Robert G. Steele, Esq.
David K. Schwirian, Esq.
Daniel C. Cooper, Esq.
Pauley, Curry, Sturgeon & Vanderford
Steptoe & Johnson
Charleston, West Virginia
Clarksburg, West Virginia
Phillip R. Scaletta, Esq.
Attorneys for Appellant
Ice, Miller, Donadio & Ryan
Indianapolis, Indiana
Counsel for Appellee American United
Life Insurance Company
Stephen R. Brooks, Esq.
Furbee, Amos, Webb & Critchfield
Fairmont, West Virginia
Counsel Appellees Gardner & White
Corporation; Gardner & White, Inc.;
and Harry D. Jackson
CHIEF JUSTICE STARCHER delivered the Opinion of the Court.
JUDGE FRED RISOVICH, II, sitting by special assignment.
JUSTICE SCOTT did not participation in the decision of the Court.
Starcher, Chief Justice:
In this appeal from the Circuit Court of Lewis County, we are asked to examine
the July 13, 1998 order of the circuit court that granted partial summary judgment against the
appellant on the issue of whether the appellee insurance company, as a general business
practice, violated the West Virginia Unfair Trade Practices Act (Act), W.Va. Code, 33-11-1
to -10.
The parties in this appeal dispute whether the Act applies to an insurance
policy that provides an insured with life insurance annuities. As set forth below, we
conclude that the Act does regulate the actions of an insurance company in the handling of
claims against an annuity policy. However, we also conclude that the appellant in this case,
when responding to the appellees' motion for summary judgment, failed to provide the
circuit court with evidence sufficient to establish a genuine question of material fact
regarding whether the appellees violated the Act as a general business practice.
Accordingly, we affirm the circuit court's partial summary judgment order.
Appellee American United Life Insurance Company (AUL) is a mutual life
insurance company. In 1971, AUL entered into a Master Group Annuity Contract (the
Contract) with the West Virginia Hospital Association (WVHA) to provide insurance
annuities as an investment medium for the pension plans of hospitals that were members of
the WVHA. Member hospitals were not required to participate in the plan, but could elect
to become a participant in the Contract if they so chose.
Appellant Stonewall Jackson Memorial Hospital (Hospital) is a private, non-
profit hospital located in Weston, West Virginia. Until January 1997, the Hospital was a
member of the WVHA.
Effective October 1, 1975, the Hospital elected to participate in the Contract
negotiated between AUL and the WVHA. Under the Contract, the Hospital could buy
annuities at a set interest rate as an investment to generate pension benefits for its employees.
The Hospital would pay money to AUL to purchase the annuities, and in return AUL would
pay money out to Hospital employees upon certain events, such as an employee's
termination, retirement or death.
The 1971 Master Group Annuity Contract contained no provision that
explicitly prohibited the Hospital from terminating its participation in the Contract and
withdrawing the money it had contributed toward the purchase of annuities. It was under the
1971 Contract provisions that the Hospital had elected to participate in 1975. The Hospital
therefore argues that it could cease to be a participant in the Contract and withdraw its
contributions at any time.
AUL counters by arguing that the original 1971 Contract contained no
provision that explicitly allowed the Hospital to withdraw its pension contributions.
Therefore, the only way the Hospital could recover the money it invested under the originalContract was through the occurrence of specific events, such as the termination, retirement
or death of an employee.
The 1971 Contract allowed AUL and the WVHA to agree, in writing, to make
changes in the Contract. However, the Contract also stated that no change could be made
that adversely affect[ed] the benefits provided . . . unless the consent of any Participant
affected is obtained.
In 1993, with no notice, no effort to obtain consent, and without the knowledge
of the Hospital, the WVHA and AUL changed the Contract by adopting Amendment No.
3. Amendment No. 3 states that if an employer terminated its participation in the Master
Group Annuity Contract, and transferred its annuity contributions to another insurance
company, then the employer would have to pay significant monetary penalties including an
investment liquidation charge.
In 1994, the Hospital stopped depositing money in the AUL Contract plan.
Then, on January 20, 1995, the Hospital tried to withdraw its contributions from AUL and
transfer the money to another insurance company for investment. At that time, the Hospital
had invested $5,250,380.27 under the annuity contract with AUL.
Upon receiving the Hospital's request that AUL transfer the entire balance of
the Hospital's annuity investments, AUL notified the Hospital that it was going to impose
a withdrawal penalty of $242,980.25 pursuant to Amendment No. 3. The Hospital pointed
out to AUL that under the terms of the original 1971 Contract, an amendment to the Contract
that adversely affected the benefits provided would not apply unless the Hospital gave its
consent. Hence, because Amendment No. 3 adversely affected the benefits available to the
Hospital and its employees, and because the Hospital did not agree to Amendment No. 3, it
demanded that AUL relinquish the entire balance of the account without imposing any
withdrawal penalties.
AUL refused to transfer any of the Hospital's annuity assets until the Hospital
signed a Notice, Election and Release form prepared by AUL, including the undisputed
amount of $5,007,400.02. The release form stated that the Hospital would agree to allow
AUL to keep the $242,980.25 withdrawal penalty, and in effect stated that the Hospital was
waiving any causes of action that might arise from the withdrawal transaction.See footnote 1
1
After discussions occurred between the Hospital and AUL, on March 31, 1995
a representative for the Hospital signed the AUL Notice, Election and Release form.
However, the form was delivered to AUL with a letter stating that the form was signed under
protest, and that the Hospital did not agree to the contents of the form.See footnote 2
2
The letter mailed
with the form specifically reserves the Hospital's right to pursue legal relief as a result of the
actions of AUL.
Several weeks after receiving the signed Notice, Election and Release, AUL
delivered to the Hospital the undisputed $5,007,400.02. However, AUL retained the
withdrawal penalty of $242,980.25.
This civil action was filed by the Hospital against AUL and against the
insurance agents who managed the annuity Contract, appellee Gardner & White, Inc. and
Gardner & White Corporation (Gardner & White), and appellee Harry D. Jackson, an
insurance agent. The Hospital's complaint generally alleged two causes of action. First, the
complaint alleged that AUL and its agents had breached the annuity contract with the
Hospital by refusing to transfer the $242,980.25. Second, the complaint alleged that the
actions of AUL and its agents amounted to unfair and deceptive insurance trade practices in
violation of the West Virginia Unfair Trade Practices Act, W.Va. Code, 33-11-4 [1985].
After substantial discovery, on June 9, 1998 appellee AUL filed a motion for
summary judgment with the circuit court. Appellees Gardner & White and Mr. Jackson
subsequently joined in the motion. Together, the appellees argued that the Hospital had not
shown any evidence of duress in the signing of the Notice, Election, and Release form, nor
any other evidence to show that the form was invalid. The appellees also argued that the
Hospital had signed the Notice, Election, and Release in consultation with its attorneys.
Therefore, the appellees argued that the release form should be construed as a bar to both the
Hospital's breach of contract action and unfair trade practices action. Additionally, the
appellees contended that the evidence was insufficient to show a breach of contract, or to
show that the appellees had engaged in unfair trade practices as a general business practice.
In an order dated July 13, 1998, the circuit court denied the appellees' motion
for summary judgment on the breach of contract issue, but granted the appellees' motion on
the unfair trade practices action.
As to the breach of contract action, the circuit court ruled that the 1971 Master
Group Annuity Contract contained no language whatsoever regarding the Hospital's right
to withdraw its money from AUL. The circuit court therefore concluded that it is implicit
in this contract that the [Hospital] could withdraw or transfer the funds held by AUL, even
before Amendment No. 3[.] Furthermore, the circuit court held that the Notice, Election
and Release form is not determinative in the resolution of this case and it is clear that [the
Hospital] executed this document but without waiving any rights it had to pursue legal
remedies. The circuit court therefore denied summary judgment as to the Hospital's breach
of contract action.
However, the circuit court granted summary judgment as to the Hospital's
claim for violations of the Unfair Trade
Practices Act. The court concluded that, [g]iven
the circumstances of this convoluted transaction, I find no fraud, duress, or violation of the
Unfair Trade Practices Act.
The case proceeded to a jury trial on the breach of contract issue. After the
presentation of evidence by the parties, the circuit court directed a verdict in favor of the
Hospital. A judgment order was entered on July 27, 1998 awarding the Hospital $242,980.25
plus 10% prejudgment interest beginning on April 18, 1995; $10,000.00 in future economic
losses; and attorneys fees and litigation expenses.
The Hospital then filed this appeal seeking a review of the portion of the circuit
court's July 13, 1998 partial summary judgment order that dismissed the Hospital's cause of
action alleging that AUL and its agents violated the Unfair Trade Practices Act. Pursuant to
Rule 10(f) of the West Virginia Rules of Appellate Procedure [1995], AUL cross-appealed
various issues raised by the circuit court's July 27, 1998 judgment order.See footnote 3
3
As set forth below, we address those issues raised by the Hospital's appeal.
We find no merit to the issues raised by AUL, and decline to address them.
In this case, the appellant Hospital asks that we examine the circuit court's
order granting partial summary judgment to the appellees on the issue of whether the
appellees violated the Unfair Trade Practices Act. We review a circuit court's entry of
summary judgment de novo. Syllabus Point 1, Painter v. Peavy, 192 W.Va. 189, 451 S.E.2d
755 (1994).
The parties' dispute over the circuit court's summary judgment order can be
broken into two issues: whether, as a matter of law, an insurance company can violate the
Unfair Trade Practices Act, when the insurance contract in dispute concerns annuities; and
whether, as a question of fact, the appellant in this case introduced sufficient evidence to
create a question of material fact regarding whether the insurance company violated the
Unfair Trade Practices Act as a general business practice.
We examine these two issues separately.
(d) Refusing to pay claims without conducting a
reasonable investigation based upon all available information;
. . .
(f) Not attempting in good faith to effectuate prompt, fair
and equitable settlements of claims in which liability has
become reasonably clear;
(g) Compelling insureds to institute litigation to recover
amounts due under an insurance policy by offering substantially
less than the amounts ultimately recovered in actions brought by
such insureds, when such insureds have made claims for
amounts reasonably similar to the amounts ultimately recovered;
. . .
(m) Failing to promptly settle claims, where liability has
become reasonably clear, under one portion of the insurance
policy coverage in order to influence settlements under other
portions of the insurance policy coverage;
(n) Failing to promptly provide a reasonable explanation
of the basis in the insurance policy in relation to the facts or
applicable law for denial of a claim or for the offer of a
compromise settlement[.]
The appellees argue that the aforementioned portions of the Act apply only to
loss claims submitted by an insured against a liability or indemnity-type policy, and are
wholly inapplicable to claims made by a policyholder against an annuity insurance contract.
The appellees characterize this case as a contract dispute between two business entities, and
suggest that the Act was intended to protect individual, non-business entities. Lastly, the
appellees take the position that the Act was never intended to apply to good-faith disputes
between businesses regarding the proper interpretation of an annuity insurance contract. We
disagree.
W.Va. Code, 33-11-4(9), cited above, repeatedly uses the terms insurance
policy and insurance contract, and refers to claims made against such a policy or
contract, in defining acts that are prohibited by an insurance company. A separate section
of the Act, W.Va. Code, 33-11-2(c) [1974], broadly defines an insurance policy as the
contract effecting insurance.See footnote 4
4
We therefore must determine whether the term insurance
policy includes contracts, sold by a life insurance company such as appellee AUL, that
provide annuities.
W.Va. Code, 33-1-1 [1957] states that insurance is a contract whereby one
undertakes to indemnify another or to pay a specified amount upon determinable
contingencies. Furthermore, W.Va. Code, 33-1-10 [1986] specifically defines the various
kinds of insurance to include annuities such as those sold by AUL to the Hospital.
Specifically, W.Va. Code, 33-1-10(a) states, with emphasis added:
The following definitions of kinds of insurance are not mutually
exclusive and, if reasonably adaptable thereto, a particular
coverage may be included under one or more of such
definitions:
(a) Life insurance--Life insurance is insurance on human lives
including endowment benefits, additional benefits in the event
of death or dismemberment by accident or accidental means,
additional benefits for disability and annuities[.]
Reading these statutes in pari materia, we conclude that a contract under which
an insurance company agrees to provide an annuity, such that the insurance company will
pay a specified amount upon determinable contingencies, is an insurance policy or
insurance contract subject to regulation under the West Virginia Unfair Trade Practices
Act, W.Va. Code, 33-11-4(9). In accord, Morton v. Amos-Lee Securities, Inc., 195 W.Va.
691, 696 n. 13, 466 S.E.2d 542, 547 n. 13 (1995) (The question may be asked as to whether
an annuity is an insurance policy under WVUTPA. That question is quickly answered in
W.Va. Code 33-1-10 (1986), wherein the definition of life insurance includes annuities.)
We can also infer that the Legislature intended for annuity contracts to be
regulated by the unfair claims practice provisions of the Act by examining one narrow statute
contained in the Act which specifically excludes life insurance annuities from certain
regulations. W.Va. Code, 33-11-5a [1996] proscribes certain requirements that an insurance
company must follow when canceling an existing life insurance policy and issuing a new
policy; W.Va. Code, 33-11-5a(c)(1) states, however, that these requirements shall not apply
to . . . [a]nnuities. We have often stated that [i]n the interpretation of statutory provisions
the familiar maxim expressio unius est exclusio alterius, the express mention of one thing
implies the exclusion of another, applies. Syllabus Point 3, Manchin v. Dunfee, 174 W.Va.
532, 327 S.E.2d 710 (1984). By expressly excluding annuities from regulation in one part
of the Act, the Legislature obviously intended that insurance policies providing annuities are
to be regulated by the other portions of the Act in a manner similar to any other type of
insurance contract.
In this case, the Master Group Annuity Contract provided that AUL would sell
annuities to the appellee Hospital. In the Contract, AUL undertook to pay the Hospital and
its employees certain benefits on the occurrence of specified contingencies, such as the
retirement or death of an employee. Accordingly, we believe that the AUL Master Group
Annuity Contract is an insurance policy or insurance contract subject to the terms of the
Act. Any dispute that the Hospital had with AUL regarding claims against the Contract
would be governed by the unfair claims practice provisions of the Act.
The question remains, however, whether the Hospital proffered evidence
sufficient to indicate to the circuit court that a genuine issue of material fact existed regarding
whether AUL engaged, as a general business practice, in unfair claims practices in its dispute
with the Hospital.
In Dodrill v. Nationwide Mut. Ins. Co., 201 W.Va. 1, 491 S.E.2d 1 (1996) we
clarified that the appellant could prove that a general business practice of unfair claims
practices existed by showing that multiple, discrete violations of the Act occurred in the
processing of a single claim. We stated in Syllabus Point 4 of Dodrill:
To maintain a private action based upon alleged violations of
W.Va. Code § 33-11-4(9) in the settlement of a single insurance
claim, the evidence should establish that the conduct in question
constitutes more than a single violation of W.Va. Code §
33-11-4(9), that the violations arise from separate, discrete acts
or omissions in the claim settlement, and that they arise from a
habit, custom, usage, or business policy of the insurer, so that,
viewing the conduct as a whole, the finder of fact is able to
conclude that the practice or practices are sufficiently pervasive
or sufficiently sanctioned by the insurance company that the
conduct can be considered a general business practice and can
be distinguished by fair minds from an isolated event.
We now turn to the record to determine whether the appellant proffered
sufficient evidence to show that the appellees engaged in multiple actions that violated the
Unfair Trade Practices Act, and sufficient evidence to show that those actions were
sufficiently pervasive so as to raise a question of fact regarding whether the conduct could
be considered a general business practice.
In its appellate brief, the appellant cites to testimony contained in deposition
transcripts which suggests that AUL and its agents, Gardner & White and Mr. Jackson, made
numerous statements to the appellant and the WVHA which tended to mislead the appellant
as to the terms of the Master Group Annuity Contract and Amendment No. 3.
The appellant also cites to cases where courts in other states have addressed
similar disputes concerning AUL's imposition of a withdrawal penalty against an employer
hospital pursuant to an un-agreed-to amendment to an annuity contract.See footnote 5
5
Furthermore, in its
appellate brief, the Hospital states that its witness list contains the names of individuals from
two other hospitals in West Virginia, and now states that these individuals were going to
testify to identical breaches of annuity contracts by AUL. If presented to a jury, the appellant
suggests that this evidence would establish that the appellees were engaging in a general
business practice that violated the Act.
Unfortunately, the evidence referred to by the appellant Hospital was never
proffered to the circuit court. We made clear in Williams v. Precision Coil, Inc., 194 W.Va.
52, 459 S.E.2d 329 (1995) that when a party files a properly supported motion for summary
judgment, the burden shifts to the non-moving party to supply the circuit court with evidence
sufficient to establish that a question of material fact remains for adjudication. We stated,
in Syllabus Point 3:
If the moving party makes a properly supported motion for
summary judgment and can show by affirmative evidence that
there is no genuine issue of a material fact, the burden of
production shifts to the nonmoving party who must either (1)
rehabilitate the evidence attacked by the moving party, (2)
produce additional evidence showing the existence of a genuine
issue for trial, or (3) submit an affidavit explaining why further
discovery is necessary as provided in Rule 56(f) of the West
Virginia Rules of Civil Procedure.
In this case, the appellees sufficiently alleged that there was no genuine issue
of material fact concerning whether AUL and its agents, as a general business practice,
violated the Act. The burden then shifted to the appellant Hospital to produce additional
evidence showing the existence of a genuine issue for trial. The Hospital never met this
burden.
The appellant contends that the circuit court erred because it granted summary
judgment without reviewing the volumes of information collected by the appellant during
discovery that would show the appellees violated the Unfair Trade Practices Act as a general
business practice. However, we find nothing in the record to indicate that the appellant ever
directed the circuit court's attention to this information. No affidavits, deposition transcripts,
documents or other evidence firmly substantiating a general business practice of violating
the Unfair Trade Practices Act was delivered to the trial judge for review.See footnote 6
6
Furthermore, the
appellant's response to the appellees' motion for summary judgment makes no mention of
this other evidence.
We stated in Syllabus Point 2 of Williams v. Precision Coil, Inc., that:
Summary judgment is appropriate if, from the totality of the
evidence presented, the record could not lead a rational trier of
fact to find for the nonmoving party, such as where the
nonmoving party has failed to make a sufficient showing on an
essential element of the case that it has the burden to prove.
In this case the appellant failed to make any showing to the circuit court that the appellees,
as a general business practice, violated the Unfair Trade Practices Act. Accordingly, it was
within the circuit court's discretion to grant summary judgment to the appellees.
In accordance with . . . the Contract, the Employer [Stonewall
Jackson Memorial Hospital] elects to have AUL make a single
lump sum payment . . . .
[T]he amount of such single sum so transferred shall be
determined on the date of transfer, and shall be . . . reduced by
the aggregate amount of any applicable Investment Liquidation
Charges. . . .
In consideration of AUL's transfer of funds in accordance with
the Employer's instructions . . . and in the amount equal to that
described . . . above, the Employer hereby releases and agrees
to hold harmless AUL and its employees, officers and directors
from any and all losses, claims, demands or causes of action
asserted against them by reason of the Employer's decision to
withdraw its participation under the Contract . . . .
Footnote: 2
2The letter sent with the Notice, Election and Release form states:
[B]e advised that the Hospital does not consent or agree to the
Notice, Election, and Release to the extent that it (i) is construed
as an accord and satisfaction with respect to the amount received
from the contract; (ii) is construed in any manner that would
preclude the Hospital from pursuing its legal remedies
concerning the amount received from AUL as result of
termination of the contract; or (iii) waives or releases any right
or remedy arising out of acts or omissions of AUL, its officers,
employees, or its agents prior to the transfer of assets.
Footnote: 3 3Appellee AUL's cross-assignments of error allege that the circuit court erred (1) in finding that the Notice, Election and Release did not bar the Hospital's breach of contract action; (2) in finding that the Hospital had a right under the Contract to withdraw its annuity investment; (3) in finding that Amendment No. 3 was not binding on the Hospital; (4) in not allowing AUL to impose a fair and reasonable surrender charge on the money withdrawn by the Hospital; and (5) in the exclusion of certain evidence from the trial.
Footnote: 4
4W.Va. Code, 33-11-2 (c) [1974] states:
Insurance policy or insurance contract means the contract
effecting insurance, or the certificate thereof, by whatever name
called, and includes all clauses, riders, endorsements and papers
attached thereto and a part thereof.
Footnote: 5
5The first case cited by the appellant is The Carle Foundation Hospital, etc. v.
American United Life Insurance Co., Case No. 93-2177 (C.D. Ill.). The appellant states that
in 1991, Carle Foundation Hospital filed suit against AUL after it attempted to transfer its
fund balance of $11,634,818.97 to another investment, and AUL imposed a withdrawal
penalty of $694,432.73 pursuant to an amendment to the initial agreement. The case was
ultimately settled for an undisclosed amount.
Another case is Rapides Regional Medical Center, et al. v. American United Life
Insurance Co., 938 F.Supp. 380 (W.D.La. 1996). In that case, in 1971 the Louisiana
Hospital Association entered into an annuity contract with AUL. (The contract number in
Rapides was G45,188; the Contract disputed in this case is number G45,190). Rapides
Regional Medical Center later elected to participate in the contract, and later brought suit
after AUL attempted to impose back-end load commissions on the annuities purchased by
Rapides.
Deposition testimony indicated that AUL was aware of the existence of yet another
case that was filed by Deaconess Hospital of Cincinnati, Ohio against appellees American
United and Gardner & White. It appears that this action also concerned the methods used
by the appellees in administering an annuity plan for a hospital. The Deaconess Hospital
case apparently settled for approximately $800,000.00.
Footnote: 6 6The Hospital's memorandum in opposition to the appellees' motion for summary
judgment contains references to the deposition testimony from two witnesses.
The first witness, Dr. Peter Kensicki, was an expert witness on insurance who
apparently gave an opinion that AUL's actions violated the Act. However, that opinion was
not presented to the circuit court for review. The one page of testimony attached to the
appellant's memorandum merely contains Dr. Kensicki's recitation of the facts surrounding
the signing of the Notice, Election and Release, and his opinion that it was absurd for
AUL to require the Hospital to sign the release before it would release the Hospital's annuity
contributions. While Dr. Kensicki's opinion could be read to establish a single violation of
the Act, it fails to establish a general business practice of violations.
The second witness cited by the appellant was appellee Harry D. Jackson, the
insurance agent who communicated between the appellant and AUL. The deposition
transcript attached to the appellant's memorandum contains Mr. Jackson's statement that, if
the Master Group Annuity Contract was ready to deny the Hospital the right to withdraw its
money, then it would not be a very good investment. We do not understand how Mr.
Jackson's statement establishes a violation of the Unfair Trade Practices Act.
We understand that these witnesses may have made numerous statements in their
depositions that could have established the existence of an issue of material fact as to
whether AUL, as a general business practice, violated the Unfair Trade Practices Act.
Unfortunately, only these small segments of their testimony were presented to the circuit
court. Standing alone, we do not believe that these two snippets of testimony are sufficient
to avoid summary judgment.