General v. Blue Cross Blue Shield

291 Mich. App. 64
CourtMichigan Court of Appeals
DecidedDecember 7, 2010
DocketDocket Nos. 290167 and 295750
StatusPublished
Cited by9 cases

This text of 291 Mich. App. 64 (General v. Blue Cross Blue Shield) is published on Counsel Stack Legal Research, covering Michigan Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
General v. Blue Cross Blue Shield, 291 Mich. App. 64 (Mich. Ct. App. 2010).

Opinions

O’CONNELL, EJ.

In these consolidated appeals, plaintiff/petitioner (hereafter plaintiff) appeals as of right the trial court’s orders granting motions for summary disposition filed by defendant Blue Cross Blue Shield of Michigan (BCBSM) in actions in which plaintiff challenged the legality of certain financial conduct by BCBSM under the Nonprofit Health Care Corporation Reform Act, MCL 550.1101 et seq. (the Act). The appeals present two significant issues: (1) whether BCBSM violated § 207 of the Act, MCL 550.1207, when its subsidiary, the Accident Fund Insurance Company of America (the Accident Fund), purchased three for-profit insurance companies; and (2) whether Michigan’s courts defer to the decisions of Michigan’s administrative agencies concerning the interpretation of Michigan statutes.

Regarding the first issue, the trial court correctly determined that § 207 of the Act did not preclude the Accident Fund from acquiring the three insurance companies. Accordingly, in Docket No. 290167, we affirm the trial court’s grant of summary disposition on count I. Regarding the second issue, the trial court erred by deferring to an administrative agency’s interpretation of the Act. Accordingly, we reverse the trial court’s dismissal of count II in Docket No. 290167, and remand to the trial court for a hearing de novo to determine whether BCBSM’s $125 million contribution to the Accident Fund violated the Act. In addition, we dismiss the appeal in Docket No. 295750 as moot.

BACKGROUND FACTS

As our Supreme Court has explained:

BCBSM is a unique creation. It is a non-profit, tax-exempt “charitable and benevolent institution”, incorporated pursuant to special enabling legislation enacted by [69]*69the Michigan Legislature in 1939, for the purpose of providing a mechanism for broad health care protection to the people of the State of Michigan.
BCBSM is not an insurance company in the usual sense of the term. It is a statutory, non-profit corporation which is regulated within the limits of special enabling legislation by the Commissioner [of the Office of Financial and Insurance Regulation (OFIR)] “in order to protect the interests of subscribers”. Although it does operate according to principles similar to those of insurance companies, “it is not carried on as an insurance business for profit * * *, but rather it provides a method for promoting the public health and welfare in assisting * * * persons to budget” health care costs.
Although BCBSM is regulated by the [OFIR] Commissioner, it is not managed by the Commissioner. It has its own officers and a board of directors to which management of the corporation is statutorily entrusted. [Blue Cross & Blue Shield of Mich v Ins Comm’r, 403 Mich 399, 415-418; 270 NW2d 845 (1978) (citations omitted).]

As a statutorily created entity, both the extent of the power of the commissioner of the OFIR (the OFIR Commissioner) to regulate BCBSM and the extent of BCB-SM’s permissible activities are governed by statute, and specifically, by the Act. Id. at 424; MCL 550.1101 et seq.

In 1993, the Legislature amended the Act to permit BCBSM to purchase the state accident fund, a for-profit workers’ compensation insurer. MCL 550.1207(l)(x). Thereafter, BCBSM formed the Accident Fund as a wholly owned, for-profit Michigan stock insurance subsidiary, and, in December 1994, the Accident Fund purchased the assets and acquired the liabilities of the state accident fund.

At issue here are a series of financial transactions undertaken by the Accident Fund to acquire three [70]*70foreign insurance companies, as well as a $125 million contribution to the Accident Fund by BCBSM. In December 2005, the Accident Fund acquired 100 percent of the outstanding common shares of workers’ compensation insurer United Wisconsin Insurance Company (UWI). On August 4, 2007, BCBSM’s board of directors approved the Accident Fund’s forthcoming acquisition of CWI Holdings, Inc. (CWI), a Delaware insurance holding company that itself owns 100 percent of the shares of CompWest Insurance Company, a California property and casualty insurance company that provides workers’ compensation insurance primarily in California, and it also approved a capital contribution from BCBSM to the Accident Fund “in an amount sufficient to insure [sic] the collective workers’ compensation companies are able to maintain an ‘A’ insurance rating.” Then, on August 31, 2007, the Accident Fund acquired 100 percent of the outstanding common shares of Third Coast Insurance Company (Third Coast), an inactive property and casualty insurance company located in Illinois. Finally, in November 2007, BCBSM transferred $125 million to the Accident Fund, as a capital contribution with no repayment obligation pursuant to the August 4, 2007, authorization of its board of directors, and the Accident Fund acquired 100 percent of the outstanding shares of CWI.

On July 2, 2008, plaintiff filed a three-count complaint against BCBSM, challenging the permissibility of the Accident Fund’s acquisition of UWI, CWI, and Third Coast, as well as of BCBSM’s November 2007 $125 million contribution to the Accident Fund. Only counts I and II are at issue before this Court.1 In count I, plaintiff alleged that the Accident Fund’s acquisition [71]*71of the three foreign insurers violated MCL 550.1207(l)(o), which provides, as follows:

A health care corporation, subject to any limitation provided in this act, in any other statute of this state, or in its articles of incorporation, may do any or all of the following:
(o) Subject to chapter 9 of the insurance code of 1956, 1956 PA 218, MCL 500.901 to 500.947, invest and reinvest its funds and, for investment purposes only, purchase, take, receive, subscribe for, or otherwise acquire, own, hold, vote, employ, sell, lend, lease, exchange, transfer, or otherwise dispose of, mortgage, pledge, use, and otherwise deal in and with, bonds and other obligations, shares, or other securities or interests issued by entities other than domestic, foreign, or alien insurers, as defined in sections 106 and 110 of the insurance code of 1956, 1956 PA 218, MCL 500.106 and 500.110, whether engaged in a similar or different business, or governmental or other activity, including banking corporations or trust companies. However, a health care corporation may purchase, take, receive, subscribe for, or otherwise acquire, own, hold, vote, employ, sell, lend, lease, exchange, transfer, or otherwise dispose of bonds or other obligations, shares, or other securities or interests issued by a domestic, foreign, or alien insurer, so long as the activity meets all of the following:
(1) Is determined by the attorney general to be lawful under section 202 [MCL 550.1202].
(ii) Is approved in writing by the commissioner as being in the best interests of the health care corporation and its subscribers.
(Hi) For an activity that occurred before the effective date of the amendatory act that added subparagraph (iv), will not result in the health care corporation owning or [72]

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Cite This Page — Counsel Stack

Bluebook (online)
291 Mich. App. 64, Counsel Stack Legal Research, https://law.counselstack.com/opinion/general-v-blue-cross-blue-shield-michctapp-2010.