Group Life and Health Insurance Company v. The United States of America

660 F.2d 1042, 48 A.F.T.R.2d (RIA) 6180, 1981 U.S. App. LEXIS 16084
CourtCourt of Appeals for the Fifth Circuit
DecidedNovember 12, 1981
Docket80-1561
StatusPublished
Cited by21 cases

This text of 660 F.2d 1042 (Group Life and Health Insurance Company v. The United States of America) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Group Life and Health Insurance Company v. The United States of America, 660 F.2d 1042, 48 A.F.T.R.2d (RIA) 6180, 1981 U.S. App. LEXIS 16084 (5th Cir. 1981).

Opinion

RANDALL, Circuit Judge:

Defendant-Appellant, the United States of America (“United States”), brings this appeal from an adverse judgment in the court below in a suit brought against it by Group Life and Health Insurance Company (“Group Life”). Group Life, the taxpayer in this case, successfully challenged a ruling by the Internal Revenue Service (“the Service”) that it did not qualify for advantageous tax treatment as a life insurance company under the Internal Revenue Code (“the Code”) and was awarded a refund of $614,270.89 in taxes it had paid for the tax year 1967. We find that the trial court was clearly erroneous in its determination that Group Life qualified for taxation as a life insurance company and was entitled to a refund of $614,270.89, and we reverse the judgment of the court and remand the case for proceedings consistent with this opinion.

I. PROCEEDINGS BELOW

In 1967, Group Life timely filed its federal income tax return for the year 1967 and paid the amount of tax shown to be due. After examination of the tax return by agents of the Service, the Commissioner of Internal Revenue assessed a deficiency for income taxes for 1967 in the amount of $466,925.83. The basis for the finding of a deficiency was a determination that Group Life did not qualify for favorable tax treatment as a life insurance company during 1967. Group Life paid the deficiency, filed a claim for a refund of $466,925.83 and, when the claim was denied by the Commissioner, filed suit for a refund of taxes paid. The case was tried before a judge. At the end of the hearing, the court found that the Service had erred in its determination that Group Life did not qualify as a life insurance company. The court further held that Group Life was entitled to a refund of an amount in excess of that originally claimed in its refund suit because, according to the court, Group Life had made an “informal” claim for an additional refund based on deductions other than those it claimed as a life insurance company at the time it was being examined by the Service as to its status as a life insurance company. The United States appealed the decision of the trial court.

II. FACTUAL BACKGROUND

Group Life is a corporation organized under the Texas Insurance Code and is authorized to issue insurance policies covering life, health and accident benefits. It operates under the Blue Cross-Blue Shield trademark in Texas, and writes medical-surgical insurance, life insurance, group term life insurance and group disability insurance to insureds in Texas. Group Life is a wholly-owned subsidiary of Group Hospital Services, Inc., a Texas non-profit corporation, and is also affiliated with Group Medical and Surgical Services, Inc., a mutual assessment company. A complete description of Group Life’s organizational structure, its method of collecting premiums and its method of payments is set forth in the findings of fact made by the district court below. Group Life and Health Insurance Company v. U. S., No. CA-3-8014-F, 78-2 U.S.T.C. ¶ 9797, 42 AFTR 2d 78-6282 (N.D.Tex.1978).

Sometime prior to 1967, Group Life, in its issuance of group term life insurance policies, 1 provided that the premium cost of the *1045 policy would be waived for any insured individual who was disabled for more than six months as long as the person was disabled. At the end of 1967, Group Life had 23 individuals who had been disabled for more than six months having total life insurance coverage of $112,000 for which premiums were being waived. Group Life established a fund (known in life insurance parlance as a “reserve” 2 and required by state insurance laws to assure solvency of the insurance company) to insure payment of the face amount of life insurance in force as to these individuals, placing $84,000 in its “disability-disabled lives” reserve. This $84,000 figure was obtained by taking 75% of the $112,000 insurance in force.

This $84,000 reserve was in addition to a number of other reserves established for different types of policies written by Group Life, including individual life insurance, health and accident policies. Group Life, in 1967, then had some reserves for life insurance policies and some for non-life, i. e., accident and health, policies.

In its examination of Group Life’s 1967 tax return, the Service determined that Group Life failed, under the Code, to qualify as a life insurance company because less than 50% of its total reserves were life insurance reserves. 3 The Commissioner determined that Group Life was not a life insurance company as he computed the ratio of its life insurance reserves to total reserves to be 48.335%. The Commissioner specifically disallowed certain reserves which Group Life had included to make up the 50% necessary to qualify for taxation as a life insurance company. Included in reserves which the Commissioner disallowed were reserves for fractional premiums, immediate payment of death claims, accidental death benefits, disability-active lives and disability-disabled lives. The Commissioner also disallowed certain “unpaid losses” claims in computing the percentage of reserves for the year 1967. Because Group Life did not qualify as a life insurance company, its tax treatment changed dramatically, to the tune of an additional $466,000 owed. 4

*1046 In Group Life’s suit for a determination of whether it should be taxed as a life insurance company, the government conceded, during briefing, that the reserves for fractional premiums, for immediate payment of death claims, for accidental death benefits, and for disability-active lives were in fact life insurance reserves under § 801(b) of the Code and therefore should have been counted in determining whether or not Group Life’s life insurance reserves comprised 50% of its total reserves. Not resolved before trial, however, were the questions whether reserves for disability-disabled lives and reserves for unpaid losses were properly calculated by Group Life so as to qualify it for treatment as a life insurance company.

Specifically, the Service claimed that Group Life, in calculating its “disability-disabled lives” reserve by taking 75% of the face value of the insurance in force, had not complied with the Code requirement that the reserve be “computed or estimated on the basis of recognized mortality or morbidity tables and assumed rates of interest. ...” 26 U.S.C. § 801(b)(1)(A) (1976). The Service asserted that the $84,000 “disability-disabled lives” reserve was not to be added to the other approved “life insurance reserves” to raise the total of life insurance reserves over 50% of the total reserves for all types of policies. Group Life maintained that it had complied with the law because its use of 75% was an estimation based on mortality or morbidity tables at an assumed rate of interest. It claimed that a 1949 report, published by the Society of Actuaries, recommended the use of 75% of the value of the insurance in force to calculate the reserve.

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Bluebook (online)
660 F.2d 1042, 48 A.F.T.R.2d (RIA) 6180, 1981 U.S. App. LEXIS 16084, Counsel Stack Legal Research, https://law.counselstack.com/opinion/group-life-and-health-insurance-company-v-the-united-states-of-america-ca5-1981.