In Re Oread, Inc.

269 B.R. 871, 2001 Bankr. LEXIS 1591, 2001 WL 1557454
CourtUnited States Bankruptcy Court, D. Kansas
DecidedNovember 28, 2001
Docket19-40067
StatusPublished
Cited by4 cases

This text of 269 B.R. 871 (In Re Oread, Inc.) is published on Counsel Stack Legal Research, covering United States Bankruptcy Court, D. Kansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
In Re Oread, Inc., 269 B.R. 871, 2001 Bankr. LEXIS 1591, 2001 WL 1557454 (Kan. 2001).

Opinion

MEMORANDUM OPINION AND ORDER

JULIE A. ROBINSON, Bankruptcy Judge.

This matter came on for trial on August 28, 2001 and September 25, 2001 on the Application for Administrative Claim on Behalf of Connecticut General Life Insurance Company (“CGLIC”), seeking administrative expense treatment of its proof of claim, as amended. 1 The original amount *873 of the claim, $720,321.99, later amended to $660,321.99, consists of three components: $559,751.00 of supplemental premium; $28,666.66 of unused bank account margins; and $131,904.33 for benefit payment account underfunding. Each of these three components includes actual and/or estimated insurance claims for medical services provided both prepetition and postpetition. Section 503(a)(1), Title 11, United States Code, 2 limits administrative expense treatment to costs and expenses . for services rendered” postpetition. Debtor, Oread, Inc. (“Debtor”), acknowledges that CGLIC is entitled to an administrative expense for the reasonable cost of insuring Debtor in the six-week period between the filing of the bankruptcy petition and its rejection of the CGLIC contract.

CGLIC did not meet its burden of proving the amount of its claim attributable to insurance coverage and medical services rendered postpetition, or the reasonable cost of insuring Debtor during the pertinent period. Accordingly, the Court grants CGLIC’s application for administrative expense in the limited amount of $81,783.00, the amount acknowledged by Debtor, which shall be credited against postpetition payments by Debtor. The Court denies the balance of CGLIC’s administrative expense claim, which is allowed as a general unsecured claim.

In addition, Debtor claims that it is entitled to a refund from CGLIC, because its postpetition payments to CGLIC exceeded the reasonable cost of insurance during the six-week period. Like CGLIC, Debtor failed to prove the amount of payments attributable to coverage and services rendered postpetition, and the Court denies the Debtor’s request for a refund.

Findings of Fact

In July 1999, Debtor entered into a contract with CGLIC to provide health insurance for Debtor’s employees and their dependents. The insurance policy was under CGLIC’s “cash management” program, which allows the insured company to reduce and/or defer part of the premium obligation. Under a “traditional” insurance policy, the premium consists of several components: the insurer’s cost of administration; the insurer’s estimate of claims to be paid during the policy period; and the insurer’s estimate of “run-out” claims, that is, claims incurred during the policy period, but paid after the policy has terminated.

In contrast, under CGLIC’s cash management program, the Debtor’s monthly premium payments were lower because the premium included only a “residual premium” for CGLIC’s monthly administrative costs plus the total of claims CGLIC paid that month, capped by a contractual “monthly maximum.” The monthly premium did not include an amount for the estimate of run-out claims. Instead, Debt- or was allowed to keep these funds, and not remit this “supplemental premium” for estimated run-out claims until the policy was terminated. Upon termination, CGLIC would demand payment of the entire supplemental premium. Debtor was expected to reserve funds for the supplemental premium obligation that would become due upon termination.

The “monthly maximum” component of the monthly premium was based on CGLIC’s estimate of claims that would be presented for payment each month. The supplemental premium amount was based on CGLIC’s estimate of run-out claims. *874 Both estimates depended on the Debtor’s actual claims history in the prior policy year, as well as CGLIC’s evaluation of the demographics and risks of the pool of insured employees. This analysis was done annually, at the time the policy was renewed. Thus, the supplemental premium might be adjusted at each yearly anniversary and renewal of the policy.

The $559,751 supplemental premium component of CGLIC’s proof of claim represents its estimate of run-out claims if the policy terminated on July 1, 2001. Although the formula by which CGLIC calculates its supplemental premium resulted in a supplemental premium effective July 1, 2000, CGLIC reduced the supplemental premium in recognition that one high cost employee, a cancer patient, had died during the 1999-2000 policy year.

Had the policy been renewed on July 1, 2001, the supplemental premium amount for policy year July 1, 2001 through June 30, 2002, might have been adjusted upward or downward, because CGLIC would analyze the actual claims history over the past policy year, and the current pool of insured employees and dependents; and then adjust the supplemental premium, as well as the monthly maximum. This was done with the goal of estimating claims with an accuracy such that little or no reserve or supplemental premium would be necessary, as the monthly maximum would sufficiently cover claims, both those presented and those to be presented in the future.

However, if the policy had been terminated on July 1, 2001, the Debtor would owe the $559,751 supplemental premium. In fact, any termination during the policy year ending on July 1, 2001, would have resulted in the Debtor owing a supplemental premium of .$559,751. Thus, had the Debtor terminated this policy prepetition during the 2000-2001 policy year, it would have owed a supplemental premium of $559,751.

This policy was terminated on March 31, 2001, when the Debtor exercised its right to reject this executory contract, pursuant to § 365. 3 At that time, there was a $116,000 deficiency in the Debtor’s Citibank Imprest Account, the account that CGLIC controlled and used to reimburse itself for insurance claims it paid each month, up to the contractual monthly maximum. During the six-week period between the filing of the bankruptcy on February 13, 2001, and the rejection of the contract, there was approximately $452,000 in funds in the bank account, available to reimburse CGLIC for claims paid. This $452,000 represents not only cash payments made by the Debtor to the account, but refunds by CGLIC of monies it had previously debited from the account that exceeded the Debtor’s actual obligation to CGLIC. The bank account statement for February 2001 shows a $309,000 debit to reimburse CGLIC, which was reversed to reflect NSF. Subsequently, however, there was another $309,000 debit to CGLIC, such that it appears that CGLIC in fact was reimbursed in the amount of this $309,000 in addition to other debits shown on the February and March Citibank account statements. It is unclear whether CGLIC had available the entire $452,000 to apply to the Debtor’s obligations, since part of this amount may have been transfers subsequently reversed. It is undisputed however, that the Debtor made post-petition cash payments to CGLIC in the amounts of $110,097.86 plus $60,000. Based on the Debtor’s calculations, CGLIC owes the Debtor $93,066.18. 4

*875

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Bluebook (online)
269 B.R. 871, 2001 Bankr. LEXIS 1591, 2001 WL 1557454, Counsel Stack Legal Research, https://law.counselstack.com/opinion/in-re-oread-inc-ksb-2001.