Liability Investigative Fund Effort, Inc. v. Medical Malpractice Joint Underwriting Ass'n

569 N.E.2d 797, 409 Mass. 734, 1991 Mass. LEXIS 190
CourtMassachusetts Supreme Judicial Court
DecidedApril 10, 1991
StatusPublished
Cited by18 cases

This text of 569 N.E.2d 797 (Liability Investigative Fund Effort, Inc. v. Medical Malpractice Joint Underwriting Ass'n) is published on Counsel Stack Legal Research, covering Massachusetts Supreme Judicial Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Liability Investigative Fund Effort, Inc. v. Medical Malpractice Joint Underwriting Ass'n, 569 N.E.2d 797, 409 Mass. 734, 1991 Mass. LEXIS 190 (Mass. 1991).

Opinion

*736 Abrams, J.

This case raises the question whether Massachusetts physicians who have been affected by certain malpractice insurance rate regulations promulgated by the Commissioner of Insurance (commissioner) may maintain an action in the Superior Court for declaratory and equitable relief. The judge in the Superior Court dismissed the plaintiffs’ complaints, holding that exclusive jurisdiction over their claims lies with this court pursuant to G. L. c. 175A, § 5A (1988 ed.). We hold that the Superior Court judge should not have dismissed the complaints in their entirety, and remand for a determination of which claims should first have been presented through the § 5A procedure. We further hold that the judge should have stayed the proceedings with respect to the plaintiff Dr. Robert S. Slocum’s G. L. c. 93A claim because the commissioner has primary jurisdiction.

The proceeding before the Superior Court was a consolidation of two actions. The plaintiffs in the first action are the Liability Investigative Fund Effort, Inc. (LIFE), a Massachusetts corporation founded and managed by Massachusetts physicians, and seven individual physicians. The physicians seek to maintain a class action on behalf of themselves and all persons who have been insured by the Medical Malpractice Joint Underwriting Association of Massachusetts (JUA) at any time from 1975 to the present and who are or may be obligated to the JUA for retroactive premium assessments. The defendants are the Commonwealth, the commissioner, and the JUA. In the second action, Dr. Robert S. Slocum is suing the JUA.

In 1975, the Legislature enacted St. 1975, c. 362, in order to guarantee the continued availability of medical malpractice insurance in the Commonwealth. The act inserted a new § 5A into G. L. c. 175A, authorizing the commissioner to “fix and establish fair and reasonable classification of risks and adequate, just, reasonable and nondiscriminatory premium charges on claims made and occurrence basis” to be charged by medical malpractice insurance writers. Section 5A provides that “[a]ny person or company aggrieved by any action, order, finding or decision of the commissioner under *737 this section may, within twenty days from the filing of such memorandum thereof in his office, file a complaint in the supreme judicial court for the county of Suffolk for a review of such action, order, finding or decision.”

Section 6 of the act created the JUA “to provide medical malpractice insurance on a self-supporting basis.” St. 1975, c. 362, § 6, 2d par. The JUA is an association of all insurers authorized to write and engaged in writing personal injury liability insurance. It has the power to issue insurance policies, in accordance with a plan of operation promulgated by the commissioner, to licensed physicians and hospitals who are unable to obtain such insurance elsewhere. “The rates, rating plans, rating rules, rating classifications, territories and policy forms applicable to the insurance written by the [JUA] . . . shall be subject to” G. L. c. 175A, § 5A, the ratemaking section discussed above. St. 1975, c. 362, § 6, 6th par. Section 6 further provides that “[a]ny deficit sustained by the association in any one year shall be recouped, pursuant to the plan of operation and the rating plan then in effect by an assessment upon the policyholders, or a rate increase applicable prospectively, or both.” St. 1975, c. 362, § 6, 7th par. In 1980, the Legislature amended this provision so that the power to recoup deficits may be exercised only by a prospective rate increase, not by an assessment. See St. 1980, c. 333.

Finally, § 6 permits an “appeal for review to the commissioner within thirty days after any ruling, action, or decision by or on behalf of the association, with respect to those items the plan of operation defines as appealable matters.” The commissioner’s decision is in turn appealable to the Superior Court. See St. 1975, c. 362, § 6, 11th & 12th pars. In addition, “[a]ny person aggrieved by any other rule or regulation of the commissioner made pursuant to this section” may appeal to the Superior Court. Id. at 12th par.

On April 1, 1983, the JUA recommended to the commissioner a 162.7 % increase in malpractice insurance premiums *738 for the 1983 rate year. 1 The commissioner did not issue a decision on the rate increase until May 18, 1984, when he allowed only a 42% increase. The JUA appealed the decision to this court pursuant to G. L. c. 175A, § 5A. We determined that the commissioner misinterpreted the applicable statutes and therefore we reversed the decision and remanded these matters for further ratemaking proceedings. See Medical Malpractice Joint Underwriting Ass’n of Mass. v. Commissioner of Ins., 395 Mass. 43 (1985). On December 24, 1985, the Legislature froze premium rates for policies issued on or after July 1, 1984, at the level contained in the commissioner’s overturned decision of May 18, 1984. The freeze was to apply until May 1, 1986. See St. 1985, c. 671, § 1. It later was extended to July 1, 1986. See St. 1986, c. 37.

Meanwhile on June 6, 1986, the commissioner issued a new decision regarding the 1983 rate, raising it 93.9% above the previous year rate, rather than the 42% rise overturned in 1985. He also raised the rate for the 1984 rate year 10.9% above the 1983 rate. No appeal was taken from that decision.

Later that month, the Legislature enacted St. 1986, c. 351, providing a means for the JUA to recover lost premiums attributable to the legislative freeze. The statute established a “total deferred premium liability,” which is a sum representing the difference between the rates set by the commissioner pursuant to c. 175A, § 5A, for the 1983-1985 rate years and the premiums actually paid for the period pursuant to the freeze. The statute provided for recovery of the total deferred premium liability over a five-year period from July 1, 1987, through June 30, 1992, by means of a “separate rate” added to the normal rate for policies issued during that period. The separate rates were to be assessed and recovered in the same manner as rates established pursuant to c. 175A, § 5A. See *739 St. 1986, c. 351, § 38. The statute did not refer to the deficit recoupment provision of St. 1975, c. 362, § 6, 7th par., discussed above.

On April 2, 1987, the JUA requested recoupment of a $140,000,000 deficit incurred between the years 1975 and 1982. A separate administrative proceeding on the request was instituted, and interim rulings were issued specifying which persons or classes of persons would be liable for the recoupment. On appeal, we affirmed the interim rulings. See Risk Management Found, of Harvard Medical Insts. v. Commissioner of Ins., 407 Mass. 498 (1990).

On May 3, 1989, the LIFE plaintiffs filed this twenty-three count class action complaint in the Superior Court for the county of Hampden, alleging a series of State and Federal constitutional violations. They also assert contractual •claims against the defendants and allege a violation of c. 175A, § 5A.

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Bluebook (online)
569 N.E.2d 797, 409 Mass. 734, 1991 Mass. LEXIS 190, Counsel Stack Legal Research, https://law.counselstack.com/opinion/liability-investigative-fund-effort-inc-v-medical-malpractice-joint-mass-1991.