Colonial Life Insurance v. Curiale

159 Misc. 2d 221, 603 N.Y.S.2d 263, 1993 N.Y. Misc. LEXIS 418
CourtNew York Supreme Court
DecidedJuly 30, 1993
StatusPublished
Cited by1 cases

This text of 159 Misc. 2d 221 (Colonial Life Insurance v. Curiale) is published on Counsel Stack Legal Research, covering New York Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Colonial Life Insurance v. Curiale, 159 Misc. 2d 221, 603 N.Y.S.2d 263, 1993 N.Y. Misc. LEXIS 418 (N.Y. Super. Ct. 1993).

Opinion

OPINION OF THE COURT

Thomas W. Keegan, J.

This is a CPLR article 78 proceeding brought by Colonial Life Insurance Company of America (Colonial) challenging two regulations promulgated by the State Superintendent of Insurance pursuant to chapter 501 of the Laws of 1992. Petitioner challenges part of regulation 145 (11 NYCRR part 360) and all of regulation 146 (11 NYCRR part 361), arguing that both are beyond the scope of authority delegated to the agency by the Legislature and, additionally, that regulation 146 is unconstitutional as applied.

Chapter 501 requires commercial insurers doing business in New York to employ community rating and to offer open enrollment for any insurance market in which they participate. Open enrollment requires the insurer to accept any applicant for coverage offered by the insurer. Community rating requires the insurer to base the policy premium on the experience of the entire pool of risks covered by that policy without regard to age, sex, health status or occupation. Until this legislation was enacted, only Empire Blue Cross/Blue Shield (Empire) was required to provide coverage for high-risk applicants, serving as the insurer of last resort in New York. The purpose of chapter 501 was to broaden the availability and affordability of health insurance in New York by precluding commercial insurers from offering coverage only to low-risk individuals, a practice known as "cherry picking”.

The court is aware that Empire is currently the subject of several investigations, including an investigation into the [224]*224validity of statements made to the Legislature concerning financial losses which may have figured prominently in the enactment of chapter 501. These investigations have no bearing on the instant proceeding. This court’s task is simply to determine whether the regulations at issue comport with the intent of the Legislature when it enacted chapter 501 last year.

Before addressing the merits of the challenged regulations, the court must first address the threshold issue of standing raised by respondent who argues that petitioner neither has nor will suffer any injury in fact as a result of chapter 501. Respondent notes that payments petitioner may be required to make to an insurance pool established pursuant to the statute are not due until October of this year and that even if petitioner is required to pay into the pool, the payments can be factored into petitioner’s application for a rate increase. In reply, petitioner cites Matter of Dairylea Coop. v Walkley (38 NY2d 6) which held that Dairylea had standing to challenge the granting of a license to a competitor because it also was within the zone of interest sought to be protected under a statute designed to " 'stabilize the * * * distribution structure of the milk industry’ ”. (Matter of Dairylea Coop. v Walkley, at 11.) In Dairylea, however, there was no controversy over whether Dairylea would suffer injury as the result of the granting of a license to his competitor.

Respondent’s argument, that petitioner has not established its claim of injury in fact, is not without merit. However, in view of the Legislature’s strongly expressed interest in encouraging insurers to remain in the individual and small group markets to assure greater availability of health insurance in the State, the court is not inclined to dismiss the case summarily without considering the merits of the claim. "Standing principles, which are in the end matters of policy, should not be heavy-handed * * * While something more than the interest of the public at large is required to entitle a person to seek judicial review * * * proof of special damage or in-fact injury is not required in every instance.” (Matter of Sun-Brite v Board of Zoning & Appeals, 69 NY2d 406, 413.)

REGULATION 146-THE POOLING MECHANISM

"Where the interpretation of a statute or its application involves knowledge or understanding of underlying * * * practices or entails the evaluation of factual data and infer[225]*225enees to be drawn therefrom, the courts regularly defer to the governmental agency charged with the responsibility for administration of the statute.” (Matter of New York Life Ins. Co. v State Tax Commn., 80 AD2d 675, 676; see also, Matter of Medical Malpractice Ins. Assn. v Superintendent, 72 NY2d 753, 761-762.) Regulation 146 which establishes a pooling mechanism for the redistribution of insurance premium dollars among members of the industry is such a regulation.

"The power to regulate the insurance business is very broad * * * There is no doubt that under its regulatory power, the state may validly regulate the business of insurance * * * so long as such regulation is reasonable and does not deprive the insurance company of due process of law.” (68 NY Jur 2d, Insurance, § 3.)

Regulation 146 mandates that insurers who have a lower share of high-risk insureds contribute to the pool; insurers who have a higher share of high-risk insureds may withdraw from the pool. Petitioner contends that regulation 146 should be declared null and void because:

1. a mandatory pooling mechanism is an unconstitutional tax, taking by regulation or an illegal gift of State money to a private organization;

2. the Legislature intended the contributions to the pool to be based on an assessment of risk for policies written after the legislation became effective and not to existing policies;

3. the Legislature intended only commercial insurers and not Empire to participate in the pool;

4. the Legislature did not intend contributions to the pooling mechanism to be mandatory.

The court finds these arguments to be without merit.

As to the constitutionality of the regulation, the court agrees with respondent that the mandatory pool contributions do not constitute a tax and are within the State’s power to regulate the industry. Nor do the regulations constitute a taking by regulation because such a taking can only occur without just compensation. Under the new law, an insurer who is required to contribute to the pool may include the contribution amount in its rate increase application. In fact, in an effort to demonstrate that the statute would work to its detriment, petitioner points to the fact that it included the projected cost of its pool contribution in its most recent application for a rate increase and offers the granting of the request by the Insurance Department as proof that it has been [226]*226damaged. The court also agrees with respondent that any property interest petitioner has in its business arises from, and may be altered by, State law. The new law and regulations altering the conduct of petitioner’s business in the future are a lawful exercise of legislative power. Furthermore, chapter 501 specifies that certain sections of the new law will apply only to policies written after a future date. Since the section establishing the pooling mechanism is not specified, it is clear that the Legislature did not intend to limit the section to policies written in the future.

Finally, as respondent appropriately notes, the State Constitution (NY Const, art VII, § 8 [2]) provides authority for the Legislature to protect New Yorkers against sickness, by insurance or otherwise.

The court also finds that regulation 146 represents a rational interpretation of chapter 501.

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Related

Colonial Life Insurance Co. of America v. Curiale
205 A.D.2d 58 (Appellate Division of the Supreme Court of New York, 1994)

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Bluebook (online)
159 Misc. 2d 221, 603 N.Y.S.2d 263, 1993 N.Y. Misc. LEXIS 418, Counsel Stack Legal Research, https://law.counselstack.com/opinion/colonial-life-insurance-v-curiale-nysupct-1993.