Medical Malpractice Joint Underwriting Ass'n v. Paradis

756 F. Supp. 669, 1991 WL 17033
CourtDistrict Court, D. Rhode Island
DecidedFebruary 8, 1991
DocketCiv. A. 86-0394-T
StatusPublished
Cited by10 cases

This text of 756 F. Supp. 669 (Medical Malpractice Joint Underwriting Ass'n v. Paradis) is published on Counsel Stack Legal Research, covering District Court, D. Rhode Island primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Medical Malpractice Joint Underwriting Ass'n v. Paradis, 756 F. Supp. 669, 1991 WL 17033 (D.R.I. 1991).

Opinion

DECISION AND ORDER

TORRES, District Judge.

This is an action to declare void a Rhode Island statute “freezing” medical malpractice insurance rates and to require the Rhode Island Director of Business Regula *671 tion (who also serves as Insurance Commissioner) to conduct hearings for the purpose of determining whether the rates proposed by the plaintiff for the year 1986-1987 are fair and reasonable. The action is brought pursuant to 28 U.S.C. § 2201 (The Declaratory Judgment Act) and 42 U.S.C. § 1983 (The Civil Rights Act of 1871) on the theory that the statute in question effects a taking of property without just compensation and deprives the plaintiffs members of their property without due process of law.

This matter was originally considered by another judge of this Court who abstained and granted the defendant’s motion to dismiss on the ground that regulation of insurance is an important state interest which involves a “complex mixture of state law and fact” that is best left to determination by the state courts. Medical Malpractice Joint Underwriting Ass’n v. Pfeiffer, No. 86-0394, slip op. at 9 (D.R.I. March 23, 1987). However, the Court of Appeals concluded that abstention was not appropriate where the constitutionality of an unambiguous state statute is directly challenged, and there is no potential for disruption of pending state court proceedings or appellate processes. Medical Malpractice Joint Underwriting Ass’n v. Pfeiffer, 832 F.2d 240, 244 (1st Cir.1987). Accordingly, the decision to abstain and dismiss the complaint was reversed, and the case was remanded and eventually assigned to this Court. After a bench trial consisting essentially of presentation of an undisputed record and the arguments of counsel, it is now ready for decision.

BACKGROUND

I. Statutory Framework

In the mid 1970’s, Rhode Island, like many other states, was experiencing a serious problem stemming from the limited availability and rapidly escalating cost of medical malpractice insurance. Insurance companies became concerned about what they perceived to be legal and market trends that made such coverage far riskier and much less profitable. Consequently, many companies stopped issuing such policies, and those that continued to do so dramatically increased their premiums. Soaring premiums substantially raised the cost of medical care and caused many physicians to consider withholding all but emergency services until corrective action was taken.

The Rhode Island General Assembly responded by enacting R.I.Gen.Laws § 42-14.1-1 which authorized creation of a joint underwriting association (the “JUA”) empowered to issue malpractice insurance policies to physicians, hospitals, and health care providers. All insurers writing personal injury liability insurance within the state were required to participate in the JUA in proportion to their respective shares of the liability insurance market.

The statute requires that policies issued by the JUA be “subject to a group retrospective rating plan” approved by the Director of Business Regulation and that they be “calculated to be self-supporting.” R.I.Gen.Laws § 42-14.1-1(0). In an apparent effort to protect policyholders from sudden rate increases and to preserve the JUA’s ability to satisfy claims, the statute also provides for creation of a stabilization reserve fund (the “SRF”). The SRF is generated from one-time assessments against each policyholder equal to one-third of the policyholder’s initial annual premium. R.I.Gen.Laws § 42-14.1-l(D); R.I. Dept, of Business Regulation, Insurance Division, Regulation XXI, § VI(B) (1982) (hereinafter “Regulation XXI”). Originally, investment income from the JUA’s underwriting fund (i.e. the fund from which claims and operating expenses are paid) was paid into the SRF. However, in 1982, the implementing regulations were amended not only to eliminate that practice; but, also, to require that investment income from the SRF be deposited in the underwriting fund. Regulation XXI, § VI(E). Consequently, at the present time, the SRF’s only source of income is the one-time assessment of new policyholders.

The stated purpose of the SRF is to “discharge when due ... any retrospective premium charges payable by policyholders of the association under the group retrospective rating plan authorized by regula *672 tion.” R.I.Gen.Laws § 42-14.1-l(D). If the fund is insufficient to pay such charges, JUA members are required to contribute whatever amount may be necessary to make up the deficit. Regulation XXI, §§ V(F), VIII.

Most of the policies issued by the JUA are of the claims-occurrence variety. That is to say, each provides coverage for incidents occurring while the policy is in force (i.e. during the policy year) irrespective of when claims arising from those incidents may be made. Since the statute of limitations for minors asserting such claims may be as long as 21 years, the JUA’s exposure has what is referred to as a “long tail.” For that reason, no policy years have yet been closed and, therefore, no retrospective rating plan has been devised. However, the parties agree that if and when the underwriting fund is unable to meet its obligations as they mature, the SRF will be used to pay any operating deficit. Moreover, if and when that fund is exhausted, the JUA’s members will be forced to advance whatever additional funds may be required to keep the JUA afloat.

It is undisputed that reimbursement for any such advances may be sought in accordance with the “recoupment” procedure prescribed in R.I.Gen.Laws § 42-14.l-l(E). That section authorizes the Director to permit participating insurers to make a surcharge with respect to future policies of up to 1% of the annual premiums charged or, alternatively, to deduct their respective shares of the deficit from past or future taxes due the State of Rhode Island.

II. The Rate-Setting Procedure

The statutes and regulations dealing with the manner in which the JUA’s rates are established reflect the mandate of § 42-14.1-1 that it be self-supporting. Thus, the implementing regulations require that:

All rates shall be on an actuarially sound basis, giving due consideration to the group retrospective rating plan and the stabilization reserve fund, and shall be calculated to be self-supporting.

Regulation XXI, § V(C).

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Bluebook (online)
756 F. Supp. 669, 1991 WL 17033, Counsel Stack Legal Research, https://law.counselstack.com/opinion/medical-malpractice-joint-underwriting-assn-v-paradis-rid-1991.