Aetna Casualty & Surety Co. v. Commonwealth

638 A.2d 194, 536 Pa. 105, 1994 Pa. LEXIS 57
CourtSupreme Court of Pennsylvania
DecidedMarch 7, 1994
Docket48 M.D. Appeal Docket 1992
StatusPublished
Cited by35 cases

This text of 638 A.2d 194 (Aetna Casualty & Surety Co. v. Commonwealth) is published on Counsel Stack Legal Research, covering Supreme Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Aetna Casualty & Surety Co. v. Commonwealth, 638 A.2d 194, 536 Pa. 105, 1994 Pa. LEXIS 57 (Pa. 1994).

Opinion

OPINION

ZAPPALA, Justice.

This appeal raises a question of first impression, whether Section 213 of the Insurance Department Act of 1921, Act of May 17, 1921, P.L. 789, as amended, 40 P.S. § 51, authorizes the Insurance Commissioner to order an insurance company to cease and desist from business practices that are not specifically prohibited by Act 78. 1 We hold that the Insurance Commissioner does not have the authority to order an insurance company to cease and desist from business practices that do not fall within the specific prohibitions set forth in Section 3 of Act 78.

During the period from September 18, 1989 through November 1, 1989, the Pennsylvania Insurance Department (“Insurance Department”) conducted a market conduct examination of The Aetna Casualty and Surety Company, The Standard Fire Insurance Company, and The Automobile Insurance Company of Hartford, Connecticut (collectively, “Aetna”). 2 *108 The market conduct examination reviewed areas of Aetna’s operations, including sales, advertising, licensing, rating, underwriting, claims practices, and complaint history. The purpose of the examination was to assess Aetna’s compliance with Pennsylvania laws and regulations governing insurance.

On December 20, 1989, the Insurance Department issued a draft report of the market conduct examination to Aetna. The report summarized the findings of the Insurance Department, identified practices that were perceived to be violations of insurance statutes or regulations, and included recommendations regarding Aetna’s practices. By letter dated January 19,1990, Aetna responded to the report, expressing its agreement with several recommendations and its objection to others. Aetna requested a hearing on the report to address legal issues raised by the recommendations to which it objected. Aetna also expressed its willingness to resolve the legal issues in an informal manner.

After attempts to informally resolve the disputed issues failed, hearings were conducted on April 27, 1990 and May 22, 1990 by an examiner appointed by the Insurance Commissioner. On January 10,1991, the Insurance Commissioner denied Aetna’s objections and issued an Order and Adjudication which finalized the report. The report was upheld and amended to include an additional recommendation. The Insurance Commissioner directed that the report be made available for public inspection and ordered Aetna to cease and desist from engaging in the following practices:

(1) applying driving experience guidelines of Auto Rite I and II to drivers aged 16 to 25 years;
(2) using the HLPV [High Loss Potential Vehicles] list to nonrenew policies;
(3) using accidents occurring under other, separate policies to nonrenew a current policy; and
(4) passively nonrenewing policies written through an agent that terminates its agency contract.

*109 The Insurance Commissioner directed the parties to submit memoranda relating to penalties for the violations proven at the hearings. On February 25, 1991, the Insurance Commissioner issued a second order directing Aetna to pay a civil penalty of $96,000. Aetna filed appeals from both orders to the Commonwealth Court.

The Commonwealth Court affirmed the Insurance Commissioner’s order of January 10, 1991, as modified by the court’s opinion. The court upheld the Insurance Commissioner’s resolution of the issues addressing (1) whether driving experience is a valid underwriting criterion for principal operators, and (2) whether an insurer may nonrenew coverage on the basis of two accidents within 36 months of the policy anniversary date where the risk was insured under two different, sequential policies. The Commonwealth Court held that the use of driving experience as an underwriting criterion was properly prohibited as unlawful under Section 3(a)(1) of Act 78, and that Aetna’s practice with regard to nonrenewal based on two accidents was unlawful under Section 3(b) of Act 78.

The Commonwealth Court held that the adjudication of the Insurance Commissioner was improper, however, insofar as it held Aetna to be in violation of Act 78 for refusing to renew policies on its High Loss Potential Vehicle (“HLPV”) list and for failing to notify insureds upon agency termination. Nevertheless, the court upheld the order directing Aetna to cease and desist from those practices, concluding that Section 213 of the Insurance Department Act grants broad powers to the Insurance Commissioner to make recommendations regarding the adoption or cessation of business practices or plans which are adverse to the interests of policyholders. The court reasoned that this power extends to business practices or plans even when they do not fall within the specific prohibitions found in Section 3 of Act 78, which identifies instances in which an insurer is prohibited from cancelling, or refusing to write or renew a policy of automobile insurance.

The court vacated the second order of the Insurance Commissioner which imposed the civil penalties on Aetna. The court held that the Insurance Commissioner violated the *110 Administrative Agency Law in the method utilized in imposing the penalties. During the proceedings, the presiding officer indicated to the parties that a second proceeding would be scheduled to address the penalty issue. The Insurance Commissioner failed to direct that a penalty hearing be held and merely ordered the parties to submit memoranda supporting or opposing penalties. The court declined to define the proper administrative procedure for the assessment of penalties since the order was vacated. The case was remanded for further proceedings consistent with the court’s opinion.

On April 15, 1992, Aetna filed a Petition for Allowance of Appeal seeking review of the Commonwealth Court’s decision relating to its interpretation of Section 213 of the Insurance Department Act. The petition was granted on June 9, 1992. Aetna has limited the issue on appeal to this Court to whether the Insurance Commissioner has the authority under Section 213 to order an insurance company to cease and desist lawful business practices in order to protect policyholders. 3

Section 213 provides in relevant part:

[The Insurance Commissioner] shall without notice at least once annually during the first five years of existence of every domestic insurance company, association and exchange, and thereafter every four years, or oftener if he deems it to be necessary, personally or by his deputy, actuary, or examiners, visit each domestic insurance company, association, and exchange, and thoroughly inspect and examine its affairs to ascertain its financial condition and its ability to fulfill its obligations, whether it has complied with the provisions of law, and any other facts relating to its business methods and management, and the equity of its plans and its dealing with its policyholders and claimants. * * * * #

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Bluebook (online)
638 A.2d 194, 536 Pa. 105, 1994 Pa. LEXIS 57, Counsel Stack Legal Research, https://law.counselstack.com/opinion/aetna-casualty-surety-co-v-commonwealth-pa-1994.