Pacific Mut. Life Ins. Co. v. Commissioner

48 T.C. 118, 1967 U.S. Tax Ct. LEXIS 111
CourtUnited States Tax Court
DecidedApril 28, 1967
DocketDocket No. 1115-65
StatusPublished
Cited by14 cases

This text of 48 T.C. 118 (Pacific Mut. Life Ins. Co. v. Commissioner) is published on Counsel Stack Legal Research, covering United States Tax Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pacific Mut. Life Ins. Co. v. Commissioner, 48 T.C. 118, 1967 U.S. Tax Ct. LEXIS 111 (tax 1967).

Opinions

Withey, Judge:

The respondent determined deficiencies in petitioner’s income tax for the years and in the amounts as follows:

Year Amount
1958 _$149,679.43
1959 _1_ 54,882.51
1960 _ 55,324 93
1961_ 58,772.85

The issues for determination are as follows:

(1) Whether petitioner may retroactively adjust its 'beginning 1958 group accident and health claim reserves and individual hospital and medical claim reserves for 'alleged overstatements therein.

(2) Whether the construction fees received by petitioner during the years 1958 through 1961 were reportable as gain from operations pursuant to section 809 (c) (3) of the Internal Eevenue Code of 19541 or as investment income pursuant to section 804(b) of the Code.

(3) Whether the option fee, standby fees, and bond commitment fees received by petitioner during the years 1959 through 1961 were reportable as gain from operations pursuant to section 809 (c) (3) or as investment income pursuant to section 804 (b).

(4) Whether the gain from the sale of short-term U.S. Treasury bills received by petitioner during 1961 was reportable as gain from operations pursuant to section 809(c)(3) or as investment income pursuant to section 804 (b).

(5) Whether ’amounts left on deposit with petitioner under settlement option provisions, as well as premiums received by petitioner on certain guaranteed renewable accident and health policies, constitute “premiums * * * attributable to nonparticipating contracts * * * issued or renewed for periods of 5 years or more,” as required by section 80.9 (d) (5) of the Code.

Additional issues raised by tlie pleadings have 'been disposed of by agreement of the parties.

GENERAL FINDINGS OF FACT

Some of the facts have been stipulated and are found accordingly.

Petitioner, a corporation duly organized and existing under the laws of the State of California, is a mutual life insurance company transacting the business of life insurance, annuities, and health and accident insurance. Its principal office is at Los Angeles, Calif. Petitioner is authorized to transact business in all States, except New York, and in the District of Columbia and Puerto Pico. Its returns for the calendar years 1958 through 1961 were timely filed with the district director of internal revenue at Los Angeles, Calif.

Issue 1. Adjustment to Accident and Health OlaimReserves

FINDINGS OF FACT

In accordance with the laws and regulations of the various States in which it operates, petitioner annually prepares and submits to the insurance departments of those States a detailed report of its financial status. This report is referred to as an annual statement and consists of numerous schedules which reflect various aspects of the company’s financial condition as of December 31 of each year. Petitioner relies on much of the inf ormation contained in its annual statement when preparing its income tax return.

Petitioner, after obtaining an extension of time, filed its income tax return for the calendar year 1958 in March 1960. On that return, petitioner claimed a deduction for death benefits of $78,168,093.16 in computing its gain from operations. That figure represented the total benefits paid or accrued under section 809(d) (1) of the Code. Of that amount, $31,672,514.42 represented total accident and health benefits paid or accrued during the year, as reflected on Schedule H of petitioner’s annual statement for 1958. Also included in the $78 million deduction, and in addition to the $31 million accident and health category, was the amount of $667,448.38 which, like the $31 million category, was intended by petitioner to reflect accident and health benefits paid or accrued during 1958. The $667,000 amount represented the total downward adjustment made by petitioner to certain of its beginning accident and health claim reserves for the calendar year 1958.2 The result of this adjustment was to reduce certain of petitioner’s beginning accident and health claim reserves so that they equaled the “total losses incurred” 3 in 1958 on such claim reserves, as reflected in Schedule O of its annual statement. The adjustment, which was disallowed by respondent, applied to two of the five accident and health claim reserves set forth in Schedule O, namely, the group accident and health claim reserves and the hospital and medical claim reserves.4 The chart below reflects the adjustment made by petitioner to each of those two categories indicating the reduction to beginning reserves of the several components in each category:

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The National Association of Insurance Commissioners prescribes no standards for establishing group accident and health claim reserves. These reserves must be established on a company by company basis, with each insurance company exercising its best actuarial judgment. In establishing beginning reserves for the first two components in its group accident and health, claim category, i.e., “disability income” and “basic medical expense,” petitioner ordinarily relied on reserve estimates obtained by the application of three methods of projecting past company experience. Comparison of the beginning 1958 reserve estimates obtained by application of those three methods, as computed on January 30, 1958, with the beginning reserves actually used by petitioner, are set forth below:

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In establishing its “disability income” and “basic medical expense” reserves for 1958, petitioner did not rely exclusively on the results calculated by any one of those three methods. Instead, using the results obtained thereby as a guide only, petitioner determined the beginning reserves by exercising actuarial judgment, taking into consideration circumstances that it thought required establishing greater reserves than were called for by application of most of the projections obtained by those three methods. In establishing its beginning 1958 reserves for the third component in the group accident and health claim category, i.e., “major medical expense,” petitioner did not attempt to project reserves from its past experience since it had only entered this field of insurance in 1956 and, as of December 31,1957, lacked adequate company data from which it could accurately project beginning 1958 reserves. After conversations with other actuaries relative to the size of the reserves needed for this component, which conversations indicated that the reserves should be between 25 and 100 percent of premiums, petitioner’s actuary determined that reserves for this component should be 65 percent of premiums paid.

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Bluebook (online)
48 T.C. 118, 1967 U.S. Tax Ct. LEXIS 111, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pacific-mut-life-ins-co-v-commissioner-tax-1967.