N.C. Steel, Inc. v. National Council on Compensation Insurance

472 S.E.2d 578, 123 N.C. App. 163, 1996 N.C. App. LEXIS 678
CourtCourt of Appeals of North Carolina
DecidedJuly 16, 1996
DocketCOA95-380
StatusPublished
Cited by7 cases

This text of 472 S.E.2d 578 (N.C. Steel, Inc. v. National Council on Compensation Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals of North Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
N.C. Steel, Inc. v. National Council on Compensation Insurance, 472 S.E.2d 578, 123 N.C. App. 163, 1996 N.C. App. LEXIS 678 (N.C. Ct. App. 1996).

Opinion

*166 WYNN, Judge.

The record, taken in the light most favorable to plaintiffs, tends to show the following: Plaintiffs in this action are North Carolina corporations which are either currently required to provide workers’ compensation insurance pursuant to Chapter 97 of the North Carolina General Statutes, or were formerly required to do so. Defendants are workers’ compensation insurers, except for National Council on Compensation Insurance (hereinafter NCCI) and North Carolina Rate Bureau (hereinafter NCRB) which are incorporated insurance rating organizations. Plaintiffs allege that defendants, along with others not named in this lawsuit, undertook actions which violated N.C. Gen. Stat. § 75-1 et seq. (1994), and that these illegal actions resulted in higher workers’ compensation premiums, and other damages to the plaintiffs. Defendants contend that plaintiffs cannot maintain this action in light of a doctrine known as the “filed rate doctrine”.

N.C. Gen. Stat. §§ 97-9, 97-93 (1991 & Supp. 1995) require that all employers, with certain exceptions not relevant to this opinion, secure workers’ compensation insurance for their employees. Employers may satisfy this statutory requirement through self-ihsurance if the employer meets the statutory requirements to self-insure. Employers which are required to insure workers under Chapter 97 and are not qualified to self-insure, or choose not to self-insure, must purchase insurance from a private company.

There are two “markets” in which a purchaser of workers’ compensation insurance may purchase that insurance: The voluntary market, and the residual market. Employers which desire workers’ compensation insurance first attempt to secure coverage in the voluntary market from a private insurance company. Employers which cannot find an insurance company to accept them in the voluntary market must purchase insurance in the residual market, which is often referred to as the assigned risk pool.

It is more advantageous for an employer to purchase insurance in the voluntary market than the residual market for three principal reasons: (1) There is a surcharge in the residual market. Residual market premiums are calculated in a similar manner as in the voluntary market, and the resulting premium amount is multiplied by a surcharge to reflect the increased risks presented by employers in the residual market; (2) dividends are often paid on policies in the voluntary market, but not on policies in the residual market; and (3) discounts *167 sometimes available in the voluntary market are not available in the residual market.

In North Carolina, workers’ compensation insurance rates are regulated by the Department of Insurance, created by N.C. Gen. Stat. § 58-2-1 (1994). That department executes the laws relating to insurance as prescribed by the General Assembly. The Commissioner of Insurance of North Carolina (hereinafter Commissioner) is an elected official who serves as the chief officer of the Department of Insurance.

When insurers request rate increases, the NCRB and the NCCI begin the process by filing a formal rate increase request with the Commissioner. In filing such a request, the NCRB attempts to estimate the amount of premium income needed to cover total projected expenses in the coming year. Included in this total are administrative expenses, and claims. From the total expenses projected, NCRB subtracts investment income, and builds in a reasonable profit.

Upon filing a request to increase rates, NCRB must submit detailed statistical information, including but not limited to investment earnings, overhead expenses, trends in insurance costs and other information requested by the Commissioner. From the information available, the Commissioner determines the workers’ compensation rates for each of nearly six hundred different job classifications. By statute, rates must not be excessive, inadequate or unfairly discriminatory. N.C.G.S. § 58-36-10.

This regulatory scheme is intended to displace price competition; insurers are forbidden from issuing a policy at a rate other than that approved by the Commissioner for the relevant job classification unless a deviation has been approved by the Commissioner.

Under the North Carolina Workers Compensation Insurance Plan (hereinafter the Plan), the Commissioner delegates management of the residual workers’ compensation market to NCRB. Each insurer must file written authority with NCRB permitting NCRB to assign risks to the insurer which cannot be placed in the voluntary market. NCRB has apparently delegated management of the Plan to defendant National Worker’s Compensation Reinsurance Pool (hereinafter National Pool).

The National Pool, consisting of all insurance companies which write workers’ compensation insurance in North Carolina, was created by defendant NCCI, and is managed by NCCI. NCCI assigns *168 each employer a servicing carrier from among the eleven companies chosen by the National Pool to service the North Carolina residual market. Servicing carriers are responsible for issuing policies, collecting premiums, conducting payroll audits, providing inspections, supervising safety programs and processing claims. Servicing carriers are not responsible, however, for paying claims; rather, the National Pool ultimately pays the claims. Employers in the residual market in effect purchase reinsurance from the National Pool in order to pay on claims in the residual market.

According to plaintiffs’ complaint, the servicing carriers are paid a fee which is determined by agreement between the National Pool and the eleven servicing carriers selected by the National Pool through NCCI to service the residual market in North Carolina. Each of the servicing carriers is paid its portion of the servicing carrier fee based upon the percentage of the total premium in the residual market which it collected. The eleven defendant insurance companies in the instant case have been servicing carriers during all or some of the time since 1989.

Plaintiffs’ complaint alleges that the agreement between the National Pool and the eleven defendant servicing carriers, which provides that each servicing carrier is paid the same amount as a servicing carrier fee, violates N.C.G.S. § 58-63-15, and thus violates N.C.G.S. § 75-1 et seq. Plaintiffs cite to case law which states that any violation of N.C.G.S. § 58-63-15 constitutes a per se violation of N.C.G.S. § 75-1.1 et seq. See, e.g., Pearce v. American Defender Life Ins. Co., 316 N.C. 461, 343 S.E.2d 174 (1986).

Plaintiffs contend that defendants’ failure to disclose information regarding their agreement to fix the servicing carrier fee misled the Commissioner because little attention was focused by the Commissioner on the amount listed as expenses in the filings submitted by defendants. Plaintiffs contend that since expenses were artificially high due to the agreement, the Commissioner approved higher rates in both the voluntary and residual markets than he would have approved “in a competitive residual market.”

Plaintiffs set forth two separate claims for relief.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Hillsboro Partners, LLC v. City of Fayetteville
738 S.E.2d 819 (Court of Appeals of North Carolina, 2013)
Novo Nordisk Pharm. Indus. Inc. v. Carolina Power & Light Co.
2008 NCBC 16 (North Carolina Business Court, 2008)
Moore v. North Carolina Cooperative Extension Service
552 S.E.2d 662 (Court of Appeals of North Carolina, 2001)
Piland v. Hertford County Board of Commissioners
539 S.E.2d 669 (Court of Appeals of North Carolina, 2000)
Lupton v. Blue Cross & Blue Shield of North Carolina
533 S.E.2d 270 (Court of Appeals of North Carolina, 2000)
Lupton v. Blue Cross and Blue Shield
1999 NCBC 4 (North Carolina Business Court, 1999)
Hyde v. Abbott Laboratories, Inc.
473 S.E.2d 680 (Court of Appeals of North Carolina, 1996)

Cite This Page — Counsel Stack

Bluebook (online)
472 S.E.2d 578, 123 N.C. App. 163, 1996 N.C. App. LEXIS 678, Counsel Stack Legal Research, https://law.counselstack.com/opinion/nc-steel-inc-v-national-council-on-compensation-insurance-ncctapp-1996.