Group Life & Health Insurance Company v. United States

434 F.2d 115
CourtCourt of Appeals for the Fifth Circuit
DecidedJanuary 8, 1971
Docket28992
StatusPublished
Cited by16 cases

This text of 434 F.2d 115 (Group Life & Health Insurance Company v. United States) 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 & Health Insurance Company v. United States, 434 F.2d 115 (5th Cir. 1971).

Opinions

ADAMS, Circuit Judge:

This case presents an important and difficult question concerning the Federal taxation of guaranteed renewable health and accident insurance companies under Subchapter L, Part I, § 801 et seq. of the Internal Revenue Code of 1954.

Plaintiff Group Life and Health Insurance Company (“Group Life”) underwrites and issues group insurance in Texas under the plan known as Blue Shield. Group Life’s parent corporation, Group Hospital Service, Inc., issues insurance in Texas under the plan known as Blue Cross. Group Life brought this income tax refund action in the District Court for the Northern District of Texas on the basis that it is entitled to be taxed as a “life insurance company” as defined by § 801(a)1 of the Internal Revenue Code of 1954 (“the Code”), 26 U.S.C.A. § 801(a). The District Court upheld Group Life’s claim and the United States appealed.

The question raised is whether the District Court erred in finding that Group Life’s “Non-Cancellable, Experience Rated Medical-Surgical Insurance Policy” qualified as “guaranteed renewable life, health, and accident insurance” within § 801 (e) 2 of the Code, and whether therefore Group Life qualifies to be taxed as a “life insurance company” within the definition of § 801(a) of the Code. This question depends, in turn, on the validity of § 1.801-3 (d) of the Income Tax Regulations (“the Regulations”), 26 C.F.R. § 1.801-3(d): “The term ‘guaranteed renewable life, health, and accident policy’ means a health and accident contract * * * which is not cancellable by the company but under which the company reserves the right to adjust premium rates by classes in accordance with its experience under the type of policy involved, and with respect to which a reserve in addition to the unearned premiums * * * must be carried to cover that obligation * * #” (emphasis added).

To understand the argument that the issuer of Blue Shield group policies may be entitled to be taxed as a life insurance company requires an examination of the history of income taxation of insurance companies.3

Since the enactment of the Revenue Act of 1921,4 the income of life insurance companies has been taxed differently from that of other corporations. In section 242 of the 1921 Act, Congress decided that a company should be taxed as a life insurance company if it were “engaged in the business of issuing life insurance (including contracts of combined life, health, and accident insurance)”, and if the company maintained “for the fulfillment of such contracts” a reserve which comprised “more than 50 per centum of its total reserve funds.” Such companies were allowed, among other benefits, to exclude premium income from their computation of taxable income because such receipts “were not true income but were analogous to permanent capital investment.” Helvering v. Oregon Mutual Life Insurance Corn[117]*117pany, 311 U.S. 267, 269, 61 S.Ct. 207, 208, 85 L.Ed. 180 (1940). This concept was based on the premise that premiums received in the early years of a level-payment life insurance policy must be invested in order to satisfy risks which increase with the age of the insured. Payments received in the early years exceed the cost of the risks insured in the early years, and such premiums thereby augment premiums for later years which would otherwise be insufficient to insure the risks which develop in later years. Significantly this characterization of a life insurance company for federal income tax purposes, set forth in the 1921 Act, made the policy reserves of a company the touchstone of the category in which it was to be placed. Alinco Life Insurance Co., supra, 373 F.2d at 347; see also Commissioner of Internal Revenue v. Swift & Co., E.B.A., 151 F.2d 625 (7th Cir. 1945).

Defining insurance companies in terms of their reserves for tax purposes next led Congress to recognize that “noncancellable" health and accident policies ought to be treated similarly to life policies. This is so because an insurance company in issuing noncancellable health and accident policies makes provision in the early years for the increased actuarial risks in later years, and has a reserve to reflect this fact. The Revenue Act of 1942,5 therefore, expanded the class of corporations taxable as life insurance companies to include those issuing noncancellable health and accident policies. The Senate Finance Committee explained the rationale for such treatment as follows:

“Since noncancellable contracts of health and accident insurance require the accumulation of substantial reserves against increased future risks, the writing of such insurance is analogous to life insurance * * * The life insurance reserves defined in * * * [§ 201] (c) (2) [superceded by § 801(b) of the present code] as they pertain to noncancellable health and accident insurance policies are those amounts which must be reserved, in addition to unearned premiums, to provide for the additional cost of carrying such policies in later years when the insured will be older and subject to greater risk and when the cost of carrying the risk will be greater than the premiums then being received.” S.Rep. No. 1631, 77th Cong., 2d Sess. (1942-2 Cum.Bull. 504, 611-612).

To accommodate the mechanics of health and accident insurance, the casualty insurance terms of “unearned premiums” and “unpaid losses” were added to the definition of a life insurance company in essentially the same language as that of the present § 801(a) of the Code. Unearned premiums are “those amounts which shall cover the cost of carrying the insurance risk for the period for which the premiums have been paid in advance.” § 1.801-3 (e) of the Regulations. The reserve for unpaid losses “represents the present value of all benefits not yet accrued at the date of valuation, arising from disabilities already incurred * * *”6. Commissioner of Internal Revenue v. Monarch Life Insurance Company, 114 F.2d 314, 322 (1st Cir. 1940). Thus, neither of these reserves cover the increased actuarial risks which accrue over the term of noncancellable policies, and an additional reserve must be maintained — a reserve similar to that maintained for level-payment straight-life insurance where “the factor for future premium deficiencies is an integral part of the actuarial tables on the basis of which the mortality reserve is computed.” Alinco Life Insurance Company, supra, 373 F. 2d at 355, fn. 37. See also Massachusetts Protective Association v. United States, 114 F.2d 304, 309 (1st Cir. 1940); § 1.801-3(c) of the Regulations.

As a result of a comprehensive review of the taxation of life insurance compa[118]*118nies, Congress enacted the Life Insurance Company Income Tax Act of 1959.7

This Act added § 801(e) to the Code: “For purposes of this part, guaranteed renewable life, health, and accident insurance shall be treated in the same manner as noncancellable life, health, and accident insurance.”

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Bluebook (online)
434 F.2d 115, Counsel Stack Legal Research, https://law.counselstack.com/opinion/group-life-health-insurance-company-v-united-states-ca5-1971.