Louisiana Safety Ass'n of Timbermen-Self Insurers Fund v. Louisiana Insurance Guaranty

17 So. 3d 350, 2009 La. LEXIS 2221, 2009 WL 2163271
Supreme Court of Louisiana·Decided June 26, 2009·No. 2009-C-0023·Published·Cited by 73 cases

Opinion

KNOLL, Justice. *

^JjThis case involves the res nova question in this Court of whether the unpaid claims of the Louisiana Safety Association of Timbermen Self-Insurers Fund (“Fund”) arising from the insolvency of Reliance Indemnity Company (“Reliance”) are covered claims under La.Rev.Stat. § 22:1375-1394, 1 the Louisiana Insurance Guaranty Association law (“LIGA”). Finding the Fund was an insurer for purposes of LIGA coverage and that Reliance was the Fund’s reinsurer, not an excess insurer, we reverse the lower courts’ determinations that the Fund’s unpaid Reliance claims were covered claims under LIGA.

FACTS AND PROCEDURE

On February 7, 1941, the Red River Timber Marketing Association was formed under the Louisiana Cooperative Marketing Act. Thereafter, on October 2, 1991, the association changed its name to the Louisiana Safety Association of Timber- *352 men (LSAT). Contemporaneously with its name change, the articles were amended to provide that members of the association could be admitted if they paid a membership 12fee, signed a membership agreement, and met other uniform conditions detailed in the bylaws. The association articles were further amended to state LSAT was a nonprofit corporation and to recognize the membership rights were not transferable by assignment, sale, or inheritance.

Subsequently, on October 7, 1991, LSAT’s members established the Louisiana Safety Association of Timbermen Self-Insurers Fund. The Fund was formed pursuant to the provisions of La.Rev.Stat. §§ 23:1195-1200.5 to allow its members to participate in a trustee-administered fund for the purpose of satisfying each member’s workers’ compensation obligations. The members then executed an indemnity agreement which had a twofold purpose: (1) to set up a method for the appointment of certain persons as the board of trustees; and (2) to provide that each member agreed to be held liable jointly and in solido for any award, to promptly pay membership premiums, and to pay all assessments lawfully levied.

LSAT’s application with the Louisiana Commissioner of Insurance for recognition as a worker’s compensation group self-insurance fund was granted. Pertinent to the present litigation, LSAT obtained the “excess insurance” as required by La.Rev. Stat. § 23:1196(A)(5)(1999) from Reliance for the 1998 policy year. 2 On | «October 3, 2001, the Commonwealth Court of Pennsylvania placed Reliance into liquidation. The Fund then provided LIGA with proof of its claims against Reliance. On February 4, 2004, LIGA denied the Fund’s claims, reasoning the Fund’s policy with Reliance was one of reinsurance through which the Fund was an insurer who sought to limit its risk and was not a “covered claim” as defined in La.Rev.Stat. § 22:1379.

Subsequently, the Fund sued LIGA, seeking declaratory relief for continuing coverage for all past and future losses in *353 accordance with the terms of the Reliance policy. LIGA filed responsive pleadings, asserting its coverage only extends to direct insurance, not reinsurance, and that the Fund is an insurer whose claims it does not cover; alternatively, LIGA contended other insurance must be exhausted before LIGA coverage is reached, and the combined net worth of the Fund’s members exceeded |4$25 million during the year prior to Reliance’s insolvency thereby precluding coverage as provided in La.Rev. Stat. § 22:1379(3)(f).

Thereafter, the Fund moved for partial summary judgment, seeking a declaration that the Reliance policy was direct excess insurance, that its claims are “covered claims,” that the Fund did not have other insurance covering the claims, and that the net worth of its members was immaterial to a determination of whether the claims are covered by LIGA.

LIGA filed a cross-motion for summary judgment, asserting the Fund’s claims are not covered because the Fund is an insurer and the 1999 amendments to the definition of a “covered claim” under the Insurance Guaranty Association Law bar the claims of a self-insurer. Additionally, LIGA moved to compel discovery of financial information about the net worth of the Fund’s members.

After conducting a contradictory hearing, the trial court granted the Fund’s motion for summary judgment, finding the Fund’s claims met the statutory definition of a “covered claim” and that the Fund did not provide insurance. In addition, the trial court denied LIGA’s motion to compel discovery, finding the Fund’s members are not affiliates of the Fund as provided in La.Rev.Stat. § 22:1379(3)(f). LIGA then timely appealed the trial court’s judgment.

Noting this was a case of first impression, the appellate court affirmed the trial court judgment, holding the Fund was not an “insurer” for purposes of LIGA that excluded any insurer from LIGA coverage, that the Fund’s claims were not excluded from LIGA coverage under provisions that excluded claims within coverage provided by a self-insurer, and that the Fund members were not “affiliates” for LIGA purposes of excluding from coverage claims asserted by an insured whose net worth, including affiliates, exceeded $25 million. Louisiana Safety Association of Timber-men Self-ffnsurerSf, Fund v. Louisiana Insurance Guaranty Association, 43,615 (La.App. 2 Cir. 12/3/08), 998 So.2d 817. We granted LIGA’s writ application to consider the correctness vel non of the appellate court’s disposition of this res nova issue. Louisiana Safety Association of Timbermen Self-Insurers Fund v. Louisiana Insurance Guaranty Association, 09-C-0023 (La.3/6/09), 3 So.3d 493.

SUMMARY JUDGMENT LAW

Summary judgments are reviewed de novo on appeal, with the reviewing court using the same criteria that govern the trial court’s determination of whether summary judgment is appropriate; whether there is any genuine issue of material fact, and whether the movant is entitled to judgment as a matter of law. Power Marketing Direct, Inc. v. Foster, 05-2023 (La.9/6/06), 938 So.2d 662, 669; Smith v. Our Lady of the Lake Hosp., Inc., 93-2512 (La.7/5/94), 639 So.2d 730, 750.

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Louisiana Safety Ass'n of Timbermen-Self Insurers Fund v. Louisiana Insurance Guaranty, 17 So. 3d 350, 2009 La. LEXIS 2221, 2009 WL 2163271 (La. 2009).

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