Indiana ex rel. Naylor v. Indiana State Teachers Ass'n

950 F. Supp. 2d 993, 2013 WL 2476726, 2013 U.S. Dist. LEXIS 83158
CourtDistrict Court, S.D. Indiana
DecidedMarch 26, 2013
DocketNo. 1:09-cv-01506-SEB-DML
StatusPublished

This text of 950 F. Supp. 2d 993 (Indiana ex rel. Naylor v. Indiana State Teachers Ass'n) is published on Counsel Stack Legal Research, covering District Court, S.D. Indiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Indiana ex rel. Naylor v. Indiana State Teachers Ass'n, 950 F. Supp. 2d 993, 2013 WL 2476726, 2013 U.S. Dist. LEXIS 83158 (S.D. Ind. 2013).

Opinion

ORDER ADDRESSING DEFENDANTS’ PENDING MOTIONS FOR SUMMARY JUDGMENT

SARAH EVANS BARKER, District Judge.

Presently before the Court are two motions for summary judgment,1 filed pursuant to Federal Rule of Civil Procedure 56 on April 13, 2012, by Defendants, the Indiana State Teachers Association (“the ISTA”) et al. [Docket No. 170], and the National Education Association (“the NEA”) [Docket No. 174], respectively. Plaintiff opposes both of the pending motions. For the reasons set forth in this entry, the Court finds that genuine issues of disputed material fact remain concerning both motions and, accordingly, DENIES these motions.

Factual Background

Plaintiff, Chris Naylor (“the Commissioner”), serves the State of Indiana as its duly appointed Securities Commissioner. Am. Compl. ¶ 3. In his official capacity, the Commissioner oversees the Securities Division of Indiana’s Office of the Secretary of State. He is tasked with administration and enforcement of the Indiana Uniform Securities Act (“the Act”), Ind.Code § 23-19-1-1 et seq. Id. In performing his duties, he has the power to conduct investigations of potential Act violations and bring an action on behalf of the State of Indiana if he believes such a violation has occurred. Id.

The ISTA is an Indiana not-for-profit corporation with its principal place of business in Indianapolis, Indiana. Am. Compl. ¶ 4. Four other defendants in this action (collectively, “the ISTA Entities”2) are [996]*996ISTA subsidiaries that maintain their principal places of business in Indianapolis, Indiana and have in common certain “directors, employees, officers, offices, and funds.” Id. ¶¶ 5-8. One of the ISTA Entities’ key functions is to provide insurance products (including long-term disability and health arrangements) to ISTA members, ie., teachers and other school employees in Indiana. Id. ¶ 12. Specifically, the ISTA Trust (“the Trust”) was established in 1985 to furnish group medical benefits to forty-one Indiana school districts. ISTA Br. at 3. The school districts joining these arrangements executed Participation Agreements and/or Funding Agreements with the Trust. See ISTA Br. Exs. 9, 10. Pursuant to these agreements, each participating school district was responsible for funding:3 “(i) the premiums4 on the stop-loss insurance policy; (ii) the Plan’s share of administrative and operating expenses of the Trust; (iii) the funding of the Reserve; and (iv) the funding of incurred claims.” ISTA Br. Ex. 10 at 3. Plans designed by the Trust included, inter alia, the “Healthe Perks Program,” a prescription drug card and mail order program, and a disease management program. ISTA Br. at 4.

Another feature of the Trust’s health insurance plan was a claims stabilization reserve (“the CSR Program”).5 Am. Compl. ¶ 14. Under the CSR Program, a Trust participant “would be credited with a CSR balance if the total amount of payments by the school district to ISTA exceeded the amount of claims paid, plus administrative expenses and other overhead amounts assessed by ISTA.” Id. ¶ 15. Many Funding Agreements — notably, those for school districts participating in the Guaranteed Group Advantage (“the GGA”) — described the CSR Program as a way the Trust could grow its reserves6 “as a result of more favorable than anticipated claims experience.” ISTA Br. at 6. School districts participating in the GGA knew that their CSR would exclusively benefit participants in their respective plans. By contrast, school districts taking part in the Small Group Pool (“SGP”) and PRIDE programs understood that CSR accumulated for all participants in those specified plans. Id. at 7. Plaintiffs allege that Defendants told the school districts that, to the extent possible, they “would receive a return on their CSR balances.” Am. Compl. ¶ 16. Part of the method for calculating this return involved determining the return earned by ISTA and the Trust on their investments. In some instances, school districts were promised guaranteed rates of return. Id. ¶ 17.

Although school districts did not typically withdraw CSR contents, these funds could be used to offset a portion of premium responsibilities for a given month (a “premium holiday”) or year. ISTA Br. at 7-8; see also Sullivan Dep. at 200-03. Local teachers’ associations often had some input as to whether the school districts within their purview could use CSR for a [997]*997“premium holiday” or as a pledge against the full year’s premium. ISTA Br. at 8. A particular school district’s entitlement to retain accumulated CSR upon the district’s termination of participation in the Trust depended on whether that district was part of the GGA, SGP, or PRIDE program. Many GGA districts “could use accumulated CSR to purchase continuing benefits for participating employees through another provider,” whereas SGP and PRIDE districts’ “accumulated CSR remained with the Trust.” Id. at 8-9. However, to the extent that any specific school district’s teachers contributed money to cover premium costs, some portion of that district’s CSR balance included money paid by teachers. Id. at 8.

Interest was applied to CSR balances at varying rates during the relevant time period of this lawsuit. ISTA Br. at 9-10. It is not entirely clear how the Trustees established interest rates each year, but the parties have cited several methods: establishing a “conservative enough” number; going over “the financial situation” via consultants; looking at the five- to ten-year Treasury rate; and even assessing previously employed bond measurements. Rogers Dep. at 133-35; Wise Dep. at 40-41; ISTA Br. Exs. 36-38. Between 1998 and 2007, the interest rates applied to CSR balances ranged from a low of 3% to a high of 6.5%. ISTA Br. at 10. Thus, when a school district was deciding whether to renew its participation in the Trust’s health care program for another year, the Trust would provide a detailed report of the plan’s financial history. These reports, which sometimes included accumulated interest dollars, typically focused on details like PPO savings, hospitalization charges, and expenses categorized by medical diagnosis. Id. at 13. Such data was presumably useful to school districts “considering] an array of factors” in their efforts to differentiate the Trust from other group health providers. See id. at 12. The ISTA asserts that “school districts did not give controlling weight — or[,] indeed, any significant weight at all — to the interest rate the Trust might apply to CSR balances.” 7 Id. at 14.

Although the foregoing facts (and, of course, the name “ISTA Insurance Trust”) establish that the Trust furnished group health insurance coverage, the Trust has never been registered with the Indiana Department of Insurance (“the IDOI”) as an insurance company. ISTA Br. at 18; Pl.’s Resp. at 9. The IDOI “held off ... asserting jurisdiction” over the Trust for approximately twenty years. ISTA Br. Ex. 75 (email from Carol Mihalik of IDOI to Chuck Rolph of ISTA).

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950 F. Supp. 2d 993, 2013 WL 2476726, 2013 U.S. Dist. LEXIS 83158, Counsel Stack Legal Research, https://law.counselstack.com/opinion/indiana-ex-rel-naylor-v-indiana-state-teachers-assn-insd-2013.