In re American Republic Insurance Company's Forms A-1598, 1-1941, A-2523MN, A-2718MN, A-2745MN, A-2673MN, A-2663MN, A-2645MN, A-2484MN, A-2485MN, A-2481MN, A-2434MN, A-2593MN

427 N.W.2d 259, 1988 Minn. App. LEXIS 732, 1988 WL 78744
CourtCourt of Appeals of Minnesota
DecidedAugust 2, 1988
DocketNo. C3-88-446
StatusPublished

This text of 427 N.W.2d 259 (In re American Republic Insurance Company's Forms A-1598, 1-1941, A-2523MN, A-2718MN, A-2745MN, A-2673MN, A-2663MN, A-2645MN, A-2484MN, A-2485MN, A-2481MN, A-2434MN, A-2593MN) is published on Counsel Stack Legal Research, covering Court of Appeals of Minnesota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
In re American Republic Insurance Company's Forms A-1598, 1-1941, A-2523MN, A-2718MN, A-2745MN, A-2673MN, A-2663MN, A-2645MN, A-2484MN, A-2485MN, A-2481MN, A-2434MN, A-2593MN, 427 N.W.2d 259, 1988 Minn. App. LEXIS 732, 1988 WL 78744 (Mich. Ct. App. 1988).

Opinion

OPINION

HUSPENI, Judge.

Relator filed a petition for a writ of certiorari seeking review of three orders of the Commissioner of Commerce: the first dated February 25, 1987, the second dated October 29, 1987, and the third dated January 25, 1988. The cumulative effect of the orders is to disapprove certain health and accident insurance policies for which relator had either previously received approval or for which it was currently seeking approval. The Commissioner disapproved the policies on the ground that each contained a nonduplication of benefits provision which was less favorable to an insured than is required by Minn.Stat. § 62A.04, subd. 3(4). Relator argues that the nondu-[260]*260plication provision contained in its policies is expressly authorized and mandated by Minn.Stat. § 62E.06, subd. l(c)(l)(iii) (1986). Relator also argues that the Commissioner’s actions were violative of its due process and equal protection rights. We affirm the order of the Commissioner.

FACTS

On June 26,1986, relator filed an application with the department of commerce seeking approval for four policies of accident and health insurance. The policies each contained the following “nonduplication” provision:

Major Medical Benefits

Amount Payable

We will pay for services and supplies that qualify as covered expenses and are received:

(a) during a calendar year; and
(b) while the covered person’s insurance is in force under this policy.
The amount payable shall be the lesser of the basic benefits or the alternative benefits. * * *
“Basic benefits” means an amount found by multiplying the covered expenses for the calendar year, in excess of the deductible amount, by the applicable coinsurance percentage * * *.
“Alternate benefits" means 100 percent of the covered expenses for the calendar year in excess of the benefits payable therefor under other plans.
The total amount payable for each covered person under this policy will not exceed the maximum benefit limit * * *.

(Emphasis in original.)

On July 22,1986, the policies were disapproved by the department of commerce on the ground that they did not comply with Minn.Stat. § 62A.04, subd. 3(4). (Under section 62A.04, subd. 3 any policy containing nonduplication of benefits provisions less favorable to the insured than the Commissioner approved language of subd. 3(4), shall not be approved by the Commissioner.)

Relator filed a request for a formal hearing on October 28, 1986. In addition to its claim that the nonduplication of benefits provision in its policies was expressly authorized under section 62E.06, relator claimed that the Commissioner’s disapproval of the forms was a violation of relator’s due process rights because the Commissioner had approved numerous forms with similar language in the past. On December 9 and 10, 1986, a hearing was held before an Administrative Law Judge (AU) to determine the validity of the disapproval of relator’s forms. The AU concluded that, while the nonduplication of benefits provisions was less favorable to an insured than is required by section 62A.04, and while section 62E.06 did not authorize such a provision, disapproval of relator’s forms would constitute a denial of its right to due process. The AU recommended that relator’s forms be approved.

On February 25, 1987, the Commissioner issued an order in which he concluded that relator’s policies were violative of section 62A.04 and that section 62E.06 did not authorize relator’s nonduplication of benefits provisions. However, finding the charge that relator’s due process rights had been violated, the Commissioner (a) approved relator’s forms, (b) referred the matter back to the AU to determine whether the Department of Commerce had intentionally or purposely discriminated against relator, and (c) commenced proceedings to disapprove all previously approved policies which were in violation of section 62A.04, subd. 3(4), including relator’s forms approved in the February 25 order.

On August 14, 1987, a remand hearing was held before the AU on the issue of whether the department had purposely and intentionally discriminated against relator. On October 2, 1987, the AU issued findings and conclusions which determined that relator was not deprived of its constitutional rights. On October 29, 1987, the Commissioner issued a final order rejecting relator’s claim that the department acted in a discriminatory manner.

On April 22, 1987, the Commissioner issued a notice of and an order for a hearing [261]*261to seek withdrawal of approval of relator’s insurance forms. The matter was heard before a second ALT on July 7,1987, with a supplemental hearing on September 23, 1987. On December 8, 1987, this AU determined that while the nonduplication of benefits provisions found in relator’s insurance policies was less favorable than the statutory language of section 62A.04, subd. 3(4), relator’s policies complied with section 62E.06, subd. l(c)(l)(iii). The AU found that “the coordination of benefits provision in Minn.Stat. sec. 62E.06, subd. 1(c)(1), supersedes any duplicate provisions in [section 62A.04].” Consequently, he recommended that relator’s forms be approved.

On January 25, 1988, the Commissioner rejected the recommendations of the second AU and withdrew approval of relator’s insurance forms which contained the nonduplication provision in question. The Commissioner again concluded that the nonduplication provisions of relator’s forms must comply with section 62A.04, subd. 3(4), finding in pertinent part that:

[Relator’s] provisions provide less favorable coverage to the insured than the model statutory provision because they result, under certain circumstances, in the insured receiving less money in claims and premium refunds than the insured would receive under the model statutory language. Further, there is substantial likelihood that, if such provisions are permitted, nonduplication provisions would proliferate throughout all insurance policies, and the consumer would be caught between two companies claiming that they do not cover for claims which could have been paid by the other carrier. As a result, the policyholder would be left with no recourse other than litigation.

The Commissioner concluded:

Minn.Stat. § 62E.06 (1986) does not authorize plans to contain “insurance with other insurers” provisions which violate Minn.Stat. § 62A.04, subd. 3(4) (1986).

ISSUE

Does Minn.Stat. § 62E.06, subd. l(c)(l)(iii) supersede the provisions of Minn. Stat. § 62A.04, subd. 3(4)?

ANALYSIS

Minn.Stat. § 62E.06, subd. l(c)(l)(iii) (1986) provides:

A plan of health coverage shall be certified as a number three qualified plan if it otherwise meets the requirements established by chapters 62A and 62C, and the other laws of this state, whether or not the policy is issued in Minnesota, and meets or exceeds the following minimum standards:
* # # * # *
(c) Covered expenses for the services and articles specified in this subdivision do not include the following:

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427 N.W.2d 259, 1988 Minn. App. LEXIS 732, 1988 WL 78744, Counsel Stack Legal Research, https://law.counselstack.com/opinion/in-re-american-republic-insurance-companys-forms-a-1598-1-1941-a-2523mn-minnctapp-1988.