Foster v. West Branch Administrators, Inc.

597 A.2d 721, 141 Pa. Commw. 381
CourtCommonwealth Court of Pennsylvania
DecidedSeptember 11, 1991
DocketDocket 337 Misc. Dkt. 1990 and 374 Misc. Dkt. 1990
StatusPublished
Cited by3 cases

This text of 597 A.2d 721 (Foster v. West Branch Administrators, Inc.) 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. West Branch Administrators, Inc., 597 A.2d 721, 141 Pa. Commw. 381 (Pa. Ct. App. 1991).

Opinion

NARICK, Senior Judge.

Before us are two petitions filed by Constance B. Foster, Insurance Commissioner of the Commonwealth of Pennsylvania (Petitioner). The first is the October 26, 1990 petition requesting ex parte seizure, and the second is the December 18, 1990 petition for liquidation of West Branch Administrators, Inc., West Branch Capitol Corporation and West Branch Consultants (Respondents).

The history of these consolidated cases is as follows. In 337 M.D. 1990, Petitioner filed a petition for ex parte seizure of Respondents’ assets on October 26, 1990. Therein, Petitioner alleged that Respondents were unlicensed, *384 insolvent insurance companies, whose continued operation would cause irreparable harm to policyholders, creditors and the public. Additionally, she alleged that seizure was necessary to prevent diversion of Respondents’ assets and records.

We granted Petitioner’s petition for ex parte seizure of Respondents’ assets on October 29, 1990. Executing the seizure order the next day, Petitioner took possession and control of Respondents’ premises, assets and records.

Respondents filed a petition for immediate stay of the ex parte seizure order on November 7, 1990. Accordingly, on November 8, 1990, we ordered that a hearing be held on November 14, 1990 with regard to the seizure as per Section 512(d) of The Insurance Department Act of 1921 (Act), 1 which requires that we hold a hearing within ten days of an “insurer’s” request. In response, Respondents filed a motion for indefinite continuance of the seizure hearing on November 14, 1990. That same day, we granted Respondents’ request and indefinitely continued the seizure hearing.

Petitioner filed a petition for liquidation of Respondents’ entities on December 18, 1990, 2 which was docketed at 374 M.D. 1990. Therein, Petitioner alleged the existence of the following grounds for liquidation:

§ 221.14. Grounds for rehabilitation
An order of rehabilitation may be based on one or more of the following grounds:
(1) The insurer is insolvent, or is in such condition that the further transaction of business would be hazardous, financially, to its policyholders, creditors or the public.
(2) There is reasonable cause to believe that there has been embezzlement from the insurer, wrongful sequestration or diversion of the insurer’s assets, forgery or fraud *385 affecting the insurer or other illegal conduct in, by, or with respect to the insurer that if established would endanger assets in an amount threatening the solvency of the insurer.
(9) Within the previous four years the insurer has willfully violated its charter or articles of incorporation or its bylaws or any insurance law in a manner which may result or has resulted in substantial harm to the property or business of an insurer or to the interests of its policy or certificate holders, creditors, or the public, or any valid order of the commissioner under sections 510 and 511.

Section 514 of the Act, as amended, 40 P.S. §§ 221.14.

On January 28, 1991, Petitioner filed a petition for extension of the ex parte seizure order. The next day, we granted the extension for an additional ninety day period. On March 19, 1991, Respondents requested that we hold a hearing on the ex parte seizure within ten days, as per Section 512(d) of the Act, as amended, 40 P.S. § 221.12(d).

Respondents waived their statutory right to a hearing on the seizure within ten days on March 25, 1991. Also on March 25, 1991, we ordered a consolidation of the seizure action, 337 M.D. 1990, and the liquidation action, 374 M.D. 1990. Further, we scheduled a consolidated hearing for May 23, 1991.

At the May 23, 1991 hearing, this Court heard testimony and accepted exhibits into evidence with regard to Respondents’ alleged exemption from the Act by virtue of the Employee Retirement Income Security Act of 1974 (ERISA), 3 their potential status as insurers under the Act, and the existence of grounds for liquidation.

There are four issues before us. The first is whether Respondents are exempt from the Act by virtue of ERISA and thus not under Petitioner’s jurisdiction. The second is whether Respondents were engaged in the business of insurance so as to subject them to Petitioner’s jurisdiction. *386 The third is whether Petitioner had reasonable grounds to seek seizure of Respondents’ assets. The fourth is whether grounds for liquidation exist such that we should grant Petitioner’s December 18, 1990 petition for liquidation.

I. APPLICABILITY OF ERISA:

Respondents argue that they were not subject to Petitioner’s jurisdiction with respect to the seizure because they were acting in a third-party administrator capacity under ERISA. According to Respondents, their activities were limited to administering and processing claims in exchange for payment, and securing and maintaining reinsurance coverage.

Under 29 U.S.C. § 1144(a), ERISA preempts state regulation of “employee welfare benefit plans” as defined in 29 U.S.C. § 1002(1). The latter section reads as follows:

(1) The terms “employee welfare benefit plan” and “welfare plan” mean any plan, fund, or program which was heretofore or is hereafter established or maintained by an employer or by an employee organization, or by both, to the extent that such plan, fund, or program was established or is maintained for the purpose of providing for its participants or their beneficiaries, through the purchase of insurance or otherwise, (A) medical, surgical, or hospital care or benefits, or benefits in the event of sickness, accident, disability, death or unemployment, or vacation benefits, apprenticeship or other training programs, or day care centers, scholarship funds, or prepaid legal services, or (B) any benefit described in section 186(c) of this title (other than pensions on retirement or death, and insurance to provide such pensions).

Courts of other jurisdictions have held that the existence of an ERISA employee benefit plan is a question of fact to be addressed in light of all the surrounding facts and circumstances. Kanne v. Connecticut General Life Insurance Co., 859 F.2d 96 (9th Cir.1988), cert. denied, 492 U.S. 906, 109 S.Ct. 3216, 106 L.Ed.2d 566 (1989). Specifically, *387 courts have used the following criteria to analyze whether a purported employee benefit plan falls under ERISA:

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Related

United Healthcare Benefits Trust v. Insurance Commissioner
620 A.2d 81 (Commonwealth Court of Pennsylvania, 1993)
Atlantic Health Care Benefits Trust v. Foster
809 F. Supp. 365 (M.D. Pennsylvania, 1992)

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Bluebook (online)
597 A.2d 721, 141 Pa. Commw. 381, Counsel Stack Legal Research, https://law.counselstack.com/opinion/foster-v-west-branch-administrators-inc-pacommwct-1991.