Pittsburgh v. Insurance Commissioner

286 A.2d 475, 4 Pa. Commw. 262, 1971 Pa. Commw. LEXIS 313
CourtCommonwealth Court of Pennsylvania
DecidedDecember 31, 1971
DocketAppeals, Nos. 911 Tr. Dkt. 1970 and 912 Tr. Dkt. 1970
StatusPublished
Cited by8 cases

This text of 286 A.2d 475 (Pittsburgh v. Insurance Commissioner) 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
Pittsburgh v. Insurance Commissioner, 286 A.2d 475, 4 Pa. Commw. 262, 1971 Pa. Commw. LEXIS 313 (Pa. Ct. App. 1971).

Opinions

Opinion by

Judge Manderino,

This case involves an appeal by the City of Pittsburgh (City) and the County of Allegheny. (County) from a decision of George F. Reed, the Insurance Commissioner of Pennsylvania, approving a rate increase requested by Blue Cross of Western Pennsylvania (Blue Cross). On April 3, 1969, Blue Cross filed with the Insurance Department a request for a rate increase for its subscribers in twenty-nine counties in western Pennsylvania, including residents of the City of Pittsburgh and Allegheny County. The requested increase was publicly announced, as was the fact that the Insurance Commissioner would hold a public hearing in Pittsburgh to afford the public an opportunity to present any relevant information concerning the increase which had been submitted to the Insurance Department. When the hearing was convened on May 28, 1969, representatives from both the City and County were permitted to make statements. However, the Insurance Commissioner explicitly refused to allow anyone, except members of the Insurance Department, to cross-examine any representative of Blue Cross. Both the City and County objected to this procedure as being violative of due process procedures required by the Administrative Agency Law, but they were overruled, by the Commissioner. The hearing was concluded on June 10, 1969, and on . July 13, 1970, the Insurance Commissioner approved Blue Cross’ request for. a rate increase. The City and County appealed from the decision of the Commissioner approving the rate increase. Blue Cross of Western Pennsylvania participated as intervenor. This appeal was subsequently transferred to the Commonwealth Court pursuant to the Commonwealth Court Act (Act No. 185 of January 6, 1970 (1969) P. L. , 17 P.S. 211-1 et seq.).

The City and County have taken this appeal under the Administrative Agency Law (Act of June 4, 1945, [265]*265as amended, P. L. 1388, 71 P.S. 1710.1 et seq.). Section 41 (71 P.S. 1710.41) of the law provides for an appeal from an adjudication of an administrative agency.

The City and County specifically challenge the failure of the Commissioner to allow the City and County to cross-examine witnesses, arguing that an adjudication by the Commissioners without having given a party the right to cross-examine is error.

Blue Cross’ position is that the approval of the rate increase was not an adjudication within the terms of the Administrative Agency Law and that therefore the procedural requirements of that law were not applicable to the hearings on the rate increase.

The central question is whether or not a decision by the Insurance Commissioner approving a rate increase by Blue Cross of Pennsylvania is an adjudication within the meaning of the Administrative Agency Law. If it is such an adjudication then the Commissioner was bound to give any party the right to cross-examine at the hearing.

First, there is no question that generally the Department of Insurance is covered by the Administrative Agency Law. That law specifically enumerates the agencies which are covered by the Administrative Agency Law and one of the listed agencies is the Insurance Department. (Section 51, 71 P.S. 1710.51).

Under the Administrative Agency Law an adjudication is defined as: “... any final order, decree, decision, determination or ruling by an agency affecting personal or property rights, privileges, immunities or obligations of any and all of the parties to the proceeding in which the adjudication is made, but shall not mean any final order, decree, decision, determination or ruling based upon a proceeding before a court, Or which involves the seizure or forfeiture of property, or which involves paroles or pardons or releases from mental institutions.” (71 P.S. 1710.2(a)).

[266]*266Blue Cross contends that the Insurance Department’s approval of a specific rate increase for a specific company is essentially a legislative function delegated by the executive branch and not subject to judicial review, rather than an adjudicative function.

The Administrative Agency Law defines not only adjudication, but also defines a regulation. The definition of regulation in the Administrative Agency Law reads: “regulation means any rule, regulation or order in the nature of a rule or regulation, of general application and future effect, promulgated by an agency under the statutory authority in the administration of any statute administered by or relating to the agency.

It is true, as the Commissioner contends, that administrative agencies sometimes are acting in what has been called a quasi-legislative fashion and sometimes an agency is acting in a quasi-judicial fashion. It has often been said that adjudication resembles what courts do in deciding cases and that rule making resembles what legislators do in enacting statutes. 1 Davis, Administrative Law Treatise §5.01 at p. 287.

It is not easy to arrive at a precise definition of what constitutes the judicial function and what constitutes the legislative function. However, certain differences do exist between the two functions. When a governmental body is exercising a legislative function, it manifests a general purpose and its final result. Thus, the Legislature enacts a law and we do not speak of the “record” as being necessary to substantiate the decisions made in the legislative enactment. A judicial decision, however, makes no sense if there is not a “record” to give foundation to the judicial decision.

In the Administrative Agency Law, two decision making functions of an agency are defined. That law speaks of adjudication by the agency and also speaks [267]*267of regulation by the agency. Both functions involve decision making which can seriously affect rights.

The definition of adjudication is very broad, as is the definition for regulation. If we attempt to find a distinction between them, we must look to the proceeding before the Commissioner in this case. It was not a proceeding to determine a rule or regulation involving rate increases of general application throughout the Commonwealth. It was a proceeding to determine specifically whether an individual non-profit corporation would be entitled in a specific geographic area to a specific rate increase. This has all the earmarks of a judicial function, not a legislative function. Indeed, we might test this by considering whether or not the Legislature itself could by legislative enactment pass legislation specifically referring to Blue Cross of Western Pennsylvania and stating in the legislation that a specific corporation was entitled to charge a specific rate to subscribers. There can be no question that such legislation would be special legislation which is prohibited by the Constitution. See Constitution of Pennsylvania, Art. 3, §32. We do not think that an administrative agency can, under the guise of designating a decision as legislative, do something that the Legislature itself could not do. The Legislature can, of course, through legislative enactment, adopt “regulations,” which is what the Legislature does all the time except that we call them laws. The distinguishing characteristics of our law is quite similar to the definition given to regulation in the Administrative Agency Law. It is an enactment of general application, not an enactment of specific application. Even those laws which appear to be enactments of specific application must be laws of specific application to a reasonable class in the society.

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Bluebook (online)
286 A.2d 475, 4 Pa. Commw. 262, 1971 Pa. Commw. LEXIS 313, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pittsburgh-v-insurance-commissioner-pacommwct-1971.