Intervenor Policy Holders of American Indemnity Trust v. Oklahoma Life & Health Insurance Guaranty Ass'n

1992 OK 17, 825 P.2d 1341, 63 O.B.A.J. 477, 1992 Okla. LEXIS 26, 1992 WL 21408
CourtSupreme Court of Oklahoma
DecidedFebruary 11, 1992
DocketNo. 75212
StatusPublished
Cited by6 cases

This text of 1992 OK 17 (Intervenor Policy Holders of American Indemnity Trust v. Oklahoma Life & Health Insurance Guaranty Ass'n) is published on Counsel Stack Legal Research, covering Supreme Court of Oklahoma primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Intervenor Policy Holders of American Indemnity Trust v. Oklahoma Life & Health Insurance Guaranty Ass'n, 1992 OK 17, 825 P.2d 1341, 63 O.B.A.J. 477, 1992 Okla. LEXIS 26, 1992 WL 21408 (Okla. 1992).

Opinion

HODGES, Vice Chief Justice.

The policy holders (Appellants/Plaintiffs) of American Indemnity Trust (AIT), who intervened in this action in the trial court, are appealing an order granting summary judgment to Appellees/Defendants, Oklahoma Life and Health Insurance Guaranty Association (Association). The parties have stipulated to the facts. Therefore, this appeal presents a question of law based on undisputed facts.

ISSUE

Whether, as a matter of law, appellants can recover against the Association for their unpaid AIT insurance claims despite the fact that AIT was never licensed as an insurer and never became a dues-paying member of the Association. We answer this question in the negative and affirm the trial court.

FACTS

AIT was established in 1981 as a trust under the Employee Retirement Income Security Act of 1974 (ERISA). However, neither the Department of Labor nor any other governmental authority ever declared that AIT was a fully qualified ERISA trust. It was organized for the purpose of marketing medical benefit plans to numerous employers. At that time, ERISA trusts were not subject to regulation by state insurance departments, therefore, AIT was not regulated by the Oklahoma Insurance Commission (Commission). However, in 1983, federal legislation made multiple employer ERISA trusts (METS) subject to state regulation unless they were totally reinsured by licensed insurance companies. After passage of this legislation, AIT did not obtain a license nor reinsurance as required by the federal legislation.

Because AIT was never licensed nor rein-sured, the Commissioner filed suit to enjoin AIT from continuing to sell its health benefit plans to the public without a license. Because of the injunction obtained by the Commissioner, AIT claimed it could not get any new business, and thus could no longer pay its claims. AIT is now insolvent.

Appellants are policyholders of medical benefit contracts issued by AIT whose claims were never paid. Appellants intervened in the original suit by the Commissioner against AIT. They now seek to have their claims against AIT paid by the Association. The parties have stipulated to the following facts:

1. The American Indemnity Trust (AIT) was never licensed as an insurer in the State of Oklahoma.
2. AIT was never a member of the Guaranty Association.
3. AIT did not share in the Guaranty Association’s administrative costs or general expenses or pay assessments used to create a fund to fulfill the Guaranty Association’s responsibilities under 36 O.S. § 2021.

When the Association was brought into this litigation by appellants, the Association requested a writ of prohibition from the Supreme Court on the grounds that AIT was not a member of the Association and that AIT’s unlicensed sale of health benefits did not bring it within the scope of the Life and Health Insurance Guaranty Association Act (ACT), Okla.Stat. tit. 36, §§ 2021-2043 (1981). Appellants argued that the writ should not be granted because no discovery had taken place which might uncover a conspiracy between the Commission and the Association to prevent AIT from becoming licensed so that the Association would not have to pay AIT’s claims. The writ was denied. During discovery, there was no evidence uncovered of a conspiracy between the Commission and the Association.

Subsequently, the Association and appellants both made motions for summary [1344]*1344judgment. The trial court denied appellants’ motion and granted the Association’s motion for summary judgment as a matter of law based upon the uncontroverted facts.

DISCUSSION

Appellants have set forth four arguments why, as a matter of law, they should be able to recover against the Association for their unpaid AIT insurance claims. These arguments cannot succeed.

I.

Appellants’ first argument is that the Association should pay AIT’s claims even though AIT was not licensed and was not a member of the Association. This argument cannot succeed because it is in direct contravention of the Act. In order for a trust to become a member of the Association, it must first be licensed in Oklahoma. The purpose of the Act is to protect consumer insureds against the risk of losses “because of the impairment or insolvency of the member insurer that issued the policies or contracts.” Okla. Stat. tit. 36, § 2022. The term “member insurer” is defined in the Act as “any person licensed by this state to transact any kind of insurance business to which this act applies.” Okla.Stat. tit. 36, § 2024 (1981). Because AIT was never a licensed Oklahoma insurer, it was never a member of the Association.

AIT claims that even though it is not a member of the Association, it is still an “insolvent insurer” under the Act. An “insolvent insurer” is defined as a member insurer who becomes insolvent. Id. Therefore, the duty to “guarantee, assume or reinsure” the policies of an “insolvent insurer” under § 2028 is not absolute, but rather conditioned upon the status of the insurance company in question as a licensed, member insurer. Because AIT was not a licensed “member insurer”, it cannot, by definition, be an “insolvent insurer” under the Act.

The Association was created under the Act with the purpose of paying benefits and continuing coverages as limited in the Act. Members of the Association are subject to assessment to provide funds to carry out the purposes of the Act. Id. at § 2022. It is not logical that member insurers, and consequently policyholders of member insurers, of the Association should be required to pay the claims of a nonmember insurer when it becomes insolvent.

AIT was never a “member insurer” and thus never an “insolvent insurer” under either §§ 2024 or 2028 of the Act. There is nothing in the Act that would require the Association to pay the claims of an insolvent non-member insurer. It follows that if the Association had no duty to pay AIT’s claims, then the Commissioner had no duty to force the Association to pay. Okla.Stat. tit. 36, § 2028(5) (1981).

II.

Appellants’ second argument is that because AIT’s policies were issued by licensed persons, i.e., the individual insurance brokers, this makes AIT an “insolvent insurer” under the Act. The Act applies to various types of insurance policies, including health insurance policies which are issued by persons licensed to transact insurance business in this state at any time. Id. at § 2025. However, appellants lose sight of the fact that AIT was not licensed, and this is the important factor.

AIT was not an “insolvent insurer” merely because it sold insurance through individual insurance agents. AIT itself should have been licensed in order to become a member insurer, and subsequently an “insolvent insurer” under the Act. Simply because AIT contracts were sold by licensed agents or brokers did not transform AIT into an “insolvent insurer” within the scope of the Act.

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Bluebook (online)
1992 OK 17, 825 P.2d 1341, 63 O.B.A.J. 477, 1992 Okla. LEXIS 26, 1992 WL 21408, Counsel Stack Legal Research, https://law.counselstack.com/opinion/intervenor-policy-holders-of-american-indemnity-trust-v-oklahoma-life-okla-1992.