Meier v. Maleski

648 A.2d 595, 167 Pa. Commw. 458, 1994 Pa. Commw. LEXIS 545
CourtCommonwealth Court of Pennsylvania
DecidedSeptember 16, 1994
Docket239 M.D. 1993
StatusPublished
Cited by100 cases

This text of 648 A.2d 595 (Meier v. Maleski) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Meier v. Maleski, 648 A.2d 595, 167 Pa. Commw. 458, 1994 Pa. Commw. LEXIS 545 (Pa. Ct. App. 1994).

Opinion

*463 FRIEDMAN, Judge.

Presently before this court are the preliminary objections of Cynthia Maleski (Commissioner), acting in her official capacity as Insurance Commissioner of the Commonwealth of Pennsylvania, and Joseph Pulcini (Director), Director of the Medical Professional Liability Catastrophe Loss Fund (collectively, Respondents), to the Amended Petition for Review in the Nature of a Complaint in Equity (Petition) of Louis A. Meier, M.D., Alphonse DiGiovanni, M.D., Robert Driscoll, D.O.,, and Arthur Martella, M.D. (collectively, Petitioners), filed in our original jurisdiction. 1 We overrule the preliminary objections.

Through their Petition, Petitioners seek both injunctive relief and an accounting because of Respondents’ alleged violation of a provision of the Health Care Services Malpractice Act (Act). 2 Specifically, Petitioners challenge Respondents’ calculation of the annual surcharge assessed against Petitioners and other Pennsylvania health care providers by the Medical Professional Liability Catastrophe Loss Fund (CAT Fund or Fund) for years 1987, 1988, 1990 and 1991. Petitioners contend that because Respondents failed to follow the Pennsylvania General Assembly’s statutory scheme for determining the annual surcharge, Petitioners were assessed excessive surcharge amounts during those years.

Petitioners base their challenge on section 701(e)(1) of the Act, 40 P.S. § 1301.701(e)(1), which establishes the process for setting the surcharge amount as follows:

The fund shall be funded by the levying of an annual surcharge on or after January 1 of every year on all health care providers entitled to participate in the fund. The surcharge shall be determined by the director appointed pursuant to section 702 and subject to the prior approval of *464 the commissioner. The surcharge shall be based on the cost to each health care provider for maintenance of professional liability insurance and shall be the appropriate percentage thereof, necessary to produce an amount sufficient to reimburse the fund for the payment of all claims paid and expenses incurred during the preceding calendar year and to provide an amount necessary to maintain an additional $15,000,000.

40 P.S. § 1301.701(e)(1) (emphasis added).

Respondents claimed overcharge for 1987, 1988, 1990 and 1991 is based on an interpretation of section 701(e)(1) of the Act asserting that the Act imposes a $15,000,000 ceiling on the CAT Fund’s annual surplus, so that any surplus in excess of this cap must be applied to reduce the surcharge for the upcoming year. Because Respondents’ surcharge calculation did not accord with this $15,000,000 surplus cap, Petitioners seek credit for the four years that the CAT Fund’s surplus exceeded $15,000,000.

In their Petition, Petitioners aver that they are physicians licensed in Pennsylvania who are also “health care providers” as defined by section 701(a)(l)(i) of the Act, 40 P.S. § 1301.701(a)(l)(i). As such, Petitioners must comply with all Act provisions or be subject to suspension of their licenses. 40 P.S. § 1301.701(f). (Petition, ¶ 2.) In support of Petitioners’ request for relief, the Petition also contains the following relevant allegations, which we summarize as follows.

In 1975, the Pennsylvania General Assembly approved the Act and created the CAT Fund to pay awards, judgments and settlements which medical liability claimants obtained from health care providers when the awards exceeded the health care provider’s basic liability insurance coverage. (Petition, ¶ 3.) 3 As a condition of licensure, health care providers must *465 pay a fee on or after January 1 of each year to reimburse the CAT Fund for expenditures made during the preceding year. The amount of this fee, known as the surcharge, is determined by the Director and is subject to prior approval by the Commissioner. 40 P.S. § 1301.701(e)(1). (Petition, ¶¶4-6). The surcharge collected must be sufficient to reimburse the CAT Fund for the awards, judgments and settlements resolved (claims paid) during the prior 12 month period ending August 31 and for the Fund’s administrative expenses incurred during the preceding calendar year. In addition to generating this sum, the surcharge must also fund an additional $15,000,000. 40 P.S. § 1301.701(e)(1). Should the Fund be exhausted by the payment of expenses and claims which have become final, the Commissioner has authority to levy an emergency surcharge to meet the shortfall. 40 P.S. § 1301.701(e)(3). (Petition, ¶¶7, 8). The Fund generally submits its surcharge filing to the Commissioner during the autumn of a given year; the Commissioner then gives public notice of the filing and approves a surcharge. In December, following Commissioner approval, the Director advises interested parties of the upcoming year’s surcharge. (Petition, ¶ 9). 4

According to Petitioners, section 701(e)(1) of the Act mandates that Respondents follow a simple mathematical formula in determining the appropriate surcharge percentage for the upcoming year. First, they must compute the claims history and expenses of the past year. Second, because the surcharge should generate an amount sufficient to cover these costs plus an additional $15,000,000, Respondents must review the Fund’s year end filing balance and, if it exceeds the $15,000,- *466 000 statutory cap, Respondents must reduce the total by the excess amount. Finally, Respondents divide this new total by 1% of the total fees paid by health care providers for their basic coverage, an amount provided to Respondents by the commercial carriers writing that basic medical malpractice coverage. 5 Presuming that Respondents had computed these percentages in compliance with the Act, Petitioners paid the surcharges levied for the upcoming years of 1986-93. (Petition, ¶¶ 15-16.)

After reviewing the Fund’s annual reports for 1986-91 and unverifiable information from the Fund’s projected filing of 1993, 6 Petitioners learned that the CAT Fund’s year end balances exceeded the $15,000,000 statutory buffer in the years 1986, 1987, 1989 and 1990 as follows:

1986- $22,429,825 1990- $26,577,189
1987- $72,940,236 1991- $ 9,620,461
1988- $56,390,956 1992- $12,788,408
1989- $52,527,982 (unverifiable)

Applying the previously noted mathematical formula to the CAT Fund’s annual reports and unverifiable projected premium information, Petitioners alleged upon information and belief that Respondents violated the Act by failing to reduce the CAT Fund’s year-end balance for calendar years 1986, 1987, 1989 and 1990 to the $15,000,000 mandated by the Act, so that Petitioners may have been overcharged for upcoming years 1987, 1988, 1990 and 1991.

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Bluebook (online)
648 A.2d 595, 167 Pa. Commw. 458, 1994 Pa. Commw. LEXIS 545, Counsel Stack Legal Research, https://law.counselstack.com/opinion/meier-v-maleski-pacommwct-1994.