Foster v. Argonaut Insurance

615 A.2d 971, 150 Pa. Commw. 387, 1992 Pa. Commw. LEXIS 584
CourtCommonwealth Court of Pennsylvania
DecidedSeptember 4, 1992
DocketNo. 249 M.D. 1990
StatusPublished
Cited by1 cases

This text of 615 A.2d 971 (Foster v. Argonaut Insurance) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Foster v. Argonaut Insurance, 615 A.2d 971, 150 Pa. Commw. 387, 1992 Pa. Commw. LEXIS 584 (Pa. Ct. App. 1992).

Opinion

LORD, Senior Judge.

In this case we are asked to decide preliminary objections to a complaint filed in this Court by Constance Foster, Insurance Commissioner of the Commonwealth of Pennsylvania in her capacity as liquidator of Rockwood Insurance Company (Rock-wood), against Argonaut Insurance Company individually and as representative of specified members of the National Workers’ Compensation Reinsurance Pool, the Pennsylvania Workers’ Compensation Plan and Reinsurance Pool, the Arkansas Stock Pool for Assigned Risks and the New Mexico Workers’ Compensation Reinsurance Pool.

Rockwood seeks to establish the liability of Argonaut in this action in which Rockwood claims that it is owed certain amounts of money which arose under the following circumstances. Individual state pools and a Pool organization were established to provide a means by which the insurance companies could provide workers’ compensation insurance to employers who could not obtain such insurance through the voluntary market. The purpose of the pool was to spread the risk among a group of insurance companies who participated [389]*389in the pool arrangement. For each state in which the National Pool operates, the members of the Pool, acting through their board of directors, contract with servicing carriers to write such insurance. The pool participants through reinsurance provide that the servicing carrier — in this instance, Rock-wood — is reimbursed for the claims that it pays. In this case, according to the complaint, Roekwood was fully reinsured, received a servicing carrier fee for writing the insurance, remitted the remaining premium to the pool and received its reimbursement for claims paid and expenses until the first quarter of 1989. It received such payments from the National Council on Compensation Insurers (NCCI), a voluntary unincorporated association which managed the pools. In this action, Roekwood now claims from Argonaut, as an individual entity and as a representative pool member, the amount that Argonaut owes, pro rata, on claims paid out and expenses incurred by Roekwood.

Before addressing the preliminary objections to this complaint on their merits, we wish to note that they are in this case somewhat unusual. Argonaut commences its preliminary objections with six paragraphs of what it entitles “background,” in which it recites a prior proceeding in this Court where the Insurance Commissioner sought a rehabilitation order to which the National Pool and the other pools objected, on the grounds that it sought improperly to restrict the set-offs that the pools claimed they had against Roekwood. In an equally unusual procedure, Roekwood in its brief to this Court opposing preliminary objections, attaches a portion of the testimony of an expert witness in that prior rehabilitation proceeding. Our disposition of this case will not in any respect rely upon these questionable procedures.

Argonaut’s first preliminary objection is that Roekwood has not stated a cause of action. The validity of this contention depends upon a construction of the agreements into which Roekwood entered. These agreements include:

1. The Servicing Carrier Agreement dated October 4, 1983 entered into with the National Pool.
2. The Articles of Agreement of the National Pool.
[390]*3903. The Articles of Agreement of the Pennsylvania Pool.
4. The Articles of Agreement of the Arkansas Pool.1

Since the preliminary objection before the Court is in the nature of a demurrer, we first examine the applicable principles. In Satchell v. Insurance Placement Facility of Pennsylvania, 241 Pa.Superior Ct. 287, 361 A.2d 375, 377 (1976), those principles are clearly outlined:

Preliminary objections in the nature of a demurrer pursuant to Rule 1017(b)(4), Pa.R.C.P., is merely an allegation by the defendant that the plaintiffs complaint has failed to state a cause of action upon which relief may be granted. Therefore, it is a “time honored principle that in passing on a demurrer a court cannot consider matters collateral to the pleading opposed but only such matters as arise out of the statement of claim or complaint itself ...” Detweiler v. Hatfield Borough School District, 376 Pa. 555, 558, 104 A.2d 110, 113 (1954). Further, every allegation in the plaintiffs complaint must be accepted as true. See, e.g., Borden v. Baldwin, 444 Pa. 577, 281 A.2d 892 (1971); Cantanese v. Scirica, 437 Pa. 519, 263 A.2d 372 (1970).

The essence of Argonaut’s argument is that the contracts attached to the complaint do not support an action against it, but rather clearly express the intention of the parties that the pool shall be the sole responsible party to pay the losses and expenses of the servicing carrier, Rockwood. We therefore turn to these contracts which are attached to the complaint.

A reading of the articles of agreement creating the pools and the servicing carrier agreement between Rockwood and the respective pools shows that the operation was to be conducted as follows. The servicing carrier would write the insurance, collect the premiums, retain a certain percentage for its work and process the claims in accordance with certain [391]*391rigid standards compelled by the servicing carrier agreement, then to be reinsured by the National Pool.

The members of the Pool, on the other hand, would participate in the pool and provide reinsurance for the servicing carrier, without which reinsurance Rockwood could not write this business. The amount that the members of the pool would contribute to provide for expenses and for the reinsurance of Rockwood as the servicing carrier would then be pro rated among the pool members by the National Pool administrators. In order for this arrangement to operate efficiently and, indeed, to operate at all, no payments would be made by the individual members of the pool to the servicing carriers. Rather, all payments would be made by the pool. We now examine in detail those agreements — the servicing carrier agreement and the articles of agreement — upon which Rock-wood’s complaint is based.

The servicing carrier agreement provides some, but no definitive assistance in deciding whether the intention of the parties was to allow suits against the individual members of the pool or not. Except for the fact that the contract itself is between Rockwood and, to use a single example, the National Workers’ Compensation Reinsurance Pool (and not the individual members) and that, understandably, all the obligations in it are expressed in terms of what duties Rockwood owes the pool and what the pool owes Rockwood, and, except for the fact that the contract provides that any required notice from Rockwood should be given to the pool at its offices in New York, we find nothing in this document so significant that it provides a clear indication of the intent of the contracting parties in this regard.

However, turning to the various pool agreements, we find, for example, in the National Pool, an agreement which requires the National Pool to make the reimbursements as follows:

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Bluebook (online)
615 A.2d 971, 150 Pa. Commw. 387, 1992 Pa. Commw. LEXIS 584, Counsel Stack Legal Research, https://law.counselstack.com/opinion/foster-v-argonaut-insurance-pacommwct-1992.