Filed: Jul. 12, 2006
Latest Update: Feb. 12, 2020
Summary: UNPUBLISHED UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT No. 05-2206 KANAWHA INSURANCE COMPANY, Plaintiff - Appellant, versus EMPLOYERS REINSURANCE CORPORATION, Defendant - Appellee. Appeal from the United States District Court for the District of South Carolina, at Rock Hill. Margaret B. Seymour, District Judge. (CA-03-2765-0) Argued: May 23, 2006 Decided: July 12, 2006 Before WILKINS, Chief Judge, DUNCAN, Circuit Judge, and Joseph R. GOODWIN, United States District Judge for the South
Summary: UNPUBLISHED UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT No. 05-2206 KANAWHA INSURANCE COMPANY, Plaintiff - Appellant, versus EMPLOYERS REINSURANCE CORPORATION, Defendant - Appellee. Appeal from the United States District Court for the District of South Carolina, at Rock Hill. Margaret B. Seymour, District Judge. (CA-03-2765-0) Argued: May 23, 2006 Decided: July 12, 2006 Before WILKINS, Chief Judge, DUNCAN, Circuit Judge, and Joseph R. GOODWIN, United States District Judge for the Southe..
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UNPUBLISHED
UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT
No. 05-2206
KANAWHA INSURANCE COMPANY,
Plaintiff - Appellant,
versus
EMPLOYERS REINSURANCE CORPORATION,
Defendant - Appellee.
Appeal from the United States District Court for the District of
South Carolina, at Rock Hill. Margaret B. Seymour, District Judge.
(CA-03-2765-0)
Argued: May 23, 2006 Decided: July 12, 2006
Before WILKINS, Chief Judge, DUNCAN, Circuit Judge, and Joseph R.
GOODWIN, United States District Judge for the Southern District of
West Virginia, sitting by designation.
Affirmed by unpublished per curiam opinion.
ARGUED: Howard Jonathan Bashman, Willow Grove, Pennsylvania, for
Appellant. Jason A. Dunn, STINSON, MORRISON & HECKER, L.L.P.,
Kansas City, Missouri, for Appellee. ON BRIEF: Kevin K. Bell,
ROBINSON, MCFADDEN & MOORE, P.C., Columbia, South Carolina, for
Appellant. Pope D. Johnson, III, MCCUTCHEN, BLANTON, JOHNSON &
BARNETTE, L.L.P., Columbia, South Carolina; Bruce E. Baty, STINSON,
MORRISON & HECKER, L.L.P., Kansas City, Missouri, for Appellee.
Unpublished opinions are not binding precedent in this circuit.
See Local Rule 36(c).
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PER CURIAM:
Appellant Kanawha Insurance Company (“Kanawha”), an insurance
company based in South Carolina, brought this diversity action
against Appellee Employers Reinsurance Corporation (“ERC”), a
reinsurance1 company based in Kansas, raising claims for (1) breach
of contract, (2) constructive fraud, (3) breach of contract
accompanied by a fraudulent act, and (4) mutual mistake, unjust
enrichment and rescission. The parties filed competing motions for
summary judgment, and the district court entered judgment in favor
of ERC on all of Kanawha’s claims. Kanawha appeals that portion of
the district court’s ruling that addressed its breach of contract
claim. We affirm the district court’s order.
I.
Kanawha began issuing long term care (“LTC”) insurance
policies to consumers in 1994. LTC policies provide benefits to
cover the cost of a nursing home stay or home health care in the
1
“Reinsurance” means the ceding by one insurance company to
another of all or a portion of its risks for a stipulated portion
of the premium, in which the liability of the reinsurer is solely
to the reinsured, which is the ceding company, and in which
contract the ceding company retains all contact with the original
insured, and handles all matters prior to and subsequent to loss.
The true reinsurer is merely an insurance company or underwriter
which deals only with other insurance companies as its
policyholders.
Carolina Nat’l Ins. Co. v. S.C. Tax Comm’n,
182 S.E.2d 878, 880
(S.C. 1971) (quoting 13 John Alan Appleman, Insurance Law and
Practice, § 7681).
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event the policyholder requires such services. Kanawha charged its
LTC policyholders level premiums. In other words, the premiums
remain constant throughout the life of the policy.
The premiums paid in the early years of a LTC policy with
level premiums are generally more than sufficient to cover any
expected benefit pay outs. However, as the policy ages, the level
premium becomes increasingly insufficient to cover the expected
benefit pay outs, which increase over time. South Carolina adopted
regulations to address this insufficiency that require the insurer
to establish active life reserves (“ALR”), also known as “contract
reserves,” that are funded with the premium over-sufficiencies in
the early years of a level premium policy. See S.C. Code Regs. 69-
7 § IV. The insurer can then use the ALR to cover the premium
insufficiency in the later years of the policy.
In 1994, Kanawha entered into two reinsurance treaties2 with
ERC3 to reinsure a portion of the risk Kanawha assumed under the
LTC policies. Under the “Quota Share Treaty,” ERC reinsured 7.5%
of the risk on each LTC policy for 7.5% of the premium Kanawha
received. The treaty required ERC to maintain ALR for the risk it
assumed, thereby shifting responsibility for that portion of the
2
A contract for reinsurance is commonly referred to as a
“treaty.”
3
Kanawha also entered into two identical reinsurance treaties
with Cologne Life Reinsurance Company, neither of which are at
issue in this appeal.
4
state mandated ALR from Kanawha to ERC. The treaty allowed either
party to terminate the agreement as to new business and then allow
the ALR to expire as the corresponding in-force policies expired.
The Quota Share Treaty also provided that Kanawha could cancel or
re-capture the in-force business and, in such event, obligated ERC
to return the corresponding ALR to Kanawha.
Under the second agreement, the “Excess Treaty,” ERC agreed to
reinsure 42.5% of the LTC risk for any benefits paid for greater
than two years in return for 18% of the premiums Kanawha received.
The Excess Treaty specifically disclaimed ERC’s obligation to
maintain ALR for its risk under the treaty. The Excess Treaty
provided that either party could cancel the treaty upon notice and,
in such event, only obligated ERC to return any unearned
reinsurance premiums. The Excess Treaty did not require ERC to pay
any money upon termination to fund or otherwise compensate Kanawha
for ALR.
It is undisputed that the two treaties were negotiated at
arm’s length by the parties and reviewed by their counsel prior to
execution. Kanawha readily admits that it signed the Excess Treaty
under the assumption that “ERC would agree to make the Excess
treaty guaranteed renewable.” J.A. 34a. Kanawha believed that
such an agreement would negate the risk it faced because of the ALR
disclaimer. As the treaty was written, ERC could unilaterally
terminate the agreement without returning any monies to Kanawha to
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fund the portion of the state-mandated ALR that corresponded to the
risk ERC assumed under the treaty.
Between 1994 and 2000, Kanawha asked ERC to modify the Excess
Treaty in relation to the ALR disclaimer on numerous occasions.
ERC never agreed to any such modification. In 2000, ERC cancelled
the Excess Treaty and returned the unearned insurance premiums to
Kanawha, as required by the Excess Treaty. Kanawha demanded that
ERC also transfer the ALR to it. ERC had established no ALR and
refused to transfer any monies to Kanawha beyond the unearned
reinsurance premiums. According to Kanawha, this allowed ERC to
retain $2,000,000 in premiums paid by Kanawha that ERC should have
used to create ALR for its portion of the risk under the Excess
Treaty.
II.
In its motion for partial summary judgment and in response to
ERC’s motion for summary judgment, Kanawha argued that ERC breached
the Excess Treaty by failing to maintain ALR and return such monies
to Kanawha when ERC cancelled the treaty. This argument flowed
from Kanawha’s contention that the ALR disclaimer in the Excess
Treaty was unenforceable because it violated South Carolina law,
primarily S.C. Code Regs. 69-7 § V.4 Kanawha argued that section
4
This regulation provides:
Increases to, or credits against reserves carried,
6
V required reinsurers to establish ALR when reinsuring risk on LTC
policies funded with level premiums.
The district court rejected this argument. It held that
section V “cautions [a] ceding insurer that with respect to
calculating credit for insurance on a financial statement, see S.C.
Code Regs. 69-53, minimum reserve standards must be protected.”
J.A. 1363a. The district court further held that it “discern[ed]
nothing in Regulation 69-7 that would restrict a [sic] ERC and
Kanawha from negotiating responsibility for the ALR obligation
arising from LTC policies sold at a level premium.”
Id. On that
basis, the district court held that the ALR disclaimer in the
“Excess Treaty is not violative of South Carolina law or public
policy” and, therefore, was enforceable.
Id. Because ERC had no
obligation to do so, the district court concluded that ERC did not
breach the Excess Treaty by not establishing ALR or returning
monies to Kanawha at termination to fund ALR.
III.
On appeal, Kanawha raises the same arguments as in the
district court, which comprehensively and correctly considered and
arising because of reinsurance assumed or reinsurance
ceded, must be determined in a manner consistent with
the[] minimum reserve standards [of S.C. Code Regs 69-7]
and with all applicable provisions of the reinsurance
contracts which affect the insurer's liabilities.
S.C. Code Regs. 69-7 § V.
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rejected them. Upon review of the parties’ briefs and
consideration of their oral arguments, it is hereby ordered that
the order under review is affirmed on the basis of the well-
reasoned opinion of the district court.
AFFIRMED
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