Monday, January 13, 2014

No. 20: An Interesting Letter from a Reader

When I announced early in October 2013 that I was ending publication of The Insurance Forum, I offered subscribers back issues of their choice to meet my obligation for undelivered issues. I owed three issues to Robert H. Harmon, CLU, ChFC (Salt Lake City), a long-time subscriber and friend. He asked me to select the issues, which I did. I knew he had seen them when they were published a decade ago, but I also knew he would want to reread them. In response he sent this letter:
Thank you for the issues you sent. I thoroughly reread them. I admit, however, that rereading "Conseco's Assault on Universal Life Policyholders" in your December 2003 issue was like ripping off the scab of a previously healed wound! Your brilliant and thoroughly researched description of what Conseco did to its policyholders by eliminating the previously undisclosed "R-factor" brought back unhappy memories of what happened to many of my family members and cherished clients.
I thought I had done a remarkable job by selling more than 300 of those policies, which originally were issued by Massachusetts General and later were acquired by Conseco. In addition to meeting with fellow agents around the country, I had visited the Mass General home office, met with several members of top management, and was convinced I would be providing a great service by selling those policies to everyone I knew. It turned out to be the most heart wrenching experience of my business life. I eventually realized I had been betrayed in the worst possible way. I learned a lot from the experience, and since then I have been happy selling policies issued by reputable companies.
I began my life insurance sales career in 1956 after receiving an MBA from UCLA. Except for those unhappy years with Mass General and Conseco, this has been a great business. I am delighted to still be a part of it.
You have had a positive and strong influence on my business life. I am deeply grateful for the unique way in which you have been on the cutting edge of bringing news about what is really going on in our great industry.

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Thursday, January 9, 2014

No. 19: A STOLI Criminal Case in Federal Court in California

On July 20, 2013, a federal grand jury in San Diego handed up a 23-count indictment against four individuals in a case involving numerous stranger-originated life insurance (STOLI) policies. The defendants are Byron Arthur Frisch, Kristian Marcus Giordano, Kasra Sadr, and Brenda N. Barrera Merriles. The defendants are charged with one count of conspiracy to commit mail fraud and wire fraud, eight counts of mail fraud, and fourteen counts of wire fraud. The case, which I learned about only recently, has interesting connections to my blog post No. 16 about a STOLI civil case in federal court in Utah. (U.S.A. v. Frisch et al., U.S. District Court, Southern District of California, Case No. 3:13-cr-2774.)

Nature of the Charges
The indictment charges the defendants with deceiving life insurance companies into issuing large life insurance policies to unqualified applicants, obtaining millions in commissions, and selling the fraudulently obtained policies to innocent purchasers. To accomplish those purposes, the defendants, among other things, 
recruited elderly individuals to apply for life insurance policies with death benefits ranging from $1.5 million to $9.5 million with the promise that there would be no cost to the applicant; promised applicants that they would receive two years of coverage at the face value of the life insurance policy, followed by a payment of a part of the sale price of the policy when it was sold to a third party after two years; [and] prepared and submitted to life insurance companies applications for life insurance that intentionally contained false representations and omitted material facts regarding the applicant's net worth, income, source of premium payments, and intent to sell the policy....
Companies and Individuals
The indictment shows in tables the names of certain companies and individuals who sent or received funds by mail or wire. They are "Lincoln B Life Insurance Co.," "Principal Life Insurance Co.," "Producers Group," "Advanced Planning Services," "Cavalier Associates," "Sadr and Barrera," "Washington Mutual Bank," "Principal Financial Group," "Spartan Marketing," "Byron A. Frisch," "Gio3 Group," "K. Giordano," "Bank of America," "Wells Fargo Bank," "US Bank," and "California Bank & Trust."

Names of insureds are not shown but are indicated by initials. Applications are mentioned for policies of $8 million for RMG, $9.5 million for GH, $5 million for DG, $6 million for VC, $4 million for LP, $4 million for TSF, $1.5 million for JDA, $3 million for KH, $3 million for SDC, $3 million for VL, $3 million for RM, and $1.5 million for WS. In addition to fraudulent applications, the examples mention concealment of the identity of the party paying the premiums.

Status of the Case
Pleas of not guilty were entered and the defendants were released on bond. The case was assigned to District Judge Janis L. Sammartino. The trial date is February 7, 2014. 

Connections to a Civil Case in Utah
In my blog post No. 16 dated December 30, 2013, I discussed a civil case in federal court in Utah. The plaintiff was PHL Variable Insurance Company, a unit of Phoenix Companies, Inc. Here are some connections between the PHL case and the Frisch case:
  • In my discussion of the PHL case, I mentioned the San Diego law firm of Sadr & Barrera. The principals of the firm are defendants in the Frisch case. 
  • Frisch was deposed in the PHL case. Unfortunately the transcript is under seal in the court file on the PHL case.
  • Frisch played football at Brigham Young University (BYU) in Provo, Utah. (Later he played professionally with the Tennessee Titans, Dallas Cowboys, New York Giants, and San Francisco 49ers.)
  • Sheldon Hathaway, whose family trust was the defendant in the PHL case, lives in Payson, Utah, near Provo.
  • In my discussion of the PHL case, I mentioned Brock Diediker. He played football at BYU.
  • In my discussion of the PHL case, I mentioned Gabriel Giordano. He played football at BYU.
  • Kristian Marcus Giordano is a defendant in the Frisch case. It seems likely that he is related to Gabriel Giordano.
The Indictment in the Frisch Case
I am making the 12-page indictment in the Frisch case available as a complimentary PDF. Send an e-mail to jmbelth@gmail.com and ask for the Frisch indictment.
 
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Monday, January 6, 2014

No. 18: Comments from Readers and Others about Universal Health Care

My blog post No. 12 entitled "The Expanded and Improved Medicare For All Act of 2013" (the Conyers bill), which also mentioned the Patient Protection and Affordable Care Act of 2010 (PPACA), generated some diverse responses. There were those who oppose universal health care. For example, Robert Bland, CLU, said:
I respectfully disagree about the need for socialized medicine and the destruction of the private practice of medicine in the U.S. We did the Amtrak and Post Office dance for decades, and mirroring those failures with one-sixth of the entire economy would be a disaster as socialized medicine is in every country that has it.
Mr. Bland went on with horror stories about long waits in Canada for routine tests that take only days in the U.S. He also said kings and queens come to the U.S. for critical medical care.

On the other hand, there were those who support universal health care. For example, Alan Press, CLU, said:
I agree with you that a single-payer system is the only solution and that the Conyers bill is unlikely to pass. However, I am not quite as pessimistic as you are about the future. The PPACA is a good step but it does not adequately address increased costs and the additional medical infrastructure, both of which will be required to provide care for those previously uninsured.
On December 5, 2013, Colin Powell, a long-time Republican, spoke in Seattle at a fundraiser for prostate cancer research. Among other prominent positions, he is a former Secretary of State, a former Chairman of the Joint Chiefs of Staff, and a retired four-star U.S. Army general. According to an article in the Puget Sound Business Journal, he expressed strong support for universal health care. He acknowledged his family's favorable experience with health care provided for the U.S. military. He said both he and his wife had swift, effective treatment for serious health problems and never had to fear whether they could afford the care they needed. He also said:
We are a wealthy enough country with the capacity to make sure that every one of our fellow citizens has access to quality health care. [Let's show] the rest of the world what our democratic system is all about and how we can take care of all of our citizens.
Providing universal health care necessarily will place pressure on the delivery system. However, I am confident that the medical education resources of our great nation are capable of expanding the supply of physicians and nurses, and that our construction industry is capable of expanding medical facilities to meet the demand. I cannot accept the idea that a major portion of our population must be denied access to adequate health care.

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Thursday, January 2, 2014

No. 17: Caramadre Sentenced to Six Years in Prison

Chief Judge William E. Smith of the U.S. District Court in Rhode Island recently sentenced Joseph A. Caramadre to six years in prison in a bizarre case about which I have written in The Insurance Forum. Judge Smith also sentenced Raymour Radhakrishnan, an employee of Caramadre's firm, to one year and a day in prison. Edward Maggiacomo and Edward Hanrahan were unindicted co-conspirators. They worked with Caramadre, cooperated with the government, and were not charged. Radhakrishnan placed his faith in Caramadre, did not cooperate with the government, and was charged. (U.S.A. v. Caramadre and Radhakrishnan, U.S. District Court, District of Rhode Island, Case No. 1:11-cr-186.)

Background
In the June 2009 issue of The Insurance Forum, I wrote in general terms about stranger-originated annuities as a vehicle for money laundering. In the April 2010 issue, I discussed civil lawsuits filed by Transamerica and Western Reserve against Caramadre, Radhakrishnan, Maggiacomo, and Caramadre's firm. The complaints alleged that the defendants, using deceptive newspaper advertisements, located terminally ill persons, gave them small cash payments characterized as charitable donations, tricked them and their families into allowing investors to purchase large variable annuities on the lives of the ill persons, arranged for the annuities to provide guaranteed minimum death benefits and other features favorable to the investors, arranged for the investors to pay the premiums and be the beneficiaries, and allowed the investors to profit significantly from the deaths of the ill persons without risk of loss.

In November 2011, the U.S. Attorney in Rhode Island charged Caramadre and Radhakrishnan with 65 counts of wire fraud, mail fraud, conspiracy, identity fraud, aggravated identity theft, and money laundering. Caramadre was also charged with one count of witness tampering. The indictment described not only the variable annuity scheme but also a "death-put bond" scheme. In the latter scheme, a corporate bond was purchased jointly by an investor and a terminally ill person, with right of survivorship. The bond was purchased at a price well below face value. At the death of the ill person, the investor redeemed the bond at full face value.

In November 2012, the trial began. It was expected to last four months. On the first four days, the government presented 14 witnesses, whose testimony was devastating to the defendants.

At the beginning of the fifth day of the trial (a Monday), in a stunning development, the defendants pleaded guilty to one count of wire fraud and one count of conspiracy. Judge Smith closely questioned the defendants about the plea agreements that had been hammered out over the weekend, accepted the pleas, ruled the defendants guilty, set a sentencing date, and terminated the trial. The government agreed to recommend prison terms of not more than ten years and move for dismissal of the other charges at the time of sentencing. The defendants stipulated to a host of facts outlining the scope of their wrongdoing.

In January 2013, although Caramadre had sworn under oath at the plea hearing that he was satisfied with his legal representation, he fired his attorneys and retained new counsel. Then, in another stunning development, he filed a motion to stay all proceedings to permit the defendants to file a motion to withdraw the guilty pleas. Caramadre's public relations firm released this statement from him:
When I pled guilty in November, I did so relying on the advice of my lawyers, and because as a husband and a father I hoped the immediate end of the trial would alleviate the serious health issues that several members of my family were experiencing as a result of the trial.
However, to enter a guilty plea to something that I did not do, simply to relieve the pressure of a 3 1/2 year criminal process, was wrong. I am innocent of the allegations leveled by the federal government against me. In the coming days, I will be asking the Court to allow me to withdraw my plea, and for the opportunity to get my day in court, wherein I can actually defend the false and misguided accusations against me.
Judge Smith denied the motion to withdraw the guilty pleas. He called the effort "bizarre, without merit, and a cynical attempt to manipulate the judicial process." He ordered Caramadre jailed immediately because of flight risk, and delayed sentencing.

Caramadre filed a motion to reconsider the detention order; Judge Smith denied the motion. Caramadre appealed the denial; the U.S. Court of Appeals for the First Circuit affirmed the denial.

Sentencing Memoranda
In its sentencing memorandum, the government asked that Caramadre be imprisoned for ten years, the maximum under the plea agreement. Caramadre asked for two years in prison followed by two years of home confinement and 3,000 hours of community service during the home confinement.

The government asked that Radhakrishnan be imprisoned for eight years. Radhakrishnan asked for one day of prison, one year of home confinement, and 2,000 hours of community service.

Letters to Judge Smith
According to press reports at the time of sentencing, Judge Smith received 89 letters requesting leniency for Caramadre. The letters were not in the electronic court file, and could be viewed by the public only at the court clerk's office in Providence. Some of the letters reportedly were from prominent persons: Thomas J. Tobin, Catholic bishop of Providence; Raymond L. Flynn, former mayor of Boston; and Robert G. Flanders, former associate justice of the Rhode Island Supreme Court.

Caramadre's attorney filed a motion for sentence variation. Attached was a list of charities to which Caramadre contributed. The list did not show dates or amounts. Also attached to the motion was evidence of a contribution of at least $100,000 to United Way, a 1987 award from the Catholic Foundation of Rhode Island, an award from the Diocese of Providence, and an award from Big Brothers of Rhode Island.

Sentencing
On December 16, 2013, Judge Smith sentenced Caramadre to 72 months in prison on one of the counts in the plea agreement and 60 months on the other count, with the terms to run concurrently, three years of supervised release, a $200 special assessment, and no fine. Judge Smith granted the government's motion to dismiss the 64 other counts and the forfeiture allegation, and recommended to the Bureau of Prisons that Caramadre be placed in a facility "as close to Rhode Island as possible." Judge Smith denied Caramadre's motion to be released during the Christmas break, gave him credit for the time he served after being jailed as a flight risk, ordered him to participate in a program of mental health treatment, ordered him to perform 1,000 hours of community service per year for a total of 3,000 hours, and said the "service shall be devoted to the terminally ill elderly in hospice or palliative care or other service for the elderly like Meals on Wheels."

The judge sentenced Radhakrishnan to "12 months and 1 day" on each of the two counts in the plea agreement, with the terms to run concurrently, three years of supervised release, a $200 special assessment, and no fine. Judge Smith granted the government's motion to dismiss the 63 other counts and the forfeiture allegation, recommended to the Bureau of Prisons that Radhakrishnan be placed in the medium-security Federal Correctional Institution (Berlin, NH) "to maintain contact with his family," and ordered him to surrender on January 13, 2014. Judge Smith ordered Radhakrishnan to spend the first six months of supervised release on home detention, perform 1,000 hours of community service per year for a total of 3,000 hours, and said the "service shall be devoted to the terminally ill elderly in hospice or palliative care or other service for the elderly like Meals on Wheels."

Restitution
U.S. Magistrate Judge Patricia A. Sullivan filed a report about restitution. She said total losses from the scheme were $46.3 million. Losses to insurance companies from 195 annuity transactions were $33.9 million. Insurance companies that suffered losses exceeding $1 million were Nationwide ($11.4), Genworth ($4.0), Security Benefit ($3.0), ING ($2.8), Jefferson National ($2.5), Midland ($1.9), MetLife ($1.7), Hartford Life ($1.5), Pacific Life ($1.3), and Western Reserve ($1.1). Losses to bond issuers from 54 brokerage accounts were $12.4 million. Bond issuers that suffered losses exceeding $1 million were General Motors Acceptance ($4.7), Countrywide Financial ($2.7), and CIT Group ($2.3). Judge Smith delayed ruling on restitution.

Scope of Wrongdoing
To my knowledge, the Caramadre case is the only criminal case thus far relating to stranger-originated annuities. Judge Sullivan, in her report on restitution, and relying on stipulations in Caramadre's plea agreement, described the scope of the wrongdoing as follows:
The Plea Agreement's Statement of Facts lays out the basics of the scheme: Caramadre concocted an insurance annuity investment scheme beginning in 1995 and a death-put bond scheme in 2006; he was joined by Radhakrishnan in July 2007 and they continued until August 2010. The purpose of the scheme was to defraud financial institutions by purchasing variable annuities and death-put bonds with a guaranteed profit by surreptitiously including terminally-ill individuals with no relationship to the real investor as a "measuring life" for the transaction. The object was to fraudulently obtain significant sums of money from insurance companies and bond issuers by making material misrepresentations and omissions. To execute the scheme, the Plea Agreement describes how they fraudulently obtained the identity information and procured signatures from terminally-ill individuals by misrepresenting the true purpose of investment documents and concealing from the terminally-ill individuals and their family members that their identities would be used on annuities and bonds to be purchased by Caramadre and his co-conspirators, clients, and their families, as well as by taking steps to prevent the terminally-ill individuals from understanding the documents they were signing....
Another essential indicia of the scheme, according to the Plea Agreement, was repeated deception of insurance companies, bond issuers, broker-dealers and brokerage houses to prevent them from uncovering the true nature of the transactions. Caramadre, sometimes assisted by or acting through Radhakrishnan or the unindicted co-conspirators, lied to and manipulated his victims: telling insurance companies, broker-dealers and representatives from brokerage houses that some of the annuity owners were friends, clients or acquaintances of the terminally-ill individuals; opening annuities with small deposits that would not attract scrutiny; delaying the filing of death claims to avoid attention; opening brokerage accounts in Radhakrishnan's name although the funds actually belonged to Caramadre; lying about Radhakrishnan's assets and income to qualify him as an account owner; misrepresenting the purpose of the co-owner bond accounts; and falsely stating that some of the funds for the accounts came from the terminally ill....
Notice of Appeal
On December 27, 2013, Caramadre's attorney filed a notice of appeal. It reads:
Now comes the Defendant, Joseph Caramadre, through counsel, and hereby gives notice of appeal to the United States Court of Appeals for the First Circuit of the conviction, sentence, and orders in the above-referenced matter.
The minute entry about the December 16 sentencing hearing states: "Court verifies that the deft [defendant] has waived his right to appeal, pursuant to the plea agreement." The November 19 plea agreement states:
Defendant hereby waives Defendant's right to appeal the convictions and sentences imposed by the Court, if the sentences imposed by the Court are at or below the government's maximum recommended sentence.
It remains to be seen whether Caramadre will actually file an appeal and, if so, what he appeals. No longer does anything about this bizarre case surprise me.

Articles about the Case
In addition to the previously mentioned June 2009 and April 2010 issues of The Insurance Forum, I wrote about the Caramadre case in the March 2012, February 2013, April 2013, and October 2013 issues. The Providence Journal and ProPublica reported often about the case. When the defendants were sentenced, The New York Times and the Associated Press reported on the case.

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Monday, December 30, 2013

No. 16: A STOLI Civil Case in Federal Court in Utah

On December 3, 2013, U.S. District Judge Robert J. Shelby issued a 19-page Memorandum Decision and Order (Order) in a stranger-originated life insurance (STOLI) civil lawsuit. The plaintiff was PHL Variable Insurance Company, a unit of Phoenix Companies, Inc. The defendants were the Sheldon Hathaway Family Insurance Trust and Windsor Securities, LLC. The Order was issued five days after the Minnesota order discussed in my posting No. 13. (PHL v. Sheldon Hathaway Trust et al., U.S. District Court, District of Utah, Case No. 2:10-cv-67.)

The Sale
The lawsuit arose out of a $4 million life insurance policy issued by PHL on the life of Sheldon Hathaway, a retired heavy equipment operator and welder. PHL issued the policy on January 31, 2008. The beneficiary was a family insurance trust of which Hathaway's son David was trustee.

Hathaway lives on 15 acres of rural property in Payson, Utah. He owns a residence and a non-commercial farm. The residence is worth about $380,000. The farmland was valued at $530,000 in 2008, but by 2012 it had decreased in value to $340,000. He owns other minor assets, including farm equipment, an old Jeep, and a Ford truck. He receives annual income of about $30,000 from Social Security and company pensions.

Jay Sullivan, Hathaway's neighbor, showed Hathaway a brochure about investor-financed life insurance that supposedly carried no liability for the insured. Sullivan said the policy would cost nothing and Hathaway would receive $300,000 when the policy was sold after two years.

The Misrepresentations
Sullivan initially estimated Hathaway's net worth as $4 million. Hathaway later testified he questioned Sullivan's estimate, but Sullivan assured Hathaway the property was worth more than Hathaway thought. On the final application, Sullivan listed Hathaway's net worth as $6,250,000 and annual income as $484,500. Also, the application said that premiums would not be financed, and that neither Hathaway nor the trust intended to transfer an interest in the policy to a third party. Hathaway signed the application.

Brock Diediker, an insurance intermediary working with Sullivan, passed the application to Gabriel Giordano, a licensed insurance producer, and Giordano's company, PRG Financial Resources, Inc. Giordano submitted the application to PHL. Giordano also submitted a producer's report on December 10, 2007, saying he had met Hathaway. However, neither Diediker nor Giordano ever met Hathaway.

The Infolink Report
PHL sought confirmation of Hathaway's net worth from Infolink, which submitted an inspection report dated December 5, 2007. The report said the information in the application appeared accurate based on a conversation with Hathaway. PHL later learned that Infolink never contacted Hathaway or otherwise confirmed his net worth.

The Money Trail
Sullivan and other intermediaries worked with David to transfer to the trust's bank account enough money to pay the $200,000 initial policy premium. The source of the money was the San Diego law firm of Sadr & Barrera APLC (S&B), which was active in the secondary market for life insurance. On March 7, 2008, the day before the initial premium was due, S&B transferred $200,000 to the trust's bank account. The money stayed there about one day before it was sent to PHL. David saw Sullivan perform the transfers telephonically during a bank visit.

When the policy was issued, PHL paid a commission to Giordano. PHL also paid a commission to Crump Life Insurance Services, Inc., a PHL broker. Crump had an agreement under which Giordano received a portion of Crump's commission under certain conditions. Giordano paid a portion of his commission to Diediker and New Concepts Financial Corporation, with which Sullivan was affiliated. Through PRG, Giordano also paid Windsor $40,000. Windsor paid $200,000 to S&B. PHL contended the latter payment was to refund the money S&B provided to pay the initial premium. Windsor said it had no knowledge of S&B's involvement and believed the payment was a reimbursement to the trust.

The Investigations
On December 18, 2008, the Utah Department of Insurance wrote to PHL requesting information about Giordano. Alerted to the department's investigation, PHL undertook its own investigation of five policies connected to Giordano, including the Hathaway policy. When PHL was unable to confirm certain information, PHL began legal action to rescind the policies.

The PHL Lawsuit
On January 28, 2010, PHL filed a civil lawsuit against the trust. On April 13, 2011, Judge Shelby granted Windsor's motion to intervene. On September 17, 2012, PHL filed a motion for summary judgment and Windsor filed a cross motion for summary judgment. On December 3, 2013, Judge Shelby's Order granted PHL's motion for summary judgment and denied Windsor's cross motion for summary judgment. The Order instructed the court clerk to enter judgment rescinding the Hathaway policy, allowing PHL to retain the initial policy premium, and permanently dismissing Windsor's claims.

Conclusion
This is another of many STOLI civil lawsuits involving gross misrepresentations in policy applications. Here is a sentence in Judge Shelby's Order:
The court finds that there are no genuine issues of disputed fact and that the false statements in the policy application were material misrepresentations upon which PHL Variable relied.
I am offering the Order as a complimentary PDF. Send an e-mail to jmbelth@gmail.com and ask for Judge Shelby's Order.

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Thursday, December 26, 2013

No. 15: A Legal Victory for Life Partners

On May 18, 2011, Sean Turnbow and others filed a six-count complaint in federal court against four defendants: Life Partners, Inc. (LPI), an intermediary in the secondary market for life insurance; Life Partners Holdings, Inc. (NASDAQ:LPHI), the parent of LPI; Brian D. Pardo, chief executive officer of LPHI, and R. Scott Peden, general counsel and secretary of LPHI. On August 25, 2011, the plaintiffs filed a significantly amended four-count complaint alleging breach of fiduciary duty, aiding and abetting breach of fiduciary duty, breach of contract, and violation of the California Unfair Competition Law (UCL). (Turnbow v. Life Partners, U.S. District Court, Northern District of Texas, Case No. 3:11-cv-1030.)

On September 15, 2011, the defendants moved to dismiss the case. On March 12, 2012, the plaintiffs moved for class certification. On September 28, 2012, U.S. District Judge Barbara M. G. Lynn denied the motion to dismiss, except that she dismissed the UCL count subject to repleading within 21 days. On October 25, 2012, the defendants answered the amended complaint. On January 8, 2013, the judge set the jury trial to begin December 9, 2013. On July 9, 2013, she denied the plaintiffs' motion for class certification. On December 2, 2013, the plaintiffs moved for voluntary dismissal of the case, and the judge granted the motion.

The 8-K Report
On December 4, 2013, LPHI filed an 8-K (material event) report with the Securities and Exchange Commission. Here is the full text:
On December 3, 2013, Life Partners Holdings, Inc. issued a press release announcing that the plaintiffs in the case styled Turnbow v. Life Partners, Inc. (Case No. 3:11-cv-1030-M, 2013 U.S. Dist. Ct., N.D. Tex., Dallas Div.) have voluntarily dismissed their lawsuit. The dismissal follows the court's denial of a motion for class certification in the lawsuit.
The Press Release
LPHI attached to the 8-K an eight-paragraph press release entitled "Plaintiffs Dismiss Lawsuit Against Life Partners," the fourth paragraph of which contains three sentences from Judge Lynn's July 9 order denying the plaintiffs' motion for class certification. Here are the third, fourth, and fifth paragraphs of the press release:
While the plaintiffs in the case could have appealed the denial of the class action or continued to pursue the case as individuals, they elected instead to voluntarily dismiss the case against the Life Partners defendants. A key allegation was that Life Partners' medical consultant used an unreasonable method of estimating life expectancies. However, this allegation was criticized by the Court as part of its 34-page order denying certification as a class action:
"Proof only of results does not address these factors. Nor could an after-the-fact analysis of the insured's deaths, in the aggregate, establish that LPI was unreasonable in using Dr. Cassidy when and how it did.... The Court is highly skeptical that an analysis of results alone could lead a reasonable juror to determine that Dr. Cassidy's methods were flawed."
Life Partners CEO Brian Pardo commented, "This is yet another example of attorney-driven litigation which damages the entire economy, not to mention the companies that are the targets of such litigation. We are very pleased that the plaintiffs decided to walk away from this case and we hope to see other similar cases end the same way."
General Observations
The sentences LPHI quoted are from page 11 of Judge Lynn's 34-page memorandum opinion and order. The first sentence quoted was the final sentence of a nine-sentence paragraph. The second sentence quoted was the first sentence of the next paragraph, which was a four-sentence paragraph. The third sentence quoted was the third sentence of that four-sentence paragraph. I think LPHI selected the three sentences to serve its purposes.

Moreover, I think it is inappropriate for a public company to use a press release about the results of a court case as a vehicle for expressing the chief executive officer's personal opinions about the court system. It is also ironic when the chief executive is known as litigious.

I think readers must examine for themselves the extent to which the three sentences quoted were judiciously selected. For that reason, I am making the 34-page memorandum opinion and order available as a complimentary PDF. Send an e-mail request to jmbelth@gmail.com for Judge Lynn's order.

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Monday, December 23, 2013

No. 14: New York Slams Markel for Overcharging on Student Health Insurance

On December 3, 2013, the Office of the New York State Attorney General (OAG) announced a $3.75 million Assurance of Discontinuance (AOD) with Markel Insurance Company for overcharging on college student health insurance plans. The AOD resolves an investigation by OAG and the New York State Department of Financial Services (DFS) revealing that the company's student health plans, college accident plans, and sports accident plans failed to meet legal requirements for minimum loss ratios.

Markel overcharged about 22,000 students at 34 New York colleges, some of which are units of the State University of New York (SUNY). Under the AOD, the company will pay about $2.75 million in restitution to students and colleges, and a combined penalty of $990,000 equally divided between OAG and DFS. The colleges at which the estimated number of students receiving refunds exceeded 500 are Albany College of Pharmacy & Health Science (1,000), Bard College (5,800), Clarkson University (750), Colgate University (1,400), Nyack College (1,850), St. Bonaventure University (1,000), St. Lawrence University (1,150), SUNY Binghamton (2,250), SUNY Oneonta (1,497), SUNY Potsdam (600), and Wells College (1,200).

The AOD also requires Markel to end an improper commission practice. Here is one paragraph of the AOD:
In addition, Markel paid bonuses or override commissions to at least one agent, based on factors such as the loss ratio. Markel entered into broker compensation agreements that provided that it would only pay the agent a bonus if the loss ratio was kept below 60%, which is below the 65% minimum loss ratio required by 11 NYCRR 52.45(f). Such agreements create conflicts of interest for the agent because they provide financial incentives for the agent to keep loss ratios low in violation of the law and contrary to the best interest of the schools' students. As a result of such agreements, Markel has paid hundreds of thousands of dollars in improper bonuses and commissions.
Also, pursuant to the Patient Protection and Affordable Care Act of 2010 (PPACA), the federal Department of Health and Human Services (HHS) issued a regulation in March 2012 covering the applicability of PPACA to student health insurance policies. HHS regulations, effective for policy years beginning July 1, 2012, require a minimum loss ratio of 80% for student health insurance policies.

OAG alleged that Markel violated three New York statutes and regulations: a statute that "prohibits persons or business entities from engaging in repeated fraudulent or illegal acts or otherwise demonstrating persistent fraud or illegality in the carrying on, conducting or transaction of business," a statute that "prohibits deceptive acts or practices," and a regulation that "requires that group and blanket health insurance achieve a 65% minimum loss ratio." The company neither admitted nor denied the allegations.

Markel said it exited the domestic student health insurance business nationwide and did not issue any blanket student health insurance plans for the 2012-2013 policy year. The company also said it will exit the blanket student accident insurance business and the blanket student intercollegiate sports accident insurance business in New York at the end of the 2012-2013 policy year.

I have combined the OAG press release and the AOD itself into a 17-page complimentary PDF. Send me an e-mail request at jmbelth@gmail.com for the OAG/Markel package.

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