Gust v. Pomeroy

466 N.W.2d 137, 1991 N.D. LEXIS 24, 1991 WL 21529
CourtNorth Dakota Supreme Court
DecidedFebruary 21, 1991
DocketCiv. 900147
StatusPublished

This text of 466 N.W.2d 137 (Gust v. Pomeroy) is published on Counsel Stack Legal Research, covering North Dakota Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Gust v. Pomeroy, 466 N.W.2d 137, 1991 N.D. LEXIS 24, 1991 WL 21529 (N.D. 1991).

Opinion

VANDE WALLE, Justice.

Tracy Gust appealed from a district court judgment affirming the North Dakota Insurance Commissioner’s decision to assess a civil penalty and suspend Gust’s insurance agent’s license for selling unnecessary or excessive insurance in violation of Section 26.1-26-42(8), N.D.C.C., and Section 45-02-02-14(1), North Dakota Administrative Code. We affirm.

On August 17, 1987, Gust sold two insurance policies providing Medicare supplement coverage and nursing home coverage to Alfred Hovde. At the time of the sale Gust knew that Hovde already had four other policies that provided Medicare supplement coverage and two other policies that provided nursing home coverage.

An administrative complaint was filed against Gust alleging that he sold unnecessary or excessive coverage to Hovde. Following an administrative hearing, the Commissioner determined that Gust sold unnecessary or excessive coverage in violation of Section 26.1-26-42(8), N.D.C.C., and Section 45-02-02-14(1), N.D.A.C. The Commissioner ordered Gust to pay a civil penalty of $600 and suspended Gust’s license to sell insurance for three months, with all but one week of the license suspension suspended.

Gust appealed to the district court, which affirmed the agency decision. Gust appealed to this court.

An appeal from a decision of the Insurance Commissioner is governed by Chapter 28-32, N.D.C.C., the Administrative Agencies Practice Act. Section 26.1-01-08, N.D. C.C.; Sierra Life Insurance Co. v. Wigen, 286 N.W.2d 296 (N.D.1979). See McCarter v. Pomeroy, 466 N.W.2d 562 (N.D.1991). Section 28-32-19, N.D.C.C., requires that the agency decision be affirmed unless:

“1. The decision or determination is not in accordance with the law.
“2. The decision is in violation of the constitutional rights of the appellant.
“3. Provisions of this chapter have not been complied with in the proceedings before the agency.
“4. The rules or procedure of the agency have not afforded the appellant a fair hearing.
“5. The findings of fact made by the agency are not supported by a preponderance of the evidence.
“6. The conclusions and decision of the agency are not supported by its findings of fact.”

Gust asserts that the Commissioner’s findings of fact are not supported by a preponderance of the evidence and that the statute prohibiting sale of unnecessary or excessive insurance coverage is unconstitutional.

Gust was charged with violating Section 26.1-26-42(8), N.D.C.C., and Section 45-02-02-14(1), N.D.A.C. Section 26.1-26-42(8) provides that the Commissioner may suspend, revoke, or refuse to continue or issue a license if:

“8. The licensee has been found to have knowingly solicited, procured, or sold *139 unnecessary, or excessive insurance coverage to any person.”

Section 45-02-02-14(1), N.D.A.C., creates a presumption of a violation of the statutory provision under certain conditions:

“1. When •presumed a violation. An agent or broker is presumed to have violated subsection 8 of North Dakota Century Code Section 26.1-26-42 when the agent or broker knowingly solicits, procures, or sells a medicare supplement policy containing both A and B coverage to any person who has such a medicare supplement policy in force unless the insured is informed by the agent and understands there is to be a replacement of the existing policy and there is an indication in writing or on the face of the application that the new policy is intended to replace the existing policy. It is not presumed to be a violation to solicit and sell a second policy which provides only B coverage. A violation may occur in other situations where there is the sale or solicitation of unnecessary or excessive coverage, even though no presumption has been established under this section.”

Gust asserts that the agency’s finding that he knowingly sold unnecessary or excessive insurance coverage to Hovde is not supported by a preponderance of the evidence. In determining whether the agency’s findings of fact are supported by a preponderance of the evidence, we do not make independent findings of fact or substitute our judgment for that of the agency’s qualified experts, but determine only whether a reasoning mind could have reasonably determined that the factual conclusions were supported by the weight of the evidence. E.g., Northern States Power Co. v. North Dakota Public Service Commission, 452 N.W.2d 340 (N.D.1990). It is not the function of the judiciary to act as a super board when reviewing decisions of administrative agencies. Id.

The record clearly establishes that Gust sold Hovde additional policies when he was admittedly aware that Hovde already had four policies providing Medicare supplement coverage and two policies providing nursing home coverage. The coverage Gust sold was duplicative of Hovde’s existing coverage. Furthermore, the Commissioner found that Gust’s sale of the Medicare supplement coverage did not comply with Section 45-02-02-14(1), N.D. A.C., because Gust did not note on the application or in any other contemporaneous writing that this policy was intended to replace Hovde’s four other Medicare supplement policies. Accordingly, there is a presumption of a violation of Section 26.1-26-42(8). An established presumption substitutes for evidence of the existence of the fact presumed until the trier of fact finds from credible evidence that the fact presumed does not exist. Rule 301(a), N.D. R.Ev. A party against whom a presumption is directed has the burden of proving that the nonexistence of the presumed fact is more probable than its existence. Id.

Gust asserts that it was his intent that these policies would in fact replace Hovde’s other policies. Although there is some evidence to support Gust’s theory, there is also conflicting evidence which supports the Commissioner’s determination that the coverage sold to Hovde was duplicative of Hovde’s existing coverage. Even if Gust’s assertion that he advised Hovde to cancel his other policies is true, there still was unnecessary duplication of coverage. The Commissioner found, and there is evidentia-ry support for his finding, that most of Hovde’s other policies had non-refundable annual premiums. Thus, even if Hovde had attempted to cancel his other policies, he could not have received a refund of premiums. The record demonstrates that there would have been coverage overlaps of up to eleven months regardless of Gust’s advice to Hovde. If Gust had truly wanted to provide replacement coverage, he could have written the policies with a delayed effective date. By writing coverage which took effect immediately, Gust guaranteed that there would be lengthy and costly overlaps in Hovde’s coverage.

We conclude that the agency’s findings of fact are supported by a preponderance of the evidence.

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Related

Northern States Power Co. v. North Dakota Public Service Commission
452 N.W.2d 340 (North Dakota Supreme Court, 1990)
McCarter v. Pomeroy
466 N.W.2d 562 (North Dakota Supreme Court, 1991)
State v. Beyer
441 N.W.2d 919 (North Dakota Supreme Court, 1989)
K Mart Corp. v. Department of State
339 N.W.2d 32 (Michigan Court of Appeals, 1983)
State v. Moore
286 N.W.2d 274 (North Dakota Supreme Court, 1979)
Sierra Life Insurance Co. v. Wigen
286 N.W.2d 296 (North Dakota Supreme Court, 1979)
State v. Hatch
346 N.W.2d 268 (North Dakota Supreme Court, 1984)

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Bluebook (online)
466 N.W.2d 137, 1991 N.D. LEXIS 24, 1991 WL 21529, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gust-v-pomeroy-nd-1991.