Third Circuit allows RICO claims against insurers
The Journal of the American Association for Justice reported in its June 2007 issue that the Third Circuit ruled that policyholders can bring federal racketeering suits against insurers in New Jersey despite the state’s lack of provisions for private rights of action.
The decision in Weiss v. First Unum Life Ins. Co., 2007 WL 968391 (3d Cir. Apr. 3, 2007) overturned a lower court’s reverse preemption ruling and held that RICO claims are not barred by the McCarran-Ferguson Act, which prohibits any federal law that would “invalidate, impair, or supersede” state insurance law unless it specifically relates to the business of insurance.
“There is nothing in the regulatory scheme that indicates that allowing other remedies as part of its regulation of insurance would frustrate or interfere with New Jersey’s insurance regime,” Judge Marjorie Rendell wrote, concluding that RICO augments, rather than impairs, the state’s insurance law.
Richard Weiss, a former investment banker, was disabled in 2001 after a heart attack left him with permanent left ventricular dysfunction and extremely low blood pressure. He had short- and long-term disability benefits provided by First Unum through his employer at the time, Tucker Anthony Sutro. The insurer paid Weiss short-term disability benefits and then approved long-term benefits of more than $11,000 a month, but it discontinued payments after three months.
Weiss, who initially sued to recover losses under state law, added the RICO claim when First Unum moved the case to federal court, alleging that the state law claims were preempted by the Employee Retirement Income Security Act. Weiss argued that the insurer violated RICO by discontinuing his disability payments as part of its racketeering scheme to stop paying expensive claims.
The ruling expanded on the U.S. Supreme Court’s holding in Humana, Inc. v. Forsyth, in which the justices held that RICO claims would not frustrate the goals of Nevada’s insurance law. (525 U.S. 299 (1999).) The defense argued that unlike in Nevada, New Jersey insurance law neither allows a statutory private right of action for nonpayment of benefits nor specifically makes punitive damages available in these cases.
But the Third Circuit found that the remedies established in the state’s Insurance Trade Practices Act (ITPA) “are not intended to be exclusive.”