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Commentary from Counsel - Update: Wisconsin Supreme Court Affirms Agent E&O Win, Strengthens Future Defenses

Posted By Kaylyn Zielinski, Monday, June 29, 2020

Gavel

By: Josh Johanningmeier | IIAW General Counsel 

 

On May 21, 2020, in Emer’s Camper Corral v. Alderman, the Wisconsin Supreme Court issued a 6-1 majority opinion confirming a rigorous causation standard for negligent procurement E&O claims.  The Court ultimately found that, in order to prevail on a claim for negligent procurement of an insurance policy, an insured must show that the promised policy was commercially available to them.  While this decision is undoubtedly a win for agents, it is critical that you take care when communicating with clients. 

 

The Emer’s Camper Corral Case and Decision 

 

Since 2004, Rhonda Emer and her husband have sold new and used camper trailers under the trade name Camper Corral.  Not long after founding the business, the Emers began purchasing Camper Corral’s insurance through the defendant insurance agency.  Starting in 2007, General Casualty Company of Wisconsin insured Camper Corral.  However, before the commencement of the 2012-13 policy year, General Casualty sent Camper Corral a nonrenewal notice after two consecutive years with at least $100,000 in hail damage claims.  

 

Following the nonrenewal, the Emers worked with their agent to obtain insurance through Western Heritage Insurance Company.  The 2012-13 policy had a $5,000 deductible for hail damage per camper.  However, the agent told the Emers that, if they could go claim free for two years, he may be able to negotiate the hail damage deductible down to $1,000 per camper.  After two claim free years, the agent contacted the Emers with the news that he had obtained a policy from Western Heritage with a $1,000 deductible per camper for hail damage and a $5,000 aggregate deductible limit.  In reality, the Western Heritage policy the Emers ultimately purchased had a $5,000 deductible per camper for hail damage with no aggregate deductible limit.

 

In September of 2014, another hail storm swept over the Camper Corral lot.  This storm damaged 25 of the campers in the Emers’ inventory.  Because of the actual terms of the Western Heritage policy, the Emers’ deductible amounted to $125,000.  As a result, the Emers sued the agent for negligence, suggesting he had breached his duty to them by failing to adequately describe the terms of the Western Heritage policy.  For damages, the Emers asked for $120,000, i.e., the difference between their deductible and the $5,000 aggregate deductible they were promised.

The case ultimately went to trial.  However, before the jury could deliberate, the agent moved for a directed verdict, arguing the Emers had not satisfied their evidentiary burden.  The trial court agreed, ruling that, without evidence that the policy promised to the Emers was commercially available to them (and not just generally available in the marketplace), they could not prevail on their negligence claim.  The Wisconsin Court of Appeals affirmed the trial court, and the Emers appealed the case to the Wisconsin Supreme Court.

 

According to the State Supreme Court, to prevail on their negligence claim against the agent, the Emers needed to prove four well-settled elements: “(1) [the agent’s] duty of care to Camper Corral; (2) [the agent’s] breach of that duty; (3) injury caused by [the agent’s] breach; and (4) actual loss or damage resulting from the injury.”  However, the only issue left for the Supreme Court to decide was the third: causation.

 

The Wisconsin Supreme Court ultimately held that the Emers had not provided sufficient evidence to satisfy the causation standard.  In their arguments before the Wisconsin Supreme Court, the Emers suggested they only needed to prove that a policy like the one they were promised was commercially available.  The Supreme Court, though, found that was one step short.  Not only did the Emers have to prove that the relevant policy was available in the marketplace, but they also had to show that the policy was commercially available to their business.  Put differently, “[w]hether the unavailability is general, or instead particular to Camper Corral, the policy’s unavailability exists independently of any negligence on behalf of the broker.”  Thus, as the Emers did not show that the policy promised to them by the agent was commercially available to their business, the Supreme Court affirmed the trial court’s directed verdict in the agent’s favor.

 

Now What? 

 

This decision is a big win for both insurance agents and E&O carriers defending claims under Wisconsin law.  With the additional burden of having to prove specific availability in negligent procurement cases, agents will see fewer judgments against them and, as a result, fewer lawsuits brought in the first place.  Further, only one Justice dissented in the Camper Corral case.  Thus, even as the makeup of the Court shifts slightly over the next few months, this decision is likely to remain binding precedent well into the future.

 

With this in mind, you should still see this case as a cautionary tale.  Sure, the case ended with a positive result for both the defendant agent, the E&O carrier and insurance agencies around Wisconsin.  But, it took a full trial and appeals all the way to Wisconsin’s highest court to achieve that result.  It is essential that you take great care when marketing policies to your clients.  Doing so will likely save you the hassle of expensive litigation. 

 

Conclusion

 

Ultimately, the Wisconsin Supreme Court’s decision in Emer’s Camper Corral v. Alderman is a huge win for insurance agents and E&O carriers around the state.  This will undoubtedly result in fewer negligent procurement cases brought against agents and stronger defenses in some of the cases and claims that are brought by disappointed insureds.  We will keep an eye on the application of this stringent causation standard—it may well cross Wisconsin’s borders into other states.

Tags:  government affairs  insuring Wisconsin  wisconsin independent insurance association  wisconsin insurance agency help  wisconsin insurance blog  wisconsin supreme court 

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Commentary From Counsel - Round 3: Supreme Court Agrees to Hear Effort to Overturn Affordable Care Act

Posted By IIAW Staff, Tuesday, June 9, 2020

By: Josh Johanningmeier | IIAW General Counsel

 

Not since the Thrilla in Manila has a third bout been as eagerly anticipated as the upcoming United States Supreme Court hearing of the latest challenge to Obamacare. Well, perhaps comparing the case to the 1975 finale of the Ali - Frazier rivalry is unfair (to Ali and Frazier), but the case does merit attention. Earlier this month, the Supreme Court agreed to again hear a case concerning the validity of the Affordable Care Act (“ACA”), President Obama’s signature healthcare legislation. If the Court takes this opportunity to overturn the law, the provision of health insurance in this country could fundamentally change. This change would be especially impactful for your business clients. 

 

 

Case Background

 

In 2017, congressional Republicans began their efforts to repeal and replace the ACA. When those efforts failed, Republicans changed tactics and instead, chipped away at one of the act’s most well-known, and unpopular, provisions: the individual mandate. To be clear, Congress did not eliminate the individual mandate itself, but, rather, eliminated the tax penalty for failing to acquire health insurance. President Trump quickly signed this change into law. 

 

Seeing an opportunity, a group of 20 states brought suit in the United States District Court for the Northern District of Texas, arguing that the entire ACA is invalid because of the changes to the law. In a previous challenge, the Supreme Court upheld the individual mandate as an exercise of Congress’ taxing power. The states challenging the ACA asserted that, with no tax penalty for violations, the individual mandate can no longer fall under Congress’ taxation powers and must be considered unconstitutional as a violation of individual liberty. Going further, the states argued that the individual mandate is a fundamental component of the ACA, and, as a result, the entire law must be overturned. In a December 2018 decision, District Judge Reed O’Connor agreed and ruled the ACA unconstitutional. 

 

Shortly thereafter, several groups, including Democratic state attorneys general and the House of Representatives, under Democratic control at that point, appealed the decision to the Fifth Circuit Court of Appeals. Given a choice between finding the individual mandate constitutional and overturning the entire law, the Fifth Circuit chose a middle way. The court agreed with Judge O’Connor that the individual mandate is unconstitutional, but sent the case back to the lower court to reconsider if such a holding renders the entire act invalid. The House and the states led by Democratic attorneys general appealed that the decision to the United States Supreme Court, which agreed to hear the case. Based on standard timeframes, the Court will likely issue a decision in spring or summer of 2021. 

 

 

Now What? 

 

Importantly, it is not clear how the Supreme Court will rule on this case. The ACA has come before the Court on two previous occasions, and it has upheld the law both times. While the makeup of the Court has changed significantly in recent years, all five Justices making up the majority in both decisions remain on the Court. However, the law has now changed, and in ways relevant to the Court’s previous opinions. The takeaway: while it is entirely possible the law will be upheld, you and your agencies should be prepared for it to be overturned. 

 

If the entire law is invalidated, a key impact will be the elimination of the “employer mandate.” As you are likely aware, currently, employers with 50 or more full-time employees, or full-time equivalents, must provide health insurance to 95% of those 

full-time employees and their children that is both affordable and ensures minimum value. Coverage is considered “affordable” if employee contributions do not exceed a specified percentage of that employee’s household income (9.78% in 2020). A plan provides “minimum value” if it pays for at least 60% of covered services (including deductibles, copays and coinsurance). If employers violate their mandate, they face a monetary penalty. 

 

If the ACA is overturned, however, there will be of course no employer mandate. This will likely result in many of your business clients evaluating changes to their employee health plans. It is critical that you and your agencies work with legal counsel so that you can make informed decisions when it comes time to design plans responsive to your clients’ needs. 

 

Conclusion

 

While it is unclear if the Supreme Court will take this opportunity to overturn the ACA, it is crucial to be prepared in the event that it does. Keep an eye on this column and other IIAW publications for developments on this case, and make sure to work with legal counsel to ensure that you and your agencies are able to successfully navigate what could be a complex path forward. 

 

Tags:  affordable care act  commentary from counsel  insurance general counsel  wisconsin insurance blog  wisconsin supreme court 

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Government Affairs - Wisconsin Re-Opens As Supreme Court Invalidates State's Safer-At-Home Order

Posted By IIAW Staff, Tuesday, June 9, 2020

Wisconsin Capital

 By: Misha Lee | IIAW Lobbyist

 

On May 13, 2020, the Wisconsin Supreme Court declared the state’s Safer-at-Home order unlawful, invalid, and unenforceable. When the ruling was first announced, businesses faced some uncertainty as to how to operate. However, it now appears there are no statewide requirements governing their operations.


By a 4-3 decision the court limited Evers’s ability to make statewide rules during emergencies such as a global pandemic, instead requiring him to work with the state legislature on how the state should handle the outbreak.


The justices wrote that the court was not challenging the Governor’s power to declare emergencies, “but in the case of a pandemic, which lasts month after month, the Governor cannot rely on emergency powers indefinitely.” Notably, the court allowed Emergency Order #28 to remain valid as to school closings for the

 2019-2020 school year, which means that while businesses may open, schools remain closed.


Neither the Governor nor the legislature have yet to offer replacement guidance on COVID-19 suppression measures. A scope statement for emergency rule-making was recently withdrawn by the Department of Health Services (DHS) for lack of legislative support. Many businesses have voluntarily adopted standards which require physical distancing, capacity limits or call for face coverings. However, there are no statewide

requirement to do so. Each business is left to determine for themselves what measures, if any, they wish to put in place.


Immediately following the ruling, a few Wisconsin counties and municipalities (i.e.

Milwaukee, Madison, Dane County, Brown County, Kenosha County) instituted their own local orders. However, some of those have since been lifted out of concern for a lawsuit or have expired, including those effecting most of the Milwaukee suburbs. Notably, Dane County and the Cities of Milwaukee and Madison continue to have versions of a Safer-At-Home order still in place.


As businesses around the state gradually begin to open up, there is concern about exposure to lawsuits that may be brought by employees or customers that contract the virus. A group of businesses trade organizations with the Wisconsin Civil Justice Council (WCJC) have been working on a legislative proposal that would provide civil immunity for businesses that reopen during the COVID-19 pandemic. Such a proposal requires legislative approval and signature from the Governor and the timeline is uncertain if and when such a measure would pass.

Tags:  governor evers  insurance in wisconsin  insurance lobbyist  safer-at-home order  wisconsin  wisconsin insurance blog  wisconsin supreme court 

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Industry Update: Wisconsin Supreme Court Affirms Agent E&O Win, Strengthens Future Defenses

Posted By Josh Johanningmeier | IIAW General Counsel, Monday, June 1, 2020

 

On May 21st, in Emer’s Camper Corral v. Alderman, the Wisconsin Supreme Court issued a 6-1 majority opinion confirming a rigorous causation standard for negligent procurement E&O claims.

 

The policy at issue? A garage policy from Western Heritage Insurance. Camper Corral claimed its agent promised a $1,000 per-unit and $5,000 maximum annual deductible for hail claims—a peril that Camper Corral had encountered in both 2011 and 2012, leading to six-figure claims and its previous policy being non-renewed. In fact, the new policy had $5,000 per-unit hail deductible with no aggregate limit, which Camper Corral allegedly learned only when a 2014 hail storm damaged 25 vehicles and it incurred $125,000 in deductibles on the loss.

 

In the ensuing E&O litigation, Camper Corral tried to prove its case against the agent based on the fact that a policy with a lower hail deductible was “commercially available” in the insurance market—but Camper Corral did not (and likely could not, based on its claims history) prove that it would have been eligible for such coverage. The trial court found, and Supreme Court agreed, that this was a failure of proof of causation of damages, i.e., Camper Corral could not show the agent’s alleged “negligence was a ‘substantial factor’ in causing its loss under the commercial availability theory without evidence that a policy with the requested terms” was actually available to Camper Corral. According to the Supreme Court, Camper Corral needed to prove that an insurer would actually have sold it the lower deductible policy it claimed it was promised by the agent—and Camper Corral’s owner’s testimony that she was shown a quote was not enough.

 

Camper Corral’s other principal theory was that the agent should have been held responsible under a “detrimental reliance” theory because it relied upon the alleged representation from the agent that he had secured a policy with a lower deductible. According to Camper Corral, if it had it known that its policy actually had the higher deductibles, it would have taken additional steps to protect its inventory. The Supreme Court dispensed with this claim because Camper Corral had introduced no evidence to support it at trial. 

 

The key holding and real win for agents and E&O carriers is the court’s causation holding:

 

"In a cause of action for negligent procurement of an insurance policy, the insured cannot establish the insurance agent’s negligence was a “substantial factor” in causing its loss under the commercial availability theory without evidence that a policy with the requested terms was available to the insured."

 

Emer’s Camper Corral v. Alderman, et al. 2020 WI 46, ¶45. This clear statement of the burden of proof will bolster the defense of future claims in similar cases. Keep an eye on the Independent Agent for a future column breaking down the Camper Corral decision and its impact.

Tags:  Camper Corral v. Alderman  E&O Risk Management  errors and omissions  wisconsin supreme court 

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