Security Plans, Inc. v. Cuna Mutual Insurance Society
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Full Opinion
This appeal from a judgment of the United States District Court for the Western District of New York (David G. Larimer, Judge) concerns the scope and effect of the implied covenant of good faith and fair dealing that, as a matter of law, accompanies contracts concluded under New
Under New York law, all contracts that confer discretion include an implied promise that neither party will âact arbitrarily or irrationallyâ in exercising that discretion. Dalton v. Educ. Testing Serv., 87 N.Y.2d 384, 389, 639 N.Y.S.2d 977, 663 N.E.2d 289, 291 (1995). The district court acknowledged this principle. But the court rejected the plaintiffs implied covenant claim, concluding that the record at the summary judgment stage reflected no evidence that CUNA Mutual acted in bad faith or with wrongful intent. We conclude that, on the facts of this case, a question of fact remains as to whether the defendant acted arbitrarily in calculating the earnout amount. We therefore vacate the portion of the district courtâs decision concerning the implied covenant and remand for further proceedings. For the reasons set forth below, we affirm the portion of the district courtâs judgment that granted summary judgment to the defendant on a separate breach of contract claim.
BACKGROUND
Security Plans, Inc., formerly known as Creditor Services, Inc., is a corporation based in Mendon, New York, which until 2002 specialized in the sale of credit-related insurance products, primarily to credit unions. Security Plansâ primary products were credit life and credit disability insurance, which promise to pay the outstanding balance on a loan in the event the borrower dies or becomes disabled. In 2002, Security Plans agreed to sell substantially all of its assets to CUNA Mutual Insurance Society, a company incorporated in Iowa, with its principal office in Madison, Wisconsin. The parties set in motion a plan to transfer Security Plansâ insurance clients (its âbook of businessâ) to CUNA Mutual. The merger was completed on January 2, 2003.
The Merger Agreement and Earnout Formula
An Asset Purchase Agreement, dated May 31, 2002, set forth the terms of this merger. CUNA Mutual agreed to pay $3 million immediately plus an additional performance-based payment to be made three years after the merger was concluded for Security Plansâ property and book of business. The deferred-payment component of this compensation package is commonly referred to as an âearnout.â
The basic formula for calculating the earnout is not in dispute. The performance of Security Plansâ book of business would be calculated annually for three years after closing, and then another three years of performance would be projected based on the data from the third year. Two variables would largely determine the size of the earnout: a weighted average of total written premiums brought in by the acquired business, and a weighted average of the businessâs combined loss ratios.
The Asset Purchase Agreement also provided:
[Security Plans] acknowledges that [CUNA Mutual] is under no obligation to operate its business after Closing in a manner focused on maximizing the Earn-Out ... and may operate the business in accordance with its best business judgment.
Asset Purchase Agreement ¶ 2.9(e).
This dispute concerns two factors that affected the calculation of the earnout. First, Security Plans contends, CUNA Mutual used incorrect figures to calculate loss ratios for these accounts, thereby leading to a lower earnout than that to which Security Plans was entitled. Second, Security Plans argues, CUNA Mutual imposed an excessive deduction relating to service fees paid to credit unions.
Loss Ratios and the Claim Reserves Issue
Insurers are required by accounting rules and by statute to carry claim reserves, which are kept in anticipation of future liabilities. Claim reserves are, for accounting purposes, considered to be a component of incurred claims. Increases in incurred claims ordinarily will, all other things being equal, increase a companyâs loss ratio. Higher loss ratios would reduce Security Plansâ earnout.
The parties agree that the loss ratios recorded for Security Plansâ book of business for 2003 through 2005 â the relevant reporting period for the earnout â were âatypically high.â Def.âs Statement of Facts Pursuant to Local R. 56.1, ¶ 30; accord Pl.âs Resp. Pursuant to Loe. R. 56.1(B), ¶ 30. Their unusually high loss ratios were largely attributable to the fact that, during the same period, CUNA Mutual was carrying abnormally high claim reserves on all of its business, including the Security Plans policies. CUNA Mutual began to release claim reserves in 2006 to compensate for the problem, but it did not correct the reserves concerning Security Plansâ book of business in time to affect the earnout.
The reason for the magnitude of the claim reserves is not entirely clear.
The record contains some evidence supporting the plaintiffs position. Rich Fischer, a CUNA Mutual manager who dealt frequently with the Security Plans merger, testified that he could not explain the high loss ratios associated with the book of business, and agreed that he was unsure that the earnout calculation was accurate in light of the unexpectedly high loss ratios. Dep. Rich Fischer, June 8, 2010, at 139-41. In an internal e-mail, Fischer described the claim reserve levels as âsuspect numbers.â E-mail from Rich A. Fischer to Gary E. Young (Feb. 22, 2007, 6:19 AM). In another e-mail, Fischer noted that â[t]he reserve looks too high for these accounts.â E-mail from Rich A. Fischer to Barry J. Owens et al. (Sept. 15, 2006, 3:43 PM). Barry Owens, another CUNA Mutual manager who worked on the issue, agreed that the claim reserves were too high. In an internal e-mail, he appeared to stress the need to correct the claim reserves calculation, telling Fischer, âyou could either correct this,â meaning, adjust the numbers in the earnout calculation, âor not use meâ in discussions with the Security Plans principals. E-mail from Barry J. Owens to Rich A. Fischer et al. (July 7, 2006, 1:44 PM). âIf you ask me to help,â Owens wrote, âI am going to be forthcoming.â Id.
In light of the claim reserves problem, both parties initially set about discussing ways to adjust the earnout calculation.
The plaintiff contends that CUNA Mutual never conducted these revisions. Fischer later testified that he did perform, revised calculations, but that they did not result in a positive earnout because other deductions made pursuant to the Asset Purchase Agreement reduced the earnout below zero, even using the more favorable
Service Fees
A credit insurer may pay an administrative service fee to a credit union if the union enrolls insured debtors, processes claims, and performs other services on behalf of the insurer. See N.Y. Comp.Codes R. & Regs. tit. 11, § 185.9. State regulations set an upper limit for these service fees, which, barring some exceptions not relevant to this appeal, is expressed as a maximum dollar amount per $1,000 of insured indebtedness. See id. § 185.9(f). Therefore, so long as the amount of insured indebtedness stayed constant, the maximum dollar amount of allowable fees would remain the same regardless of any change in the premiums charged on an insurance policy.
For the purposes of calculating Security Plansâ earnout, the Asset Purchase Agreement also imposed an upper limit on service fees paid to credit unions pursuant to any of the Security Plans policies. This limit did not, strictly speaking, prevent the payment of service fees at any amount permitted by law. It did, however, provide that any fees paid above the contractual limitation would be deducted from Security Plansâ earnout, whereas fees paid below that limit would not be deducted. This cap, unlike the limit imposed by law, was expressed as a percentage of the written premium assessed on any credit life or credit disability insurance policy. Thus, under the framework imposed by the contract, any increase or decrease in the premium charged on an insurance policy would entail a corresponding change in the maximum dollar amount of allowable service fees on that policy.
The upshot of all this was that service fees pegged to the maximum allowable fee under state law might exceed the caps set by the contract, especially if insured indebtedness is relatively high and premiums are low. If this happened, the fees paid in excess of the contractual cap would be deducted from Security Plansâ earnout.
At the time of the merger, Security Plansâ underwriter was paying the maximum service fee allowable under New York law, while CUNA Mutual was not. In a- letter dated March 13, 2002, John OâKipney, one of the Security Plans founders, requested that CUNA Mutual confirm its willingness to continue paying credit unions the maximum service fee once the Security Plans policies were transferred. In the discussion of service fees, OâKipney did not mention the earnout payment or the percentage caps in the earnout calculation. OâKipneyâs letter also addressed a variety of other items not relevant to the present dispute. OâKipney stated that â[i]n all likelihood, weâll want to incorporate the companyâs response to many of these items into the Definitive Agreement.â Letter of John OâKipney to Gary E. Young (Mar. 13, 2002).
Margaret Immerfall, a CUNA Mutual vice president, responded that the company did not wish to revise the Asset Purchase Agreement at that late stage of negotiations. OâKipney Decl. ¶ 33. OâKipney recalls, however, that he and Immerfall agreed to address the issue in a âletter of understanding.â Id. Then, on April 10, 2002, Immerfall replied by letter to OâKipneyâs correspondence of March 13, confirming CUNA Mutualâs âwillingness to pay identical service fees to those currently being paidâ to Security Plansâ clients. Letter of Margaret Immerfall to John OâKipney (Mar. 13, 2002). That letter stated only that CUNA Mutual would continue paying the fees. It did not mention that, under the terms of the Asset Purchase Agreement, any fees charged in excess of the contractual cap
When the Asset Purchase Agreement was finalized at the end of May 2002, the earnout provision remained unchanged â it continued to impose a cap on service fees for purposes of calculating the earnout payment and did not acknowledge that the letter of April 10, 2002, would allow service fees to be charged above this cap. OâKipney has stated that he nonetheless understood the letter of April 10, 2002, to âsupersedeâ the relevant provisions of the Asset Purchase Agreement, such that fees charged above the cap pursuant to the letter would not be deducted from the earnout. OâKipney Decl. ¶ 36.
The following July, CUNA Mutual wrote to the New York State Chief Insurance Policy Examiner requesting permission to take over Security Plansâ business. It said that service fees would remain the same. At this point, service fees on the majority of Security Plansâ programs, exceeded the caps set in the Asset Purchase Agreement. Throughout the time period relevant to the earnout, CUNA Mutual continued to pay service fees at the same level that Security Plans had been paying prior to the merger.
Final Earnout Calculation
CUNA Mutual finalized its accounting of the earnout on August 8, 2006. It determined that Security Plansâ book of business carried a six-year average written premium of $7.1 million and an average loss ratio of 70.2 percent, which would entitle Security Plans to an earnout of $301,000. That amount was then reduced nearly to zero, though, by $291,752 in excess service fees paid to credit unions. Any remaining payment was wiped out by an additional $1.5 million deduction for so-called âexperience refunds.â
This Litigation
On July 14, 2008, the plaintiff filed a complaint commencing this lawsuit in the United States District Court for the Western District of New York invoking the courtâs diversity jurisdiction under 28 U.S.C. § 1332(a), and alleging breaches .of contract and of the implied covenant of good faith and fair dealing. The complaint did not specify the amount of damages it was seeking, although it alleged that a fairly and accurately calculated earnout would have exceeded $75,000.
Arguments in the district court focused on three principal claims. First, the plaintiff asserted that CUNA Mutualâs handling of the claim* reserves issue constituted a breach of the implied covenant of good faith and fair dealing, and led to a lower earnout calculation than was appropriate. Second, the plaintiff argued that CUNA Mutualâs decision to deduct $291,752 in excess service fees violated an understanding, reflected in the letter of April 10, 2002, that no such deductions would be made. Third, the plaintiff maintained that the deduction of certain so-called experience refunds from the earnout was imper
In an order filed November 16, 2012, the district court granted CUNA Mutualâs motion for summary judgment as it pertained to the claim reserves and the service fee issues, but found a triable issue of fact concerning the experience refund claim.
The plaintiff appeals, challenging the district courtâs judgment based on the loss ratio and service fee issues.
DISCUSSION
âWe review a district courtâs decision to grant summary judgment de novo, construing the evidence in the light most favorable to the party against which summary judgment was granted and drawing all reasonable inferences in its favor.â Wachovia Bank, N.A. v. VCG Special Opportunities Master Fund, Ltd., 661 F.3d 164, 171 (2d Cir.2011), cert. denied, - U.S. -, 132 S.Ct. 2439, 182 L.Ed.2d 1063 (2012). We also review de novo âquestions as to the plain meaning or ambiguity of the language of a contract.â Fabozzi v. Lexington Ins. Co., 601 F.3d 88, 90 (2d Cir.2010). We will affirm a grant of summary judgment only if there is no genuine issue of material fact and the prevailing party was entitled to judgment as a matter of law. Id.; Fed.R.Civ.P. 56(a).
I. Breach of Contract Claim: Determination of Service Fees
The parties do not dispute that, under the terms of the Asset Purchase Agreement finalized on May 31, 2002, CUNA Mutual was entitled to deduct $291,752 in excess service fees from the earnout payment to Security Plans. Security Plans argues, however, that CUNA Mutualâs letter of April 10, 2002, in which CUNA Mutual expressed its willingness to continue paying service fees that were higher than the caps imposed by the Asset Purchase Agreement, constituted an implicit promise that excess fees would not be deducted from the earnout payment. This letter was sent by CUNA Mutual and received by the plaintiff more than a month before the agreement was finalized. The plaintiff nonetheless argues that CUNA Mutual was bound by the terms of this letter to refrain from deducting service fees when calculating the earnout.
The district court correctly observed that such a result would âplainly run[] afoul of the parol evidence rule.â Order at 17. In New York, â[i]t is well
The letter of April 10, 2002, upon which the plaintiff relies, falls beyond the borders of the partiesâ written agreement, and therefore constitutes parol evidence. The Asset Purchase Agreement contains a merger clause, which states that the contract is an integrated document reflecting a complete statement of the bargain between the parties. Asset Purchase Agreement ¶ 13.7. The merger clause does not incorporate by reference the letter of April 10, 2002. See id. (incorporating specified documents, including exhibits, but not the April letter). We deem the parties, by defining the scope of their agreement in a merger clause, to have intended âto require the full application of the parol evidence rule in order to bar the introduction of extrinsic evidence to alter, vary or contradict the terms of the writing.â Jarecki v. Shung Moo Louie, 95 N.Y.2d 665, 669, 722 N.Y.S.2d 784, 745 N.E.2d 1006, 1009 (2001).
We might consider extrinsic evidence to illuminate an ambiguous contractual term. See, e.g., Schron, 20 N.Y.3d at 436, 963 N.Y.S.2d 613, 986 N.E.2d at 433. But we find no such ambiguity here.
We also reject the plaintiffs argument that the doctrine of promissory estoppel bars CUNA Mutual from deducting excess service fees. To demonstrate promissory estoppel under New York law, a party must show reasonable and detrimental reliance upon a clear and unambiguous promise. Kaye v. Grossman, 202 F.3d 611, 615 (2d Cir.2000). As a general matter, âa party may not maintain a promissory estoppel claim where the promises on which the claim is based are expressly contradicted by a later written agreement covering the same subject matter.â Underdog Trucking, LLC v. Verizon Servs. Corp., No. 09-Civ.-8918, 2010 WL 2900048, at *6, 2010 U.S. Dist. LEXIS 72642, at *18-* 19 (S.D.N.Y. July 20, 2010); see also Fariello v. Checkmate Holdings, LLC, 82 A.D.3d 437, 438, 918 N.Y.S.2d 408, 409 (1st Depât 2011) (holding that promissory es-toppel claim is barred by merger clause in subsequent agreement between the pqr
Even if the letter of April 10, 2002, did constitute a promise not to deduct the service fees,
II. Implied Covenant of Good Faith Claim: Determination of Claim Reserves
The plaintiff also contends that the defendantâs handling of the claim reserves and the resultant earnout calculation violated the implied covenant of good faith and fair dealing. New York law implies such a covenant in all contracts. Fishoff v. Coty Inc., 634 F.3d 647, 653 (2d Cir.2011); 511 W. 232nd Owners Corp. v. Jennifer Realty Co., 98 N.Y.2d 144, 153, 746 N.Y.S.2d 131, 773 N.E.2d 496, 500 (2002); see also Restatement (2d) of Contracts § 205 (1981). Pursuant to this principle, âneither party shall do anything which will have the effect of destroying or injuring the right of the other party to receive the fruits of the contract.â Moran v. Erk, 11 N.Y.3d 452, 456, 872 N.Y.S.2d 696, 901 N.E.2d 187, 190 (2008) (internal quotation marks omitted). A breach of the covenant is considered a breach of the underlying contract. Natâl Mkt. Share, Inc. v. Sterling Natâl Bank, 392 F.3d 520, 525 (2d Cir.2004).
The implied covenant does not âundermine a partyâs âgeneral right to act on its own interests in a way that may incidentally lessenâ â the other partyâs expected benefit. M/A-COM Sec. Corp. v. Galesi, 904 F.2d 134, 136 (2d Cir.1990) (per curiam) (quoting Van Valkenburgh, Nooger & Neville, Inc. v. Hayden Publâg Co., 30 N.Y.2d 34, 46, 330 N.Y.S.2d 329, 281 N.E.2d 142, 145, cert. denied, 409 U.S. 875, 93 S.Ct. 125, 34 L.Ed.2d 128 (1972)). The covenant will be breached only in a narrow range of cases. A plaintiff must show substantially more than evidence that the defendantâs actions were negligent or inept. See Behren v. Warren Gorham & Lamont, Inc., 24 A.D.3d 132, 133, 808 N.Y.S.2d 157, 158 (1st Depât 2005) (noting, in affirming summary judgment, that the plaintiff had admitted that the âdefendantâs alleged mismanagement was due to ineptitudeâ); Wagner v. JP Morgan Chase Bank, No. 06-Civ-3126(RJS), 2011 WL 856262, at *4, 2011 U.S. Dist. LEXIS 2456, at *11-* 12 (S.D.N.Y. Mar. 9, 2011) (stating that the plaintiff must show something more than that the defendant was âmisguided or ignorant or even merely negligentâ (citation omitted)); cf. United Steelworkers of Am., AFL-CIO-CLC v. Rawson, 495 U.S. 362, 372-73, 110 S.Ct. 1904, 109 L.Ed.2d 362 (1990) (observing that âmere negligenceâ is insufficient to constitute arbitrary conduct that breaches unionâs statutory duty of fair representation); McClary v. Civil Serv. Emps. Assân,
The plaintiff alleges two violations of the implied covenant of good faith and fair dealing. Only one of them, we think, has merit based on the record at summary judgment.
The implied covenantâs prohibition on arbitrary or irrational exercises of discretion may apply to this second claim. The Asset Purchase Agreement expressly confers on the defendant broad discretion to âoperate the business in accordance with its best business judgment.â Asset Purchase Agreement, ¶ 2.9(e). And the contract places on the defendant the responsibility for calculating the earnout, thereby conferring a limited discretion in selecting the values â such as loss ratios and written premium â that enter into the calculation in the first place. See id. ¶ 2.9(b)(vii). This latter form of limited discretion is indeed the subject of the plaintiffs claim in this case,
Furthermore, the provision in the Asset Purchase Agreement entitling CUNA Mu
The record on appeal, moreover, presents sufficient evidence to create a triable issue of fact as to the defendantâs handling of the earnout calculation. The parties understood that the earnout would be based on the âperformanceâ of Security Plansâ former book of business. Asset Purchase Agreement, ¶ 2.9(a). Although Security Plansâ business appeared to perform poorly during the relevant period, it was understood by CUNA Mutual managers that a system-wide problem with excessive claim reserves had distorted the performance data. This realization led several of the managers to consider the relevant loss ratio numbers with suspicion, thinking they were too high and thus not entirely accurate. These managers apparently took initial steps to recalculate the earnout using more accurate figures that would have benefited the plaintiff, but appeared to abandon that effort before any revised calculation was completed and supplied.
Making all inferences in the plaintiffs favor, a rational trier of fact could properly conclude that it was arbitrary for the defendant to refuse to revise the earnout calculation in order to correct for the suspect numbers. On this record, a trier of fact could, but would not necessarily be required to, conclude that: (i) the initial decision that set high claim reserves for the earnout period was made by mistake, and not as a result of actuarial judgment; (ii) this mistake caused Security Plansâ performance data to be distorted in ways that negatively affected the earnout; (iii) this mistake was noticed in time to revise the earnout calculation accordingly, and such revision was possible; (iv) the mistake was acknowledged by all parties con
In other words, this is not a case in which the plaintiff alleges only that that the defendantâs mismanagement or ineptitude in running the business post-merger damaged its ultimate payment. See, e.g., Wagner, 2011 WL 856262, at *4-*5, 2011 U.S. Dist. LEXIS 24518, at *11-*12 (rejecting a claim on this basis under New York law); Fireman v. News Am. Mktg. In-Store, Inc., No. 05-11740, 2009 WL 3080716, at *10, 2009 U.S. Dist. LEXIS 91286, at *27-*29 (D.Mass. Sept. 26, 2009) (same); Tagare v. Nynex Network Sys. Co., 994 F.Supp. 149, 159-60 (S.D.N.Y.1997) (same). Although nothing in the record indicates that the initial decision to set abnormally high claim reserves was anything more serious than negligence, the plaintiff also has presented evidence suggesting that CUNAâs managers recognized their error and understood that the numbers used to calculate the earnout calculation were faulty insofar as they did not reflect the businessâs performance. Despite this awareness, CUNA Mutual declined to provide the plaintiff with a revised calculation, and their reasons for doing so are unclear from the record developed at the time of the motion for summary judgment. A trier of fact could conclude that the decision was arbitrary.
On remand, the plaintiffs claim based on the implied covenant will depend, in large measure, on the defendantâs reasons for not revising the-calculation. If CUNA Mutual can convince the trier of fact that it had a genuine and colorable business justification for its decision, then its actions will not have been arbitrary, and thus will not have violated the implied covenant. Cf. Levandusky, 75 N.Y.2d at 541 n. *, 554 N.Y.S.2d 807, 553 N.E.2d at 1323 n. *. For example, CUNA Mutual manager Rich Fischer testified that he did, in fact, conduct a revised calculation with more appropriate numbers, but that any earnout was nonetheless wiped out by other contractually permitted deductions. This testimony might provide one possible convincing