Employers Resource Management Co. v. Department of Insurance

141 P.3d 1048, 143 Idaho 179, 37 Employee Benefits Cas. (BNA) 2820, 2006 Ida. LEXIS 75
CourtIdaho Supreme Court
DecidedMay 9, 2006
DocketNo. 30837
StatusPublished
Cited by2 cases

This text of 141 P.3d 1048 (Employers Resource Management Co. v. Department of Insurance) is published on Counsel Stack Legal Research, covering Idaho Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Employers Resource Management Co. v. Department of Insurance, 141 P.3d 1048, 143 Idaho 179, 37 Employee Benefits Cas. (BNA) 2820, 2006 Ida. LEXIS 75 (Idaho 2006).

Opinion

SCHROEDER, Chief Justice.

Employers Resource Management Company (ERM) is a Virginia corporation doing business in Idaho, providing a variety of insurance services, including a health benefit plan. The Idaho Department of Insurance (the Department) filed an administrative complaint to determine whether ERM’s operations in Idaho were subject to regulation by the Department, and, if so, whether ERM was in violation of Idaho law and subject to sanctions. A bifurcated administrative hearing was held, followed by a review by the [181]*181Director of the Department. The Director’s decision was appealed to the district court.

The district court affirmed the Director’s finding that the health benefit plan operated by ERM is subject to regulation by the Department. The district court also affirmed the Director’s order that ERM is to bring the subject health benefit plan into compliance with the requirements of Idaho law and Department regulations. However, the district court reversed the Director’s finding that ERM is subject to monetary sanctions for each violation.

ERM appeals to this Court. The Department cross-appeals the decision of the district court setting aside the sanctions awarded by the Director.

I.

FACTUAL AND PROCEDURAL BACKGROUND

ERM provides professional employment services to small businesses throughout Idaho, including insurance services, such as hospital and medical expenses. The small business clientele who contract with ERM sign a “co-employment agreement” in which these clients are said to be “co-employers” of ERM, in their relationship with ERM.

ERM has been doing business in Idaho for over 12 years. ERM has 84 “co-employer”/clients in Idaho and does not hold a certificate of authority to operate as an insurer in Idaho under I.C. § 41-305. ERM has not registered to provide insurance as a self-insured Multiple Employer Welfare Arrangement (MEWA) under Title 41, chapter 40 of the Idaho Code.

The Department filed an Administrative Complaint against ERM on April 21, 2000, to determine whether ERM’s operations in Idaho were subject to regulation by the Department, and the consequences of that decision. A hearing officer was assigned to conduct the hearing. The hearing officer bifurcated the hearing into two phases. Phase I was to decide whether ERM’s operations were subject to regulation. Phase II was to decide if ERM was subject to sanctions.

The hearing officer determined that ERM was a Multiple Employer Welfare Arrangement (MEWA), as defined by 29 U.S.C. § 1002(40), because it offered health benefits to two or more employers. Subsequently the hearing officer determined that ERM had violated the Idaho Insurance Code by transacting the business of insurance without authorization, and as such, was subject to monetary sanctions pursuant to I.C. § 41-117. The hearing officer ordered that ERM cease and desist from marketing, offering or accepting, or any combination thereof, any insurance plan until such time as ERM complied with Idaho law.

ERM appealed to the Department Director who issued a Final Order largely affirming the hearing officer’s decision, correcting the Idaho statute that was appropriate for imposing a monetary sanction. The Director found I.C. § 41-117A rather than I.C. § 41-117 to be the appropriate penalty statute.

ERM filed a Petition for Judicial Review and a Petition for Judicial Stay with the district court. The district court affirmed the Director’s decision in part and reversed the decision in part. The district court affirmed the Director’s finding that the health benefit plan operated by ERM is subject to regulation by the Department. The district court also affirmed the Director’s order that ERM is to bring the subject health benefit plan into compliance with the requirements of Idaho law and Department regulations. However, the district court reversed the Director’s finding that ERM has been in violation of Idaho’s insurance code, and therefore subject to monetary sanctions for each of these violations.

ERM argues that the district court incorrectly affirmed the Director’s conclusion that the Department has subject matter jurisdiction over ERM. ERM asserts that the district court (and Director) incorrectly concluded that ERM is a MEWA, maintaining that ERM is exempt from the registration requirement and other injunctive action. ERM argues that various procedural errors and decisions by the Director have significantly prejudiced ERM’s position on appeal.

On cross-appeal the Department argues that the Final Order issued by the Director of the Department should stand in its entire[182]*182ty and requests attorney fees and costs pursuant to I.A.R. 41 and I.C. § 12-117.

II.

STANDARD OF REVIEW

This Court reviews the agency record independently from the district court acting in its appellate capacity under the Administrative Procedure Act. Serious consideration is given to the district court’s decision, but we review the matter as if the case were directly appealed from the agency. The county’s decision may be overturned only where it: (a) violates statutory or constitutional provisions; (b) exceeds the agency’s statutory authority; (c) was made upon unlawful procedure; (d) is not supported by substantial evidence in the record as a whole; or (e) is arbitrary, capricious, or an abuse of discretion.
The Court exercises free review over interpretation of a statute. Our primary function when interpreting a statute is to determine and give effect to the legislative intent. “If the statutory language is unambiguous, ‘the clearly expressed intent of the legislative body must be given effect, and there is no occasion for a court to consider rules of statutory construction.’ ” The plain meaning of a statute will prevail unless clearly expressed legislative intent is contrary or plain meaning leads to absurd results.

Kootenai Med. Ctr. v. Bonner County Comm’rs, 141 Idaho 7, 8-9, 105 P.3d 667, 668-69 (2004) (internal citations omitted).

III.

THE DIRECTOR CORRECTLY CONCLUDED THAT ERM’S TRUST WAS A MEWA

ERM first argues that it cannot be a MEWA because it is a professional employer organization (“professional employer”) under the Idaho Professional Employer Recognition Act (IPERA). ERM is incorrect. Whether ERM is a MEWA is a federal question to which Idaho law does not apply. Further to the extent that IPERA does not conform to the Employee Retirement Income Security Act of 1974 (ERISA), ERISA supersedes IPERA. Therefore, whether ERM is a professional employer does not affect its status as a MEWA.

ERISA is the federal law which regulates employee welfare benefits. 29 U.S.C. § 1001, et seq. The provisions of ERISA “supersede any and all State laws insofar as they ... relate to any employee benefit plan” established or maintained “by any employer [or employer organization) engaged in commerce or in any industry or activity affecting commerce.” 29 U.S.C. §§ 1003(a), 1144(a). There are exceptions to this broad preemption.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Verska v. Saint Alphonsus Regional Medical Center
265 P.3d 502 (Idaho Supreme Court, 2011)

Cite This Page — Counsel Stack

Bluebook (online)
141 P.3d 1048, 143 Idaho 179, 37 Employee Benefits Cas. (BNA) 2820, 2006 Ida. LEXIS 75, Counsel Stack Legal Research, https://law.counselstack.com/opinion/employers-resource-management-co-v-department-of-insurance-idaho-2006.