Alabama Insurance Guaranty Ass'n v. Association of General Contractors Self-Insurer's Fund

80 So. 3d 188, 2010 Ala. LEXIS 222, 2010 WL 4777547
CourtSupreme Court of Alabama
DecidedNovember 24, 2010
Docket1060495 and 1071194
StatusPublished
Cited by7 cases

This text of 80 So. 3d 188 (Alabama Insurance Guaranty Ass'n v. Association of General Contractors Self-Insurer's Fund) is published on Counsel Stack Legal Research, covering Supreme Court of Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Alabama Insurance Guaranty Ass'n v. Association of General Contractors Self-Insurer's Fund, 80 So. 3d 188, 2010 Ala. LEXIS 222, 2010 WL 4777547 (Ala. 2010).

Opinions

MURDOCK, Justice.

The Alabama Insurance Guaranty Association (“the AIGA”) appeals from a summary judgment entered by the Montgomery Circuit Court against the AIGA and in favor of the Association of General Contractors Self-Insurer’s Fund (“the AGCSF”).1 The issue on appeal is whether the AGCSF may recover from the AIGA based upon a claim arising out of an insurance policy (“the Reliance policy”) issued by Reliance National Indemnity Company (“Reliance”). We hold that it may, and we affirm.

I. Facts and Procedural History

A. General

The AGCSF is a group of employers who, through their participation in [190]*190AGCSF, have qualified as “self-insurers” under Ala.Code 1975, § 25-5-9(a), a part of the Workers’ Compensation Act, Ala. Code 1975, § 25-5-1 et seq. Section 25-5-9(a) states:

“The Director of Industrial Relations may, under such rules and regulations as he may prescribe, permit two or more employers, as such term is defined in Section 25-5-1, to enter into agreements to pool their liabilities under this chapter for the purpose of qualifying as self-insurers under this chapter. Each employer member of such approved group shall be authorized to operate as a self-insurer under this chapter.”

The AIGA is “a nonprofit unincorporated legal entity,” Ala.Code 1975, § 27-42-6, created pursuant to the Alabama Insurance Guaranty Association Act, Ala.Code 1975, § 27-42-1 et seq. (“the Guaranty Act”). The legislature enacted the Guaranty Act and created the AIGA

“to provide a mechanism for the payment of covered claims under certain insurance policies, to avoid excessive delay in payments and to avoid financial loss to claimants or policyholders because of the insolvency of an insurer, to assist in the detection and prevention of insurer insolvencies and to provide an association to assess the cost of such protection among insurers.”

Ala.Code 1975, § 27-42-2.

As it existed at the time the claim arose in the present case, the Guaranty Act defined a “covered claim” as

“[a]n unpaid claim, including one of unearned premiums, which arises out of, and is within the coverage and not in excess of, the applicable limits of an insurance policy to which this chapter applies, issued by an insurer, if such insurer becomes an insolvent insurer after January 1, 1981, and (i) the claimant or insured is a resident of this state at the time of the insured event; or (ii) the property from which the claim arises is permanently located in this state. ‘Covered claim’ shall not include any amount due any reinsurer, insurer, insurance pool, or underwriting association, as subrogation recoveries or otherwise.” 2

Ala.Code 1975, § 27-42-5(4) (emphasis added). Section 27-42-3, Ala.Code 1975, states that the Guaranty Act “shall apply to all kinds of direct insurance, except life, annuities, disability, accident and health, title, surety, credit, mortgage guaranty and ocean marine insurance.” The parties’ dispute primarily concerns (1) whether the AGCSF’s claim under the Reliance policy and against the AIGA concerns an amount due an “insurer” or an “insurance pool,” as those terms are used in § 27-42-5(4), and (2) whether the Reliance policy is one for direct insurance, i.e., an “insurance policy to which [the Guaranty Act] applies.”

Based upon an affidavit from Joseph S. Ammons, chief counsel for the Workers’ Compensation Division of the Alabama Department of Industrial Relations, “[sjince January 1, 1982, [the AGCSF] has been recognized by the State of Alabama as a group of employers that have pooled their [191]*191resources together to meet their liabilities to injured employees for the purpose of qualifying as self-insurers pursuant to the [Workers’ Compensation Act].”3

Also, according to an affidavit from Don Jones, the administrator of the AGCSF,

“[i]f an employer wants to join [the AGCSF], it and [the AGCSF] must enter into a participation agreement. Pursuant to this participation agreement, an employer is assessed contributions for its membership in [the AGCSF], The members’ contributions are placed in a fund and are available for the payment of workers compensation claims made by the injured employees of [the AGCSFJs members. According to the participation agreement which each member enters into, each member remains jointly and severally liable for any payments above the sum of the members contributions. Each member retains the financial risk of loss for those claims filed by the member’s employees and also for the claims filed by the employees of the other members of [the AGCSF].”

(References to exhibits omitted and emphasis added.) See Ala. Admin. Code (Department of Industrial Relations), r. 480-5-3-.06 et seq. (regulatory requirements for self-insured-employer groups). It does not appear that the participation agreement between the AGCSF and the member at issue in the present case, M & D Power Construction Co. (“M & D Power”), was included in the parties’ submissions to the trial court.

The explanation of how the AGCSF operates provided by Jones’s affidavit is consistent with the amended and restated bylaws of the AGCSF (“the bylaws”). The bylaws require the AGCSF to establish a “claims-fund account” to hold members’ contributions and from which to pay workers’ compensation claims. The bylaws further state:

“The [AGCSF] and its members shall be jointly and severally liable to assume and discharge, by payment, any claim due to be paid by the [AGCSF], any settlement approved by the [AGCSF,] and any judgment under the Alabama Workers’ Compensation Act against the [AGCSF] or any of its members.”

According to an affidavit from David Parsons, the deputy commissioner for the Alabama Department of Insurance, so far as the Department of Insurance is concerned, “[s]elf-insured workers’ compensation groups are not ‘insurers’ under the laws pertaining to insurance in the State of Alabama and these groups are not regulated by the Alabama Department of Insurance.” See Ala.Code 1975, § 27-1-2(2) (defining an “insurer” as “[e]very person engaged as indemnitor, surety or contractor in the business of entering into contracts of insurance ” (emphasis added)) and § 27-1-2(1) (defining “insurance” as “[a] contract whereby one undertakes to indemnify another or pay or provide a specified amount or benefit upon determinable contingencies”). Consistent with Parsons’s affidavit, the bylaws state that the AGCSF “is not an insurance company and does not sell insurance.” Of course, such a [192]*192statement is not determinative of whether the law deems the AGCSF to be an insurer or to issue insurance contracts. See Schoepflin v. Tender Loving Care Corp., 631 So.2d 909, 912 (Ala.1993) (“ ‘[A] company may be found to be engaged in an insurance business even though it expressly disclaims any intention to sell insurance.’ ” (quoting 43 Am.Jur.2d Insurance § 4 (1982))).4

In 1987, several § 25-5-9(a) self-insured-employer groups, including the AGCSF, established the Alabama Reinsurance Trust Fund (“the Reinsurance Trust Fund”) pursuant to Ala.Code 1975, § 25-5 — 9(b). Section 25-5-9(b) provides that “[t]wo or more employer groups as described in [§ 25-5-9](a) ...

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80 So. 3d 188, 2010 Ala. LEXIS 222, 2010 WL 4777547, Counsel Stack Legal Research, https://law.counselstack.com/opinion/alabama-insurance-guaranty-assn-v-association-of-general-contractors-ala-2010.