Columbia Memorial Hospital v.Marcel E. Hinds , Kim E. Schoch v. Lake Champlain OB-GYN, Maple Medical v. Joseph Scott (And Five Related Appeals)

CourtNew York Court of Appeals
DecidedMay 19, 2022
Docket36-43
StatusPublished

This text of Columbia Memorial Hospital v.Marcel E. Hinds , Kim E. Schoch v. Lake Champlain OB-GYN, Maple Medical v. Joseph Scott (And Five Related Appeals) (Columbia Memorial Hospital v.Marcel E. Hinds , Kim E. Schoch v. Lake Champlain OB-GYN, Maple Medical v. Joseph Scott (And Five Related Appeals)) is published on Counsel Stack Legal Research, covering New York Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Columbia Memorial Hospital v.Marcel E. Hinds , Kim E. Schoch v. Lake Champlain OB-GYN, Maple Medical v. Joseph Scott (And Five Related Appeals), (N.Y. 2022).

Opinion

State of New York OPINION Court of Appeals This opinion is uncorrected and subject to revision before publication in the New York Reports.

No. 36 Columbia Memorial Hospital, Appellant, v. Marcel E. Hinds, Respondent. ---------------- No. 37 Kim E. Schoch, Respondent, v. Lake Champlain OB-GYN, P.C., Appellant. ---------------- No. 38 Maple Medical, LLP, Appellant, v. Joseph Scott, &c., Respondent, et al., Defendant. (And Five Related Appeals) Case No. 36:

Andrew L. Zwerling, for appellant. Seth A. Nadel, for respondent. James D. Sullivan et al.; Wyckoff Heights Medical Center; Brooklyn Hospital Center et al.; Regional Medical Practice, P.C. et al., amici curiae.

Case No. 37:

James R. Peluso, for appellant. Justin A. Heller, for respondent. James D. Sullivan et al.; Wyckoff Heights Medical Center; Brooklyn Hospital Center et al.; Regional Medical Practice, P.C. et al., amici curiae.

Case Nos. 38-43:

Carl L. Finger, for appellant. Justin A. Heller, for respondent. James D. Sullivan et al.; Wyckoff Heights Medical Center; Brooklyn Hospital Center et al.; Regional Medical Practice, P.C. et al., amici curiae.

WILSON, J.:

Medical Liability Mutual Insurance Company (MLMIC), formerly a mutual

insurance company, issued professional liability insurance policies to the eight medical

professionals who are litigants in the eight cases before us on these appeals. The premiums

-1- -2- Nos. 36-43

for those policies were paid by their employers. In October 2018, MLMIC demutualized

and was acquired by National Indemnity Company. Pursuant to its “Plan of Conversion”—

approved by the New York State Department of Financial Services—MLMIC sought to

distribute $2.502 billion in cash consideration to “Eligible Policyholders.”

The question presented is as follows: when an employer pays premiums to a mutual

insurance company to obtain a policy for its employee, and the insurance company

demutualizes, who is entitled to the proceeds from demutualization: the employer or the

employee? We answer that, absent contrary terms in the contract of employment, insurance

policy, or separate agreement, the employee, who is the policyholder, is entitled to the

proceeds.

I

A

MLMIC was a mutual insurance company, which means that it was “organized,

maintained and operated for the benefit of its members”—and “[e]very policyholder [was]

a member of” MLMIC (Insurance Law § 1211 [a]). National Indemnity Company (NICO),

a member of the Berkshire Hathaway Group, sought to buy MLMIC in exchange for $2.502

billion in cash consideration. On June 15, 2018, MLMIC submitted a “Plan of Conversion”

(Plan) to the New York State Department of Financial Services (DFS) seeking to convert

from a mutual insurance company owned by its members to a stock insurance company.

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According to the Plan, the cash consideration was to be distributed to “Eligible

Policyholders,” defined, consistent with the Insurance Law, as “each person who had a

policy ‘in effect’ during the three-year period preceding the MLMIC Board’s adoption of

the resolution” to convert, which would result in MLMIC becoming a wholly owned

subsidiary of NICO.

On September 6, 2018, DFS approved both MLMIC’s demutualization and NICO’s

acquisition subject to approval by a policyholder vote. DFS noted that, at the public

hearing, different medical employers “contend[ed] that the cash consideration should be

paid to them in the circumstances where they paid the premiums on behalf of policyholders

and/or acted as policy administrators.” In particular, “[o]ne commenter referred to the

provision of Insurance Law § 7307 (e) stating that[,] in calculating such person’s equitable

share[,] one must factor in the amount ‘such policyholder has properly and timely paid to

the insurer’” on the insurance policy and “suggested that this means that the person that

paid the premium is automatically entitled to the proceeds of the sale.” DFS rejected that

interpretation because “the same provision refers to the ‘policyholder,’ which might or

might not be the person who paid the premium.” One week later, two-thirds of the

policyholders approved the plan. On October 1, 2018, MLMIC and NICO closed both the

demutualization and acquisition deal.

In the Plan approved by DFS, MLMIC established an objection and escrow

procedure. According to the objection procedure, a “Designee”—defined to include

“Policy Administrators . . . to the extent designated by Eligible Policyholders to receive

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the portion of Cash Consideration allocated to such Eligible Policyholders,” with “Policy

Administrator” defined as “a Person designated on the declarations page of the applicable

Policy or otherwise as the administrator on behalf of the applicable Policyholder”— could

object to the distribution of the cash consideration to the policyholder if it believed that it,

rather than the policyholder, was entitled to receive the distribution. Upon a timely

objection, the money would be placed in escrow pending the agreement of the parties or

the outcome of an adversarial proceeding. On January 14, 2019, DFS issued an order

related to cash consideration remaining in escrow, which provided that if MLMIC received

timely notice that an employer and employee were in a dispute resolution process or

litigation about the cash consideration, MLMIC would continue to hold the funds in

escrow.

B

The eight cases before us on these appeals have slight differences but share the facts

that are necessary for resolving the legal question before us. The facts of each case have

-4- -5- Nos. 36-43

been detailed extensively by Supreme Court1 and the Appellate Division,2 so we only

summarize them here.

In each case, a medical professional/employee was the sole named policyholder of

a professional liability insurance policy issued by MLMIC. In each case, the medical

practice/employer had included the provision of such insurance coverage as a term of

employment in each employee’s employment agreement; had, in most of the cases, been

designated by its employee as the policy administrator3 and had handled the administrative

logistics of the policy, including receiving dividends and paying policy premiums; and,

after the demutualization, had asserted that it, and not its employee, was entitled to the cash

consideration that MLMIC allocated to each medical professional/employee despite the

absence of an assignment of the cash consideration to the employers.

1 Columbia Mem. Hosp. v Hinds, 65 Misc 3d 1205(A), 2019 NY Slip Op 51508(U) (Sup Ct, Columbia County 2019); Schoch v Lake Champlain Ob-Gyn, P.C., 64 Misc 3d 1215(A), 2019 NY Slip Op 51176(U) (Sup Ct, Saratoga County 2019); Maple Med., LLP v Scott, 64 Misc 3d 909, 2019 NY Slip Op 29210 (Sup Ct, Westchester County 2019); Maple Med., LLP v Goldenberg; 64 Misc 3d 1213(A), 2019 NY Slip Op 51128(U) (Sup Ct, Westchester County 2019); Maple Med., LLP v Arevalo, 64 Misc 3d 1213(A), 2019 NY Slip Op 51127(U) (Sup Ct, Westchester County 2019); Maple Med., LLP v Sundaram, 64 Misc 3d 1213(A), 2019 NY Slip Op 51130(U) (Sup Ct, Westchester County 2019); Maple Med., LLP v Mutic, 64 Misc 3d 1213(A), 2019 NY Slip Op 51129(U) (Sup Ct, Westchester County 2019); Maple Med., LLP v Youkeles, 64 Misc 3d 1213(A), 2019 NY Slip Op 51131(U) (Sup Ct, Westchester County 2019). 2 Columbia Mem. Hosp.

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