Guarantee Trust Life Insurance Company v. Superintendent of Insurance

2013 ME 102, 82 A.3d 121, 2013 WL 6164046, 2013 Me. LEXIS 103
CourtSupreme Judicial Court of Maine
DecidedNovember 21, 2013
DocketDocket BCD-13-56
StatusPublished
Cited by17 cases

This text of 2013 ME 102 (Guarantee Trust Life Insurance Company v. Superintendent of Insurance) is published on Counsel Stack Legal Research, covering Supreme Judicial Court of Maine primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Guarantee Trust Life Insurance Company v. Superintendent of Insurance, 2013 ME 102, 82 A.3d 121, 2013 WL 6164046, 2013 Me. LEXIS 103 (Me. 2013).

Opinion

ALEXANDER, J.

[¶ 1] Guarantee Trust Life Insurance Company (GTL) appeals from a judgment entered in the Business and Consumer Docket (Horton, J.) that affirmed a decision of the Superintendent of Insurance. The Superintendent concluded that GTL violated 24-A M.R.S. §§ 1420-Md), 1 1902, 2 and 2412(1-A)(B) 3 (2012) and that GTL is *124 accountable, pursuant to 24-A M.R.S. § 1445(1)(D)(2012), 4 for violations committed by Cinergy Health, Inc., a company acting as GTL’s producer. Based on these conclusions, the Superintendent ordered GTL to pay a civil penalty of $150,000.

[¶ 2] GTL argues that (1) it cannot be accountable pursuant to section 1445(1)(D) for Cinergy’s misconduct occurring at a time when no common law agency relationship existed between the companies; (2) there is insufficient evidence to support the Superintendent’s finding that GTL certificates of coverage were issued to Maine consumers and therefore GTL could not be found liable pursuant to section 2412(1— A)(B); (8) the Superintendent’s decision should be vacated as untimely; (4) the Superintendent abused her discretion by holding GTL liable under section 1420-M because that section applies to producers and because Cinergy was not GTL’s agent; and (5) the Superintendent abused her discretion by penalizing GTL for violating 24-A M.R.S. § 1902, when a violation of that statute had not been alleged in the Bureau of Insurance’s amended petition. We affirm the judgment.

I. CASE HISTORY

[¶ 3] GTL is an Illinois-domiciled insurance company licensed to do business in Maine as an insurance company. Cinergy Health, Inc., based in Florida, was licensed in Maine as a nonresident producer agency. Cinergy began marketing a limited medical benefit health insurance plan to individuals nationwide in 2007. Pursuant to an agreement between Cinergy and the National Congress of Employers (NCE), Cinergy marketed coverage under the plan to individuals who, by virtue of enrolling in the plan, became members of NCE. NCE was a New York non-profit association, but was not an approved association in Maine.

[¶ 4] In most states, the limited medical benefit plan that Cinergy marketed and sold was provided under a policy or policies issued to NCE by American Medical and Life Insurance Company (AMLI), a New York insurance company. AMLI had applied for a license to provide insurance coverage in Maine. However, the Bureau of Insurance deemed AMLI not qualified and denied its application to provide insurance to Maine consumers in 2006.

[¶ 5] To enable it to offer the limited medical benefit plan marketed by Cinergy in Maine, AMLI entered into an agreement with GTL (the Agreement), effective January 1, 2008, in which GTL would act as a “fronting carrier” for AMLI because GTL is fully licensed to issue insurance in Maine. Under this arrangement, GTL would “issue a policy, and [AMLI] and its entities [would] perform the administration of that policy, and through a reinsurance agreement, a majority of the risk [would] be shifted to [AMLI].” 5 Pursuant to the Agreement, GTL retained ten percent of the risk (profits or losses) and received five percent of the gross net collected premiums. As part of the fronting arrangement, GTL and AMLI contracted in the Agreement that any insurance premiums paid to AMLI were deemed to have been received by GTL.

[¶ 6] GTL issued a group limited benefits health insurance policy to NCE, effec *125 tive January 1, 2008 (the Master Policy). GTL’s issuance of the Master Policy enabled GTL to provide coverage under NCE-issued policies to individuals in Maine. Evidence in the record also indicates that GTL confirmed that it “issued at least one insurance policy to a Maine resident through [NCE].” GTL never obtained approval from the Bureau of Insurance to issue a group policy to NCE in Maine. 6

[¶ 7] Under the Agreement, AMLI retained responsibility for most of the administrative duties including marketing, underwriting, and premium billing. The Agreement stated that AMLI would subcontract some of its duties to other parties and that AMLI would indemnify GTL for the actions of AMLI and its subcontractors. The Agreement specifically identified two entities by name as AMLI subcontractors, which GTL accepted.

[¶ 8] As GTL acknowledged at oral argument on this appeal, it negotiated the terms of the Agreement “word by word.” Despite the purported level of care in negotiating the Agreement, no entity identified in the Agreement — AMLI or the two named subcontractors — was licensed to perform third-party administrative services in Maine. GTL claims that it relied on AMLI under the terms of the Agreement to ensure the necessary licensure. However, GTL never took steps to verify that AMLI or either of its two named subcontractors were licensed in Maine.

[¶ 9] The record indicates that AMLI subcontracted marketing duties in Maine to Cinergy. Cinergy marketed and sold coverage under the Master Policy to individuals in Maine, including making sales to more than fifty Maine residents between February 2008 and October 19, 2008. Over $80,000 in premiums was collected from Maine insureds from the sale of this coverage; GTL received its share pursuant to the Agreement. Although GTL did not have actual notice when AMLI contracted marketing to Cinergy, the record contains testimonial evidence showing that GTL knew as early as August 2008 that it was one of the insurers of the plan that Cinergy marketed and that Cinergy was involved, or that AMLI subcontracted or may have subcontracted with Cinergy to provide services.

[¶ 10] Beginning in March 2008 and continuing through July 2008, Cinergy ran television ads in Maine that stated, in a brief display, that its advertised coverage was provided by AMLI, for whom GTL knew that it was the fronting carrier; that identified the number of the Master Policy issued by GTL to NCE; and that stated that coverage was offered through membership in NCE. Then, as of September 2008, Cinergy television advertisements ran in Maine in which GTL was clearly, if somewhat quickly, named as the underwriter along with AMLI. According to the telephone sales script that Cinergy claims it used to market coverage under the Master Policy to one Maine insured in August 2008, Cinergy informed the insured, whose coverage became effective September 15, *126 2008, that “[t]he plan is offered by Cinergy Health, a licensed insurance agency, and underwritten by the Guarantee Trust Life Insurance Company, an AM Best rated insurance company.” Additionally, though the dates of his receipts are not indicated in the record, one Maine insured whose coverage was effective September 1, 2008, received statements for benefits paid that listed both GTL and Cinergy at the top.

[¶ 11] On October 20, 2008, more than eight months after Cinergy began marketing coverage under the Master Policy, GTL appointed Cinergy as its producer agency pursuant to 24-A M.R.S.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
2013 ME 102, 82 A.3d 121, 2013 WL 6164046, 2013 Me. LEXIS 103, Counsel Stack Legal Research, https://law.counselstack.com/opinion/guarantee-trust-life-insurance-company-v-superintendent-of-insurance-me-2013.