Kentucky League of Cities, Inc. v. General Reinsurance Corp.

174 F. Supp. 2d 532, 2001 U.S. Dist. LEXIS 18456, 2001 WL 1472646
District Court, W.D. Kentucky·Decided October 31, 2001·No. 3:99CV-499-H·Published

Opinion

MEMORANDUM OPINION

HEYBURN, District Judge.

The Court now considers the parties’ cross-motions for partial summary judgment. Plaintiff, Kentucky League of Cities, Inc. (“KLC”), is the successor in interest to a self-insurance fund that provided workers’ compensation insurance to a group of cities and counties (“KACo-KML”) as allowed in KRS § 342.350. 1 De *534 fendant, General Reinsurance Corporation (“GenRe”), a Delaware corporation, sold an insurance policy to KACo-KML providing “aggregate excess” insurance for the years 1986 and 1987 (the “Policy”). 2 Plaintiff claims that the Policy violated Kentucky law because it was issued on a “claims paid” rather than a “claims incurred” basis. KACo-KML has paid all the workers’ claims. This case concerns whether GenRe should reimburse some of these payments. Plaintiff seeks: (1) to conform the Policy under terms complying with Kentucky law; (2) to reform the Policy based on a mutual mistake of fact; and (3) breach of contract. The present motions concern only Plaintiffs claim for conformation of the Policy. The Court has had the benefit of excellent memoranda and extensive oral argument on these complex and unique issues.

I.

Kentucky law requires every employer' in the Commonwealth to insure its workers’ compensation liabilities. See KRS § 342.340. Most employers do so by purchasing a conventional workers’ compensation insurance policy. However, employers do have an alternative. The Kentucky Workers’ Compensation Board (the “Board”) may authorize a group of “employers to enter into agreements to pool their liabilities ... for the purpose of qualifying as self-insurers.” KRS § 342.350(4). 3 The statute says only that such “employers securing certification as group self-insurers are regulated by the rules and regulations drawn by the workers’ compensation board and are not to be in any way subject to the provisions of [other] subsections ... of this section ...."Id.

As provided by statute, the Board promulgated regulations “establishing minimum requirements through which groups of employers may join together to self-insure their workers compensation liability.” 803 KAR 25:025, et seq. (1987). 4 Un *535 derstanding the certification and operation of self-insured funds requires an explanation of the complex interrelationship between myriad regulatory provisions, most of which feature insurance industry terms of art.

The central concept to understand is the “self-insurance fund.” The regulations define the fund as comprised of the “loss fund,” together with all other expenses related to the self-insurance program, including, inter alia, the cost of “aggregate and specific excess insurance.” Id. at § 1(9). The “loss fund” is “the amount of total retained liability for claims by-the group members as set forth in the aggregate excess insurance policy,” which is determined annually. Id. at § 1(8). Stated *536 more simply, the “loss fund” is the projected total claims liability for the coming year. Sometimes this is also referred to as the retained liability. See id. at § 1(8) and § 5(4)(a). Each year, in order to receive Board certification, the trustees must estimate and then assess premiums sufficient to cover all projected claims and expenses. These premiums create and fund the “self-insurance fund.” Id. at § 5(5)(a). The possibility exists, of course, that the actual claims could exceed the projected “loss fund” for that year. Therefore, the trustees must purchase excess insurance to cover claims which exceed the amount available in the loss fund for that year. See id. at § 5(4)(a). Additional protections exist because employers may be individually liable for claims and the Board may require additional coverage when a group disbands. See id. at § 2(1) and § 4.

The regulations specify two forms of excess insurance, “specific” and “aggregate.” “Aggregate excess insurance,” the type at the center of this controversy, “means an insurance policy which covers statutory claims in excess of a certain percentage of the normal premium subject to a maximum dollar amount.” Id. at § 1(6). The regulations describe the precise scope of aggregate excess insurance which the fund’s trustees must purchase. See id. at § 5(4)(a). The self-insurance fund cannot exceed 100 percent of the “assessment^],” or “charges to group members to sustain the self-insurance fund.” Id. at § 5(4)(a) and § 1(10). And, the liability of an aggregate excess insurance policy is capped at a certain figure, but this ceiling cannot be less than $1,000,000 or 50% of the normal premium, whichever is higher. See id. at § 5(4)(a).

In accord with these regulations, KACo-KML first attained certification as a self-insured fund in 1978. This controversy arises from KACo-KML’s 1986 purchase of the GenRe Policy for aggregate excess insurance. The Policy provided coverage only for claims both filed and paid within the policy year, subject to the aggregate excess limitation. 5 A “claims incurred” policy, which Plaintiff says the regulations require, would cover all claims originating during the policy year, regardless of when those claims are paid, subject to the aggregate excess limitation. At issue is not whether the claims actually paid in 1986 and 1987 exceeded the self-insurance fund. 6 KACo-KML says that due to the Policy, it was without coverage for excess claims that originated in 1986 and 1987, but were not paid until certain future years. Thus, the practical consequence of Plaintiffs argument is that GenRe should be liable for claims in those years after 1987 where KACo-KML’s annual claims exceeded the self-insurance fund and where those claims were not otherwise insured by aggregate excess insurance purchased for that policy year.

II.

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Kentucky League of Cities, Inc. v. General Reinsurance Corp., 174 F. Supp. 2d 532, 2001 U.S. Dist. LEXIS 18456, 2001 WL 1472646 (W.D. Ky. 2001).

174 F. Supp. 2d 532 (Kentucky League of Cities, Inc. v. General Reinsurance Corp.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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