Guardian Life Insurance Co. of America v. Insurance Commissioner

446 A.2d 1140, 293 Md. 629, 1982 Md. LEXIS 281
CourtCourt of Appeals of Maryland
DecidedJune 29, 1982
Docket[No. 168, September Term, 1981.]
StatusPublished
Cited by50 cases

This text of 446 A.2d 1140 (Guardian Life Insurance Co. of America v. Insurance Commissioner) is published on Counsel Stack Legal Research, covering Court of Appeals of Maryland primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Guardian Life Insurance Co. of America v. Insurance Commissioner, 446 A.2d 1140, 293 Md. 629, 1982 Md. LEXIS 281 (Md. 1982).

Opinion

Murphy, C. J.,

delivered the opinion of the Court.

This case involves a claim for benefits under a policy of group health insurance written by The Guardian Life Insurance Company of America (Guardian), a New York corporation licensed to do business in Maryland. The policy covers employees of Data Technology Industries, Inc. (DTI), a Maryland corporation with its principal place of business in this State. The basic issue is whether charges incurred by two DTI employees for outpatient mental health treatment — charges not covered under the terms of the Guardian policy — must nevertheless be paid by the insurer because of the provisions of Maryland Code (1957, 1979 Repl. Vol.), Art. 48A (the Insurance Code), § 477E, which mandate the inclusion of coverage for such outpatient treatment in every group health insurance policy "delivered or issued for deliverance” in Maryland. Guardian declined to pay the charges, contending that the policy was issued and delivered in Rhode Island, and consequently it was required to make payment only to the extent that the outpatient charges were covered by the benefit provisions of the policy. 1 The Maryland Insurance Commissioner, and on appeal from his order, the Baltimore City Court, concluded that Guardian *632 was required to pay the benefits mandated by § 477E to the Maryland Foundation of College Park, Inc. (the Foundation), which had provided the outpatient treatment to DTI’s employees. 2 Guardian appealed to the Court of Special Appeals. We granted certiorari prior to decision by that court to consider the important issues of statutory construction presented in the case.

I

"Group health insurance” is defined in § 471 of the Insurance Code as "that form of health insurance covering groups of persons [as thereafter defined in seven subsections] .. . and issued upon the following basis:

(1) •• •
(2) ...
(3) Under a policy issued to the trustees of a fund established by two (2) or more employers in the same or related industry .. ., which trustees shall be deemed the policyholder, to insure employees of the employers . . . .”

Section 472 requires that "[e]ach such group health insurance policy” contain a provision, among others:

"that the insurer will furnish to the policyholder for delivery to each employee or member of the insured group, a statement in summary form of the essential features of the insurance coverage of such employee or member and to whom benefits thereunder are payable.”

*633 Section 477A provides that insurers who "substantially conform” their group health policies to any of the groups described in § 471 may solicit coverage in Maryland without prior approval of the Insurance Commissioner. Section 377A of the Insurance Code provides that no health insurance policy may be "delivered or issued for delivery in this State” if it contains, inter alia, a provision that the contract is to be construed according to the laws of another state, or that the rights and obligations of the insured are governed by other than the laws of Maryland.

II

The record discloses that on March 27, 1967, a trust agreement was executed between Guardian, as settlor of the trust, and the Rhode Island Hospital Trust Company (the Bank), as trustee. The stated purpose of the agreement was to implement "a group insurance plan for the benefit of employees of employers who become participants in accordance with the terms ... [of the trust agreement] through the utilization of an insurance fund created by the participants . . . .” Article II of the trust agreement entitled "Creation of the insurance fund by participants,” identified the "participants” as those employers in the services industry who agreed in writing to be bound by the agreement’s provisions and who were approved by Guardian for insurance coverage under a group insurance policy "held by the trustee.” By its terms, the trust agreement required each participating employer to pay into the insurance fund, either to the trustee, or to Guardian if the trustee appointed the insurer as its collection agent, amounts sufficient to pay premiums for the insurance coverage acquired, together with an allocable share of the trustee’s administrative charges. The agreement specified that the trustee accepted the trust in Rhode Island and that all questions pertaining to its validity, construction and administration would be determined in accordance with the law of Rhode Island. Title to the insurance fund under the agreement was vested in the *634 trustee. The agreement provided that the insurance fund would be disbursed only to pay premiums for group insurance procured by the trustee and for reasonable charges made by the trustee. The agreement further provided that the trustee, "as the policyholder,” would procure group insurance of various specified types through Guardian. Guardian was empowered by the agreement to remove the Bank as trustee upon thirty days’ written notice. Finally, Article IV provided that requests for participation from employers "shall be made by executing an adoption agreement binding said employer to the terms of this agreement and to the terms of the insurance policy or policies issued hereunder,” subject to the approval of the insurer.

On June 1,1967, Guardian issued Group Insurance Policy No. 1 (the master policy), identifying the "policyholder” as the Bank acting as "Trustees of the Services Industry Insurance Trust Fund.” The master policy states on its cover page that it was delivered in Rhode Island and is governed by the laws of that state; that premiums are payable by the "policyholder” and that benefits are as specified "in the employer rider applicable to each participating employer”; that "[a]n eligible employer may become a participating employer by filing, through the trustees, with the home office of the insurance company, an agreement executed by the employer adopting the terms of the trust agreement and by receiving the insurance company’s approval, in writing, of its inclusion as a participating employer”; and that the employer becomes a "participating employer” in accordance with the terms of the employer rider, which forms a part of the master policy and which "contains details of the plan of insurance pertaining to the employees of ... [the] participating employer.” The master policy provides under the heading "Schedule of Insurance and Premium Rates” that "[t]his group policy, together with any amendments thereto, contains all the insurance coverages which may be provided by the employer rider.” Under heading of "The Contract” the policy specifies that it, and any riders and amendments thereto, "and the application of the pol *635

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Bluebook (online)
446 A.2d 1140, 293 Md. 629, 1982 Md. LEXIS 281, Counsel Stack Legal Research, https://law.counselstack.com/opinion/guardian-life-insurance-co-of-america-v-insurance-commissioner-md-1982.