Aetna Life Insurance v. United States

16 Cl. Ct. 364, 63 A.F.T.R.2d (RIA) 792, 1989 U.S. Claims LEXIS 42, 1989 WL 13401
CourtUnited States Court of Claims
DecidedFebruary 22, 1989
DocketNos. 264-78T, 556-81T
StatusPublished
Cited by15 cases

This text of 16 Cl. Ct. 364 (Aetna Life Insurance v. United States) is published on Counsel Stack Legal Research, covering United States Court of Claims primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Aetna Life Insurance v. United States, 16 Cl. Ct. 364, 63 A.F.T.R.2d (RIA) 792, 1989 U.S. Claims LEXIS 42, 1989 WL 13401 (cc 1989).

Opinion

OPINION

SMITH, Chief Judge.

This case comes before the court on defendant’s motion for summary judgment and concerns a tax refund claim for insurance reserve deductions taken in the years of 1961 through 1970.1 Although this case originally entailed a variety of issues, the sole question remaining is whether the insurance reserves at issue fall within the meaning of “life insurance reserves” under I.R.C. § 801(b)(1)(B).2

In its motion, defendant contends that the reserves at issue are not within the definition of “life insurance reserves,” and that plaintiff’s case should, therefore, be dismissed as a matter of law. Plaintiff, on the other hand, contends that the reserves at issue are “life insurance reserves,” and that the motion should be denied, in any event, because the issue before the court is essentially one that must be resolved at trial.

Having considered the arguments of both parties, this court holds that defendant is correct in asserting that the present issue is not one of fact, but of law. The court, however, disagrees with defendant’s treatment of these reserves as falling beyond the scope of the statute at hand and finds that the reserves at issue are “life insurance reserves” within the meaning of I.R.C. § 801(b)(1)(B). Accordingly, defendant’s motion for summary judgment must be denied.

FACTS3

Insurance Terms and Coverage

Plaintiff is an insurance company incorporated and with its principal place of business in Hartford, Connecticut. Plaintiff issued a variety of individual and group insurance contracts throughout the tax years in dispute.

All of the contracts involved in this case were issued on behalf of employees or multi-employer groups. Some of these contracts required employee contributions; others did not. While plaintiff issued many such contracts during this time, four sample contracts have been filed with the court in order to simplify these proceedings. Neither party has made any objection to the representative quality of these samples.

The sample contracts provided several different types of coverage. All of the contracts, however, provided life insurance coverage and coverage in the event of an employee’s permanent and total disability occurring before the age of sixty-five.

Each of the contracts was renewable by the employer corporations for one-year terms, but plaintiff reserved the right to recalculate the price. Recalculation was allowed once every year and could be done on the basis of plaintiff’s experience. This recalculation of price based on experience [366]*366could include factors such as the employee’s age, the company’s experience with a particular employee and the general risks faced by a particular employee class.

Plaintiff also reserved the right to discontinue coverage if any one of three conditions was met. First, plaintiff could discontinue coverage where fewer than ten employees were currently insured under an employer plan. Second, plaintiff could discontinue coverage where less than 75% of the employees eligible for its noncontributory insurance were actually insured. Lastly, plaintiff could discontinue coverage for employees of certain ages.

If an employee’s coverage was discontinued due to his ineligibility or due to his termination or retirement from his employer, the employee could elect to receive an individual life insurance policy with plaintiff in replacement. That policy, however, did not contain all of the benefits provided under the group employee plan. The individual plan only included direct life insurance benefits and did not include other benefits contingent upon disability.

Besides the direct benefit of payment upon death, all of the sample group contracts also provided for continued life insurance coverage without additional premium payments upon proof of disability.4 Under this benefit, plaintiff was obligated to provide continued life insurance coverage once an employee had become disabled without further cost to the employer. The policy for the disabled employee could no longer be cancelled because of age or because of an employee’s termination or retirement. The policy had to remain in force even if the employer was no longer insured by plaintiff.

Two out of the four sample contracts provided an additional monthly income benefit upon the proof of disability. This benefit provides an employee with a monthly cash payment upon employee’s disability. This benefit, like the benefit of continued coverage, could not be cancelled by plaintiff and had to remain in force even if the employer was no longer insured by plaintiff.

All of the relevant sections pertaining to the employee disability benefits were contained under the same sections of the sample contracts. Each of these sections was either entitled “Extended Insurance in the Event of Permanent and Total Disability” or “Benefits in Event of Permanent and Total Disability Occurring Before the Age of Sixty-five.”

The relevant portion of the first two sample contracts, which simply provided for continued life insurance without further premiums upon proof of disability, specifically stated that

the Insurance Company is allowed the opportunity to examine the person of the employee when and as often as it may reasonably require before approving such proof, the Insurance Company, as a permanent total disability benefit, extend insurance for the employee under this Title, in an amount determined from the terms of this section and without payment of further premiums, during the further continuance of such total and permanent disability____

The other two sample insurance contracts, which provided for both the continuation of life insurance without further premiums and for monthly income benefits upon proof of disability, were worded slightly different. Yet, neither party contends that these differences were of any legal significance for the purposes of this case.5

[367]*367 Reserves Maintained

Under the laws of Connecticut, plaintiff was required to set aside and maintain reserves for its insurance policies. These amounts were required to be “equal in amount to its liabilities under all policies ... [based] upon consideration of ascertained experience for the purpose of adequately protecting the insured or securing the solvency of the company.” C.G.S. § 38-25 (West 1987). Reserves were estimated on the basis of recognized mortality and morbidity tables with assumed rates of interest.

In accordance with Connecticut law, plaintiff maintained reserves for the monthly income benefit and for the continued insurance benefit provided upon disability. These reserves were maintained separately from each other and from plaintiff’s other insurance reserves.

According to the National Association of Insurance Commissioner’s (“NAIC’s”) annual statements,6 plaintiff’s reserves for the continuation of life insurance upon disability were maintained under two separate subgroups. The first type of reserve was labeled as a “Disability Reserve on Disabled Lives.” This reserve was increased each time an insured employee became disabled and was designed to meet future payments as they come due upon the employee’s death. See, e.g., United Benefit Life Ins. Co. v. McCrory,

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Bluebook (online)
16 Cl. Ct. 364, 63 A.F.T.R.2d (RIA) 792, 1989 U.S. Claims LEXIS 42, 1989 WL 13401, Counsel Stack Legal Research, https://law.counselstack.com/opinion/aetna-life-insurance-v-united-states-cc-1989.