
issues.
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