Massachusetts Care Self-Insurance Group, Inc. v. Massachusetts Insurers Insolvency Fund

26 Mass. L. Rptr. 130
CourtMassachusetts Superior Court
DecidedSeptember 24, 2009
DocketNo. 0703712E
StatusPublished

This text of 26 Mass. L. Rptr. 130 (Massachusetts Care Self-Insurance Group, Inc. v. Massachusetts Insurers Insolvency Fund) is published on Counsel Stack Legal Research, covering Massachusetts Superior Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Massachusetts Care Self-Insurance Group, Inc. v. Massachusetts Insurers Insolvency Fund, 26 Mass. L. Rptr. 130 (Mass. Ct. App. 2009).

Opinion

Troy, Paul E., J.

The plaintiff, Massachusetts Care Self-Insurance Group, Inc. (“MCSIG”), sought payment from the defendant, Massachusetts Insurers Insolvency Fund (“Fund”), on insurance policies its insolvent insurer had issued. After the Fund denied MCSIG’s requests, MCSIG commenced this action pursuant to G.L.c. 231A, essentially seeking a declaration that MCSIG is not excluded from the Fund’s obligation under G.L.c. 175D to pay the claims of insolvent insurers. The case is before this court on MCSIG’s motion for partial summary judgment and on the Fund’s cross motion for summary judgment. For the following reasons, the Fund’s motion is ALLOWED and MCSIG’s motion is DENIED.

BACKGROUND

The following facts are viewed in the light most favorable to MCSIG as the non-moving parties. Humphrey v. Byron, 447 Mass. 322, 325 (2006).

I. MCSIG

MCSIG filed its Articles of Organization under G.L.c. 180 in September 1990, establishing itself as a non-profit workers’ compensation self-insurance group pursuant to G.L.c. 152, §§25E-25U, for the purpose of “support[ing] the interests of organizations engaged in the nursing home, long-term care and assisted residential living industry in Massachusetts . . .” MCSIG Articles of Organization, Article II. Members of MCSIG (“member employers”) are required to make payments to MCSIG “consist[ing] in part of required premium payments and other payments . . . to cover the costs of purchasing excess insurance, establishing and maintaining a claims fund account, and establishing and maintaining an administrative fund account.” MCSIG Bylaws, §1.3; see G.L.c. 152, §250. MCSIG is currently made up of thirty-nine member employers.1

MCSIG has a Massachusetts Workers’ Compensation and Employers’ Liability Coverage Certificate (“Certificate”) with each of its member employers.2 The Certificate describes the arrangement between MCSIG and its member employers as “a contract of liability coverage” under which MCSIG agrees to “pay promptly when due the benefits required of [the member employer] by the worker’s compensation law.” Certificate, at 6, 7, and Endorsement. Additionally, MCSIG reserves the right “to inspect [the member employers’] workplaces at any time.” Certificate, at 15. These inspections “relate only to the insurability of the workplaces and the premiums to be charged . . . [MCSIG] may .. . recommend changes” to the member employers based on these inspections. Id. MCSIG acknowledges that this provision is “the same” as the rights “[ijnsurance rate service organizations have . . .” Id.

MCSIG and its member employers also enter into an Application and Indemnity Agreement (“Indemnity Agreement”), pursuant to which MCSIG “agrees to provide the [m]ember [employer] with the customary risk management services and workers’ compensation and employers’ liability coverage as and to the extent described in [MCSIG’s] [C]ertificate[,]” and pursuant to which the member employer “agrees to pay the premiums, assessments, and entry fee, if any, as provided herein, for such services and coverage, any late fees, interest or liquidated damages as provided in the By-Laws . . . and all costs of collection thereof, including attorneys fees.” Indemnity Agreement, §6.3 MCSIG further agrees “[t]o administer, investigate, settle, and pay all of the workers’ compensation claims and such other liabilities as are defined in the [Certificate to prepare all required forms; .. . to provide a defense if required!;] . . . [to] negotiate settlements!;] . . . [and to] retain and supervise legal counsel necessary for the prosecution or defense of any litigation on behalf of and at the expense of [MCSIG].” Indemnity Agreement, §12; see Certificate, at 7. Finally, MCSIG and its member employers agree

[131]*131to defend, indemnify and hold harmless each other and every other member [employer] of [MCSIG] . . . from and against any claim or damage arising from the non-compliance by the indemnitor with a provision of . . . [G.L.c. ] 152 . . . [and] [although recourse for any and all payments of workers’ compensation and employers’ liability benefits covered by [MCSIG’s] [C]ertificate . . . shall first be made to [MCSIG’s] assets (but not the individual assets of any member of [MCSIG]), [each] [m]ember [employer] understands, acknowledges, and agrees that, under said Chapter 152, the [m]ember [employer] is and shall be jointly and severally liable for the workers’ compensation and employers’ liability obligations of [MCSIG] and its member[] [employers] which were incurred during the [mjember [employer’s] period of membership in [MCSIG] . . .

Indemnity Agreement, §15(a), (b); see G.L.c. 152, §25G(l)(i) (requiring workers’ compensation self-insurance groups to enter into “indemnity agreement jointly and severally binding the group and each member thereof’).4

A board of trustees made up of representatives of the member employers manages MCSIG. MCSIG Bylaws, §4.1; see G.L.c. 152, §25J. Among the board’s powers is the authority to “[p]urchase . . . insurance or reinsurance and surety bonds[,]” MCSIG Bylaws, §4.3.1(f), to adopt rules concerning the “[p]ayment of workers’ compensation claims and losses incurred by” member employers, MCSIG Bylaws, §4.3.1(e), and to “appoint an Administrator . . .” MCSIG Bylaws, §4.5. The Administrator is “an individual, partnership, corporation or unincorporated association engaged ... to carry out the policies established by the board of trustees and to provide daily management of the [MCSIG].” MCSIG Bylaws, §1.1.5

Reliance National Indemnity Company (“Reliance”) issued two insurance policies to MCSIG for the time period of January 1, 1995, through January 1, 1996: (1) “Specific Excess Workers’ Compensation and Employers’ Liability Policy” (“Specific Policy”) and (2) “Reinsurance effected by Holbom Corporation (“Holb-ornPolicy”) (collectively, “Reliance Policies”).6 Reliance was adjudicated insolvent in October 2001, and the Fund took over the administration of Reliance’s claims pursuant to G.L.c. 175D.7

II. Specific Policy

The Specific Policy named MCSIG as the insured. MCSIG agreed to certain retentions:

a. Retention each loss: $250,000 per accident and per employee as respects occupational disease.
b. Aggregate Retention: Subject to audit at the end of the Policy Period, the Insured’s Aggregate Retention . . . shall be the greater of either
(1) 105% of the Manual Premium
or
(2) Minimum Loss Fund amount of $9.492,000.

In determining whether the Insured’s Aggregate Retention has been exhausted, the following Loss Limitations shall be applied:

(1) Each accident: $250.000: and
(2) Each employee for disease: $250.000.

Specific Policy, Endorsement #2, §1 (bold and underlining in original).8 “Once [MCSIG’S] Aggregate Retention has been exhausted by payment of losses, [Reliance] agrees to indemnify [MCSIG] for claims expenses but only until [Reliance’s] Limit of Indemnify is exhausted by the payment of losses.” Specific Policy, Endorsement #2, §3 (bold in original).

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Bluebook (online)
26 Mass. L. Rptr. 130, Counsel Stack Legal Research, https://law.counselstack.com/opinion/massachusetts-care-self-insurance-group-inc-v-massachusetts-insurers-masssuperct-2009.