Individual Healthcare Specialists, Inc. v. BlueCross BlueShield Of Tennessee, Inc.
Case Details
- Judge(s)
- Presiding Judge Frank G. Clement, Jr.
- Status — whether other courts must follow this ruling
- Published
- Procedural Posture — the stage the case had reached
- bench trial
Related Laws
No specific laws identified for this ruling.
Claim Types
Outcome
Court found BlueCross breached the general agency agreement by underpaying commissions and rejected the statute of limitations defense based on inherent undiscoverability. IHS prevailed on its breach of contract claims regarding both historical underpayment and failure to pay renewal commissions directly to IHS.
Excerpt
This is a breach of contract action in which the issues hinge on the meaning of several provisions in the agreement. In 1999 and again in 2009, BlueCross BlueShield of Tennessee, Inc. ("BlueCross") and Individual Healthcare Specialists, Inc. ("IHS") entered into a general agency agreement that authorized IHS to solicit applications for individual insurance policies through IHS's in-house agents and outside "subagents." The commission rates to be paid were stated in a schedule, which was subject to modification by BlueCross. During the first eleven years, BlueCross modified the commission schedule several times and each modification was prospective only. In 2011, BlueCross modified the commission schedule and, for the first time, applied the commission schedule retrospectively. At the same time, IHS determined that BlueCross had been underpaying commissions since 1999. As a consequence, it commenced this action asserting claims for, inter alia, breach of contract and damages, while also claiming it was entitled to recover its attorney's fees based on the contract's indemnification provision. BlueCross denied any breach of contract. It also asserted the statute of limitations defense as a bar to recovering any commissions that accrued more than six years earlier, and asserted that IHS was not entitled to recover its attorney's fees because the indemnification provision did not apply to disputes between the contracting parties. Shortly thereafter, BlueCross terminated the general agency agreement and began paying renewal commissions directly to IHS's subagents instead of paying them to IHS as it had done since 1999. IHS then amended its complaint to assert a claim that BlueCross also breached the agreement by failing to pay commissions directly to IHS. Following a bench trial, the court denied BlueCross's statute of limitations defense on the ground that IHS's claims were "inherently undiscoverable." The court also determined that BlueCross breached the contract by und
What This Ruling Means
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